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Is nondipping in 24 h ambulatory blood pressure related to cognitive dysfunction?

OBJECTIVE: Associations between the outcome of 24 h ambulatory monitoring and cognitive performance were studied in order to evaluate the potential relevance of ambulant blood pressure status to brain function. It was hypothesized that a small daytime-night-time difference in mean blood pressure (nondipping) is associated with reduced cognitive performance, in line with studies in hypertensive subjects that have reported associations between nondipping and target-organ damage. METHODS: The study followed a cross-sectional design and was part of a larger research programme on determinants of cognitive aging (Maastricht Aging Study, MAAS). A group of 115 community residents aged 28-82 years was recruited from a general practice population and screened for cardiovascular events and medication use. All underwent 24 h blood pressure monitoring. Cognitive performance was measured with tests of verbal memory, attention, simple speed and information processing speed. RESULTS: Mean daytime or night-time levels of both systolic and diastolic blood pressure were unrelated to cognitive outcome, when age, sex and educational level were controlled for. Differences between mean daytime and night-time blood pressure (based on both narrow and wide measurement intervals for day and night-time periods) were positively associated with memory function (5-9% of additional variance explained) and one sporadic positive association was found on the sensorimotor speed score (4%). Nondippers (n=15) showed lower levels of both memory and sensorimotor speed scores. CONCLUSIONS: Ambulatory blood pressure status was not associated with cognitive performance. A reduced nocturnal blood pressure drop was associated with quite specific cognitive deficits, but the underlying mechanism remains to be determined.

Adult↗

[Neurophysiologic correlations of cognitive dysfunction in depressed patients with syndrome of juvenile asthenic deficiency].

Peculiarities of cognitive process were studied in 34 right-handed endogenously depressed patients with "juvenile asthenic deficiency" ("endogener juveniler Versagensyndrome" according to J. Glatzel and G Huber, 1968) by means of visual evoked potentials (EP) in the emotional recognition task. Two control groups consisted of 19 healthy individuals and 20 patients with other types of depressions. The main and control groups were matched for age, sex, handedness and education level. Compared to controls the patients with "juvenile asthenic deficiency" demonstrated highly significant alterations in indices of EP late negative wave in anterior areas of the left hemisphere which related to neither the nosology of "juvenile asthenic deficiency" (cyclothymia, schizophrenia) nor the types of dominant cognitive disorders. Dependence on both nosology and clinical subtype of asthenic deficiency was found only for separate characteristics of earlier EP waves. The results suggest the disturbance of the final stages of information processing and the decision making specific for "juvenile asthenic deficiency".

Adolescent↗

[Cognitive dysfunction in patients with Parkinson's disease].

Neurocognitive functions have been studied in 100 patients with Parkinson's disease (PD). PD was associated with cognitive impairment due to frontal lobes dysfunction, with hippocampus and right hemisphere involvement in advanced stages of the disease. Severity of cognitive impairment increased simultaneously with severity of movement disorder. Patient's age correlated with cognitive abilities. Mild dementia developed in the oldest patients with advanced PD. Besides typical cognitive disturbances, there were more pronounced memory impairment and speech disorders in some patients that might be related to concomitant pathology.

Aged↗

Targeting the dopamine D1 receptor in schizophrenia: insights for cognitive dysfunction.

BACKGROUND AND RATIONALE: Reinstatement of the function of working memory, the cardinal cognitive process essential for human reasoning and judgment, is potentially the most intractable problem for the treatment of schizophrenia. Since deficits in working memory are associated with dopamine dysregulation and altered D(1) receptor signaling within prefrontal cortex, we present the case for targeting novel drug therapies towards enhancing prefrontal D(1) stimulation for the amelioration of the debilitating cognitive deficits in schizophrenia. OBJECTIVES: This review examines the role of dopamine in regulating cellular and circuit function within prefrontal cortex in order to understand the significance of the dopamine dysregulation found in schizophrenia and related non-human primate models. By revealing the associations among prefrontal neuronal function, dopamine and D(1) signaling, and cognition, we seek to pinpoint the mechanisms by which dopamine modulates working memory processes and how these mechanisms may be exploited to improve cognitive function. RESULTS AND CONCLUSIONS: Dopamine deficiency within dorsolateral prefrontal cortex leads to abnormal recruitment of this region by cognitive tasks. Both preclinical and clinical studies have demonstrated a direct relationship between prefrontal dopamine function and the integrity of working memory, suggesting that insufficient D(1) receptor signaling in this region results in cognitive deficits. Moreover, working memory deficits can be ameliorated by treatments that augment D(1) receptor stimulation, indicating that this target presents a unique opportunity for the restoration of cognitive function in schizophrenia.

Animals↗

[Subjective cognitive dysfunctions in the elderly: a change-oriented viewpoint].

The relation between subjective cognitive complaints and the actual level of cognitive performance in the elderly is of interest in both basic and applied cognitive research. However, most studies suggest a small to moderate correlation between complaints and actual performance. In contrast to previous studies, we examined the relation between changes in fluid and crystallized intelligence, changes in memory performance, and changes in subjective cognitive complaints in a sample of 465 older adults (M = 62.9 years) at two measurement occasions four years apart. The results indicate significant relationships between changes in subjective complaints and changes in memory performance and changes in fluid intelligence. The discussion focuses on the importance of a change-oriented view in examining subjective cognitive complaints from an applied perspective.

Aged↗

The short human figure drawing scale for evaluation of suspect cognitive dysfunction in old age.

Human figure drawings have been widely used to assess cognitive development in children. In the present study, free-hand human figure drawings were examined for 62 demented patients, and 60 normal elderly subjects. The drawings were scored for 53 body details using a method derived from work with children. A short scale of 15 details was developed by selecting body details with high item-total correlations which are simple to score even for untrained staff. This short scale had excellent interscorer and test-retest reliability and excellent concurrent validity as well. It correlated highly with the Mini-Mental State Examination, a commonly used screening test for dementia. The short scale discriminated demented and non-demented subjects and different levels of dementia severity as graded by the Clinical Dementia Rating Scale. However, no differences were observed between Alzheimer patients and patients with vascular dementia concerning presence of details in human figure drawings.

Journal Article↗

Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy.

BACKGROUND: Objective data regarding adverse cognitive deficits associated with maintenance electroconvulsive therapy (M-ECT) are lacking. This study examined the cognitive state of depressive patients during M-ECT. METHOD: A cross-sectional study was carried out in 11 depressive patients in remission, all with a DSM-IV diagnosis of major depressive disorder. The mean number of previous ECT sessions was 36.1, and the mean intersession interval was 52.7 days. A group of 11 patients who had not received ECT was selected for comparison and matched for diagnosis, sex, age and years of schooling. All subjects were assessed using a complete neuropsychological battery including memory, attention and frontal function tests. RESULTS: Groups did not present differences in long delay verbal recall. Encoding of new information and results on the frontal function tests were significantly lower in the M-ECT patients. CONCLUSION: Depressed patients preserve long-term memory, but suffer short-term memory impairment and frontal function alteration during M-ECT. Further longitudinal studies are necessary to determine the influence of M-ECT on non-memory functions and different memory subtypes.

Cognition Disorders↗

White matter volume and cognitive dysfunction in early Huntington's disease.

BACKGROUND: Structural abnormalities of the striatum and cognitive impairments have consistently been shown in patients with Huntington's disease (HD). Fewer studies have examined other cerebral structures in early HD and potential associations with cognition. METHOD: Ten patients with early HD and 10 matched control subjects underwent magnetic resonance imaging to provide quantitative measures (volumes) of cortical gray and white matter and the caudate, putamen, and thalamus. Patients completed the Unified Huntington's Disease Rating Scale, including three cognitive tasks. RESULTS: Although striatal volumes were clearly reduced, white matter was also morphologically abnormal. Cortical gray matter volume was not significantly correlated with cognitive performance. However, the cognitive tasks were most highly correlated with cerebral white matter and, to a lesser degree, striatal volume. CONCLUSIONS: Cerebral white matter volume may be an important variable to examine in future studies of HD.

Adult↗

Prolonged cognitive dysfunction in survivors of critical illness.

A prospective study using neuropsychological testing explored cognitive performance, and specifically executive function, in survivors of critical illness during the first year of recovery. Fifty-one patients who had survived 3 days or more in the intensive care unit were studied approximately 3 months after discharge; 45 of them were studied again 6 months later. General health was assessed using the Short-Form 36. Cognitive and executive functions were measured using Raven's Progressive Matrices, the Hayling Sentence completion test and the Six-Element Test. Three months after discharge from intensive care, all eight domains of Short-Form 36 were impaired among survivors; by 9 months, four of the eight domains showed significant improvement. At 3 months, 35% of patients scored at or below a level equivalent to the lowest performing 5% of a normal population (i.e. the fifth percentile) on two or more tests of cognitive function; by 9 months only 4% of patients were impaired to this extent. Although cognitive performance improved with time, it remained below normal.

Adult↗

Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?

OBJECTIVE: The purpose of this study was to determine whether cognitive impairment is related to cardiopulmonary bypass. METHODS: Twenty-five patients undergoing coronary artery bypass grafting without cardiopulmonary bypass were matched with 50 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. All patients received the same anesthetic regimen, and one surgeon performed all the operations. A battery of 10 standard tests of neuropsychologic function were performed before, at discharge, and 3 months after the operation. A comprehensive multidimensional measure of subjective health status was used as the primary clinical measure of functional outcome. RESULTS: The groups were similar with respect to age, sex, and ventricular function and differed only in the need for a circumflex artery graft. Both groups showed significant improvement in the comprehensive multidimensional measure of subjective health status at 3 months. At discharge most neuropsychologic tests had deteriorated in both groups (the same 4 tests had deteriorated significantly in both groups, and an additional test had deteriorated significantly in the cardiopulmonary bypass group). At 3 months all but one test in the cardiopulmonary bypass group had returned to or exceeded baseline performance. The same 2 tests had improved significantly in both groups, and a further test had improved significantly in the group without cardiopulmonary bypass. At no specific time point was there a significant difference between the absolute or change scores between the groups on any of the tests. CONCLUSIONS: The similar pattern of early decline and late recovery of cognitive function in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass suggests that cardiopulmonary bypass is not the major cause of postoperative cognitive impairment. This merits consideration in deciding optimal treatment strategies in coronary revascularization.

Cardiopulmonary Bypass↗