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PubMed2005

Plasma concentrations of nitric oxide products and cognitive dysfunction following coronary artery bypass surgery.

BACKGROUND AND OBJECTIVE: Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia-reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3-/NO2-) and cognitive dysfunction after CABG. METHODS: Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied. RESULTS: A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3-/NO2- concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3- plus NO2-) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups. CONCLUSIONS: Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.

Adult↗
PubMedDate not supplied

Treatment response of high cognitive dysfunction depressed inpatients.

A sample of depressed inpatients was subdivided according to their initial levels of cognitive dysfunction. These high cognitive dysfunction (HCD) patients and low cognitive dysfunction (LCD) patients received either pharmacotherapy or combined pharmacotherapy plus cognitive-behavioral psychotherapy. Treatments began in the hospital and continued for 20 weeks on an outpatient basis. Results indicated that HCD patients had significantly better treatment response to the combined treatment than pharmacotherapy alone, while LCD patients responded equally to pharmacotherapy alone and combined treatment.

Adult↗
PubMed1993

Lack of evidence for Huntington's disease-like cognitive dysfunction in obsessive-compulsive disorder.

Cognitive deficits in patients with structural lesions of the basal ganglia (e.g., Huntington's disease) commonly include slowed processing, reduced verbal fluency, difficulty switching set, impaired egocentric spatial ability, poor recall, and impaired acquisition of motor skills. The goal of this study was to determine if patients with obsessive-compulsive disorder (OCD) would have a similar pattern of cognitive dysfunction. A battery of neuropsychological tests, including reaction time-based measures of cognitive processing speed and a test of procedural, motor-skill learning, was administered to 17 unmedicated OCD patients and 16 age-and education-matched normal controls. Eleven individuals with trichotillomania, matched with the OCD patients on age, education, age at symptom onset, depression, and anxiety were also tested. Contrary to expectation, neither the OCD nor trichotillomania patients were impaired on any of the measures in the battery. The essentially normal performance by these patients suggests that the brain regions responsible for cognitive dysfunction in patients with Huntington's disease may differ from those associated with OCD.

Adolescent↗
PubMedDate not supplied

Cognitive dysfunction in multiple sclerosis: Assessment, imaging, and risk factors.

Up to 70% of multiple sclerosis (MS) patients experience cognitive dysfunction during the course of their disease. The most often affected domains are attention, memory, and information processing speed. Sequelae of cognitive dysfunction include negative effects on activities of daily living, employment, and relationships. This article reviews cognitive dysfunction in MS and focuses specifically on assessment, imaging, and risk factors. A number of neuropsychological batteries have been developed specifically for assessing cognitive dysfunction in MS patients. Trade-offs in length, administrative support, and efficiency exist between the various batteries. Modern imaging techniques provide a clearer picture of MS-related damage to the central nervous system, which is the major cause of cognitive dysfunction. Additionally, candidate risk factors have been identified that may help predict which patients will develop cognitive dysfunction.

Adult↗
PubMed2006

Anti-N-methyl-D-aspartate receptor antibodies, cognitive dysfunction, and depression in systemic lupus erythematosus.

OBJECTIVE: To assess the association of cognitive dysfunction and depression with serum antibodies to N-methyl-D-aspartate (NMDA) receptor (anti-NR2) and analyze clinical and neuroimaging correlates in patients with systemic lupus erythematosus (SLE). METHODS: Sixty patients underwent neurocognitive assessment, evaluation for depression with the Beck Depression Inventory II (BDI-II) and psychiatric interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria), brain magnetic resonance imaging, and proton magnetic resonance spectroscopy imaging (1H-MRSI). Cognition was assessed in 5 domains: memory, attention/executive, visuospatial, motor, and psychomotor, and adjusted to each individual's best level of prior cognitive functioning estimated from the reading subtest of the Wide Range Achievement Test-3 (WRAT-3). Serum anti-NR2 antibodies were measured by enzyme-linked immunosorbent assay using a pentapeptide from the human NMDA receptor. RESULTS: Cognitive dysfunction was found in 28 of 60 patients (mild in 8, moderate in 20) before adjustment for WRAT-3 and in 35 of 60 patients (mild in 15, moderate in 11, and severe in 9) after adjustment for WRAT-3. The changes were most pronounced in the memory and visuospatial domains. There was no significant association between anti-NR2 antibody levels and cognition. On 1H-MRSI, patients with moderate or severe cognitive dysfunction had significantly higher choline:creatine ratios in the dorsolateral prefrontal cortex and the white matter, compared with patients with mild or absent cognitive dysfunction. Anti-NR2 antibodies were significantly correlated with BDI scores; patients with BDI-II scores of > or =14 had higher serum levels of anti-NR2 antibodies (P = 0.005, 95% confidence interval 0.83, 4.31), and there was a trend toward higher anti-NR2 antibody levels among patients who fulfilled the DSM-IV criteria for major depression. CONCLUSION: Serum anti-NR2 antibodies are associated with depressive mood but not with cognitive dysfunction in SLE at a given time point. Larger longitudinal studies are needed to address the possible association between anti-NR2 antibodies and depression in SLE.

Adult↗
PubMed2002

The effect of lidocaine on early postoperative cognitive dysfunction after coronary artery bypass surgery.

UNLABELLED: We investigated the effect of lidocaine on the incidence of cognitive dysfunction in the early postoperative period after cardiac surgery. One-hundred-eighteen patients undergoing elective coronary artery bypass surgery with cardiopulmonary bypass (CPB) were randomized to receive either lidocaine (1.5 mg/kg bolus followed by a 4 mg/min infusion during operation and 4 mg/kg in the priming solution of CPB) or placebo. A battery of nine neuropsychological tests was administered before and 9 days after surgery. A postoperative deficit in any test was defined as a decline by more than or equal to the preoperative SD of that test in all patients. Any patient showing a deficit in two or more tests was defined as having postoperative cognitive dysfunction. Eighty-eight patients completed pre- and postoperative neuropsychological tests. Plasma lidocaine concentrations (microg/mL) were 4.78 +/- 0.52 (mean +/- SD), 5.38 +/- 0.95, 4.52 +/- 0.39, 5.82 +/- 0.76, and 7.10 +/- 1.09 at 10 min before CPB; 10, 30, and 60 min of CPB; and at the end of operation, respectively. The proportion of patients showing postoperative cognitive dysfunction was significantly reduced in the lidocaine group compared with that in the placebo group (18.6% versus 40.0%; P = 0.028). We conclude that intraoperative administration of lidocaine decreased the occurrence of cognitive dysfunction in the early postoperative period. IMPLICATIONS: Postoperative cognitive dysfunction is a commonly recognized complication after cardiac surgery. Intraoperative cerebral microembolism and hypoperfusion have been proposed to be the major mechanisms. The results of this study show that intraoperative administration of lidocaine decreased the occurrence of early postoperative cognitive dysfunction, perhaps because of its neuroprotective effects.

Aged↗
PubMed2003

[Difference between alcohol dependence and nicotine dependence in cognitive dysfunction].

The extent of cognitive dysfunction in the nicotine and/or alcohol dependent subjects has been evaluated with Digit Span, Number Connection Test and Wisconsin Card-Sorting Test. Samples were divided into 4 groups, 8 subjects with alcohol and nicotine dependence, 9 subjects with alcohol dependence, 10 subjects with nicotine dependence and 31 subjects without the dependences who met ICD-10 criteria for dependence syndrome. The performance times of Number Connection Test were prolonged in the alcohol dependence and the presence of the nicotine dependence did not influence the performance times of Number Connection Test. The performances on the Wisconsin Card-Sorting Test were impaired by the alcohol dependence and the presence of the nicotine dependence did not influence the performances on the Wisconsin Card-Sorting Test.

Adult↗
PubMed2002

Postoperative cognitive dysfunction in middle-aged patients.

BACKGROUND: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent. METHODS: The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living. RESULTS: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months. CONCLUSIONS: Postoperative cognitive dysfunction occurs frequently but resolves by 3 months after surgery. It may be associated with decreased activity during this period. Subjective report overestimates the incidence of POCD. Patients may be helped by recognition that the problem is genuine and reassured that it is likely to be transient.

Adult↗
PubMed2005

Cognitive dysfunction after cardiac surgery: revisiting etiology.

Cognitive dysfunction remains a frequent complication of cardiac surgery. Despite many years of research, few preventive strategies and no definitive therapeutic options exist for the management of this troublesome clinical problem. This shortcoming may be secondary to an incomplete understanding of the pathophysiology and etiology of cognitive loss after cardiac surgery; a better understanding of the etiology is essential to finding new therapies. The etiology of cognitive dysfunction after cardiac surgery is multifactorial and includes cerebral microembolization, global cerebral hypoperfusion, systemic and cerebral inflammation, cerebral temperature perturbations, cerebral edema, and possible blood-brain barrier dysfunction, all superimposed on genetic differences in patients that may make them more susceptible to injury or unable to repair from injury once it has occurred. This review expands on these potential etiologies in detailing the evidence for their existence.

Blood-Brain Barrier↗
PubMed2005

Cognitive dysfunction following cardiovascular surgery.

OBJECTIVE: The aim of this study was the evaluation of perioperative cognitive dysfunction in patients undergoing cardiovascular surgery with or without cardiopulmonary bypass (CPB) and identification of the risk factors. SUBJECTS AND METHODS: Between July 2001 and October 2003, we performed cognitive examinations in 192 patients (mean age 65.5 +/- 7.6 years) who underwent elective cardiovascular surgery with or without CPB. The cognitive examinations (Hasegawa dementia scale) were done both pre- and postoperatively. Forty-six patients who had developed cognitive dysfunction postoperatively were included in Group A. The remaining 146 patients were placed in the control group (Group B). RESULTS: The patients in Group A were noted to be significantly older than those in Group B (69.8 +/- 7.4 vs. 64.1 +/- 7.2, p < 0.05). The number of patients who at risk for cerebrovascular disease was significantly higher in Group A than in Group B (p < 0.05). Among intraoperative variables, there were no significant differences between the two groups concerning the presence or absence of CPB, CPB duration, and operation duration. The length of postoperative hospitalization of the Group A patients was greater. Age was identified as the only predictor of postoperative cognitive dysfunction in multivariate analysis. CONCLUSION: In the present study, it is possible that CPB did not play a significant role in the genesis of cognitive dysfunction after cardiovascular surgery. Age appears to be the only significant predictor of postoperative cognitive dysfunction.

Age Factors↗
PubMed2001

Cognitive dysfunction as a major determinant of disability in patients with heart failure: results from a multicentre survey. On behalf of the GIFA (SIGG-ONLUS) Investigators.

Cognitive dysfunction is a frequent finding among older patients with left ventricular systolic dysfunction; however, the clinical outcomes of such a finding are unknown. Also, disability is a common condition in heart failure, poorly responding to commonly used cardiovascular medications. The association between cognitive dysfunction and disability was assessed in 1583 patients with heart failure, but without cerebrovascular disease, previous stroke, or Alzheimer's disease, who were enrolled during 2 years of a multicentre pharmacoepidemiology survey. The association between groups of variables (demographics, comorbid conditions, medications, and objective tests, including the Hodkinson abbreviated mental test) and functional disability (as indicated by need for intensive assistance in at least one of Katz' activities of daily living) was first analysed using separate age and sex adjusted logistic regression models. Those variables, significant at a p<0.1 level in these models, were simultaneously entered into an age and sex adjusted summary regression model. Among 1583 patients suitable for analysis, cognitive dysfunction (as detected by abbreviated mental test score <7) was detected in 265/461 disabled patients, and in 150/1122 independent subjects (p<0.0001). According to logistic regression analysis, cognitive dysfunction was associated with disability (OR=6.49; 95% CI=4.39-9.59) after adjusting for potential confounders.Thus, cognitive dysfunction in patients with heart failure is independently associated with disability, which currently represents an overwhelming medical and financial problem to patients, caregivers, and public health services. As early recognition and treatment of low cardiac output states might reverse cognitive dysfunction, cost effective treatment for heart failure should include systematic diagnostic and therapeutic approaches to cognitive dysfunction.

Aged↗
PubMed2026

Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized controlled trial.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery. Exercise-based prehabilitation may enhance functional reserve and reduce vulnerability to perioperative cerebral insults. We hypothesized that multimodal prehabilitation reduces POCD 3&#xa0;months after cardiac surgery. METHODS: This prespecified substudy of a single-center randomized controlled trial (NCT03466606) included patients aged &#x2265;50&#xa0;years undergoing elective coronary artery bypass grafting and/or valve surgery. Participants were randomized 1:1 to 4-6&#xa0;weeks of multimodal prehabilitation (exercise training, nutritional support, and psychological support) or standard preoperative care. Cognitive function was assessed at baseline and 3&#xa0;months postoperatively using an age- and education-adjusted neuropsychological battery. POCD was defined as performance &#x2265;1.5 standard deviations below normative values in at least 2 cognitive tests, excluding the Mini-Mental State Examination. Logistic regression analyses were performed to evaluate factors associated with POCD. RESULTS: Of 160 participants screened from the parent trial, 134 met eligibility criteria for the substudy and were randomized; 116 completed 3-month follow-up (prehabilitation n&#xa0;=&#xa0;53; control n&#xa0;=&#xa0;63). POCD occurred in 29 patients (25%), including 15/53 (28%) in the prehabilitation group and 14/63 (22%) in controls (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.54-3.50, P&#xa0;=&#xa0;0.52). In multivariable analysis, preoperative cognitive impairment was independently associated with POCD (OR 13.28, 95% CI 4.06-43.41, P&#xa0;<&#xa0;0.001), whereas prehabilitation was not (OR 1.09, 95% CI 0.35-3.45, P&#xa0;=&#xa0;0.877). Higher physical activity levels at 3&#xa0;months were associated with lower odds of POCD (OR 0.97, 95% CI 0.95-1.00, P&#xa0;=&#xa0;0.047). CONCLUSIONS: In this randomized controlled trial, a 4-6-week multimodal prehabilitation program did not reduce postoperative cognitive dysfunction 3&#xa0;months after cardiac surgery. Although the intervention did not achieve measurable cognitive protection, the observed association between postoperative physical activity levels and postoperative cognitive dysfunction warrants further investigation.

Humans↗
PubMed2006

Cognitive dysfunction in patients with relapsing-remitting multiple sclerosis.

Cognitive dysfunction is considered one of the clinical markers of multiple sclerosis (MS). However, in the literature there are inconsistent reports on the prevalence of cognitive dysfunction, and separate data for the relapsing-remitting (RR) type of the disease are not always presented. In this study, we submitted 461 RRMS patients to a battery of neuropsychological tests to investigate their impairment in various cognitive domains. As a consequence of the exclusion criteria, the sample is not fully representative of the entire population of RRMS patients. In this selected sample, when only the eight scores of a core battery (Mental Deterioration Battery) were considered (with respective cutoffs), it emerged that 31% of the patients were affected by some degree of cognitive deficit. In particular, 15% had mild, 11.2% moderate and 4.8% had severe impairment. Information processing speed was the most frequently impaired area, followed by memory. When two other tests (SDMT and MCST) were added and cognitive domains were considered, it emerged that 39.3% of the patients were impaired in two or more domains. When four subgroups were obtained by means of cluster analysis and then compared, it emerged that information processing speed and memory deficits differentiated the still cognitively unimpaired from the mildly impaired MS patients. Significant associations were found between cognitive and clinical characteristics. However, due to the large sample size, clinically irrelevant relationships may also have emerged. Even with the limitations imposed by the sample selection and the possible underestimation of the prevalence and severity of cognitive dysfunction, these results seem to provide further evidence that information processing speed deficit may be an early and important marker of cognitive impairment in MS patients.

Adult↗
PubMed2006

Cognitive dysfunction is associated with poor diabetes control in older adults.

OBJECTIVE: To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes. RESEARCH DESIGN AND METHODS: Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities. RESULTS: Sixty patients (age 79 +/- 5 years, diabetes duration 14 +/- 13 years) were evaluated. Thirty-four percent of patients had low CIB (< or =5), and 38% of patients had low CDT (< or =13). Both CIB as well as CDT were inversely correlated with HbA(1c), suggesting that cognitive dysfunction is associated with poor glycemic control (r = -0.37, P < 0.004 and r = -0.38, P < 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 +/- 1.7 vs. 4.6 +/- 2.0; P < 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%). CONCLUSIONS: Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

Aged↗
PubMed2004

Postoperative cognitive dysfunction: true deterioration versus random variation.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication, especially in the elderly. The aim of this study was to describe how variability in neuropsychological testing could lead to the detection of cognitive improvement and poor consistency of POCD between postoperative test sessions. METHODS: In four published studies performed by the ISPOCD group, we included 2536 patients and 359 healthy controls. Cognitive function was assessed using neuropsychological tests preoperatively and at 7 days and 3 months thereafter, comparing the changes between those at baseline with those after surgery. Postoperative cognitive dysfunction was defined as a Z score greater than 2, and we also defined a corresponding improvement as a Z score less than -2. Consistency of POCD between postoperative test sessions was analyzed and we also assessed test-retest variability using data from healthy control subjects. RESULTS: Improvement in cognitive function was found in 4.2-8.7% of patients after 1 week and in 5.0-7.8% after 3 months. The ratio between incidence of dysfunction and improvement varied in patients between 3.3 and 6.2 early after major surgery. Of those patients who displayed POCD at the 3-month test, 30-48% also had POCD at the previous test at 1 week. The test-retest reliability was between 0.56 and 0.90, except for the error score in Concept Shifting Test, where the values were 0.20 and 0.37. CONCLUSION: Variability in neuropsychological test data contributes to a low consistency between postoperative test sessions but it does not explain the detection of cognitive dysfunction after major surgery.

Adult↗
PubMed2002

The value of clock drawing in identifying executive cognitive dysfunction in people with a normal Mini-Mental State Examination score.

BACKGROUND: Executive cognitive dysfunction can precede the memory disturbances of dementia. People with executive cognitive dysfunction can have a normal Mini-Mental State Examination (MMSE) score but still have severe functional limitations. We evaluated the usefulness of clock drawing in identifying people with executive dysfunction who have a normal MMSE score. METHODS: We reviewed the charts of consecutive patients referred between July 1999 and June 2000 to a multidisciplinary geriatric assessment clinic because of concerns about functional inabilities. The patients had all undergone the Executive Interview for the diagnosis of executive cognitive dysfunction as well as an MMSE and clock-drawing test (scored by 2 methods: one described by Watson and colleagues [the Watson method] and one described by Sunderland and colleagues [the Sunderland method]). RESULTS: We reviewed the charts of 68 patients (40 women, 28 men); their mean age was 79 years (range 55-94). Thirty-six patients had an MMSE score of less than 24, and 32 had a "normal" MMSE score (24-30). Among those with a normal MMSE score, 22 had an abnormal Executive Interview score. Using the Executive Interview as the gold standard, the sensitivity and specificity of the Watson method of scoring clock drawings to predict an abnormal Executive Interview score were 59% and 70% respectively; the corresponding values were 18% and 100% for the Sunderland method. INTERPRETATION: The presence of an abnormal MMSE score alerts clinicians to the possibility of cognitive impairment. For patients referred for geriatric assessment who have a normal MMSE score, a clock-drawing test, scored by either the Watson or the Sunderland method, is a moderately sensitive and specific adjunct for detecting executive cognitive dysfunction.

Aged↗