SEARCH · PubMed Health

Results for “Cognitive Dysfunction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources

PubMed2005

Neurological and neuropsychiatric syndromes associated with liver disease.

The clinical presentation of acute liver failure and hepatic encephalopathy (HE) in patients with cirrhosis differs significantly. The most serious neurological complication of acute liver failure is the development of devastating brain oedema. Therefore, intracranial pressure monitoring is urgently needed in these patients. Brain oedema is amplified by hypoglycemia, hypoxia and seizures, which are also frequent complications of acute liver failure. Therefore, these parameters must also be monitored. In contrast to acute liver failure in which cerebral dysfunction progresses rapidly, cognitive decline may be clinically undetectable for a long time in cirrhotic patients, until clinically overt symptoms such as psychomotor slowing, disorientation, confusion, extrapyramidal and cerebellar symptoms or a decrease in consciousness occur. Clinically, overt HE is preceded by minimal alterations of cerebral function that can only be detected by neuropsychological or neurophysiological measures, but which nevertheless interfere with the patient's daily living. Rapidly progressing spastic paraparesis (hepatic myelopathy) is a rare complication of cirrhosis. In contrast to HE, it does not respond to blood ammonia lowering therapies but must be considered as an indication for urgent liver transplantation. Cognitive dysfunction has recently been detected in hepatitis C virus (HCV)-infected patients with normal liver function. The patients presented with severe fatigue, cognitive dysfunction and mood disorders. Alterations in brain metabolites, as detected by magnetic resonance spectroscopy, indicated central nervous system alteration in these patients. In contrast to patients with HE, HCV-infected patients did not show motor symptoms or deficits in visual perception, but considerable deficits in attention and concentration ability.

Hepatic Encephalopathy↗

PubMed2006

Cognitive testing in early phase clinical trials: outcome according to adverse event profile in a Phase I study.

BACKGROUND: It has been proposed that objective cognitive testing provides additional information to that collected via adverse event (AE) recordings. However, in clinical trials of compounds with potentially negative effects on cognition, the results of cognitive testing may overlap with AE recordings. AIMS: To examine cognitive function in subjects who do and do not report sedation-related AEs in a Phase I clinical trial. METHODS: Five computerized cognitive tasks were administered to 28 healthy male volunteers enrolled in a simulated Phase I study using midazolam to induce sedation-related AEs and cognitive dysfunction. For each subject, the magnitude of cognitive change between pre-dose and 1 hr post-dose assessments was calculated. Group and individual level cognitive outcome was compared between subjects who did and did not report sedation-related AEs following administration of 1.75 and 5.25 mg midazolam. RESULTS: At both doses of midazolam, cognitive dysfunction was observed in both subject groups (i.e., those who did and did not report AEs). Analysis of individual outcomes identified consistent cognitive dysfunction among subjects who reported sedation-related AEs. Further, in the 5.25 mg condition a subset of individuals (66.7%) who did not report sedation-related AEs nevertheless displayed substantial cognitive dysfunction. CONCLUSIONS: Following administration of oral midazolam, there is a dissociation between sedation-related AE recordings and performance on computerized cognitive tests of motor function, attention, strategy use and problem solving, learning and delayed recall. Inclusion of computerized cognitive tests in early phase trials may allow identification of subtle cognitive change, beyond that which is possible by self-report and clinical observation.

Adolescent↗

PubMed2006

Cognitive functions in brain tumor patients.

As effective treatment interventions have increased survival rates, there has been greater awareness that many brain tumor patients experience cognitive dysfunction despite adequate disease control. Cognitive difficulties often have an impact on quality of life and interfere with the patient's ability to function at premorbid levels; however, the incidence of cognitive dysfunction in brain tumor patients is unknown, because it has not been investigated systematically. Future prospective clinical trials in neuro-oncology should include cognitive outcome measures to increase understanding of the contribution of the tumor and the delayed effects of treatment to cognitive dysfunction.

Brain Neoplasms↗

PubMed1995

Visual dysfunction predicts cognitive deficits in Alzheimer's disease.

Deficits in basic visual capacities are prevalent in Alzheimer's disease (AD), raising the question of their impact on cognitive function. We examined the relation between vision and cognition in 72 patients with AD. Vision tests assessed color discrimination, stereoacuity, contrast sensitivity, and backward pattern masking. For cognitive tests of object recognition, at least 25% (up to 50%) of score variance was predicted by performance on a vision test. For tests of spatial localization, only 2 to 11% of the variance was predicted by performance on a vision test. The results indicated that: (1) visual dysfunction was a significant predictor of cognitive dysfunction in AD, and (2) visual deficits in AD may have a strong functional impact on performance in specific cognitive domains.

Aged↗

PubMed2006

Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings.

BACKGROUND: Antiphospholipid syndrome (APS) is a multisystem disorder characterized by arterial and venous thromboses, pregnancy morbidity, and various neuropsychiatric manifestations. Cognitive dysfunction in APS has been poorly recognized. We examined for the first time, to our knowledge, the presence of cognitive dysfunction in patients with APS and its association with clinical, laboratory, and cerebral magnetic resonance imaging characteristics. METHODS: Sixty patients (39 with primary APS and 21 with systemic lupus erythematosus-related APS) and 60 healthy individuals matched for age, sex, and education were examined by means of a comprehensive 3-hour battery of neuropsychological tests. Twenty-three patients had a history of central nervous system involvement. Fifty-nine of 60 patients underwent brain magnetic resonance imaging at the time of neuropsychological assessment. A disease control group not fulfilling criteria for APS (15 patients with systemic lupus erythematosus and 10 with rheumatoid arthritis) was also included. The demographic, clinical, and laboratory characteristics of patients were recorded. RESULTS: Twenty-five (42%) of the 60 patients with APS had cognitive deficits compared with 11 (18%) healthy control subjects (P = .005). No patient was diagnosed as having dementia. The most commonly involved cognitive domains were complex attention and verbal fluency. No difference was found in cognitive performance between patients with primary APS and those with systemic lupus erythematosus-related APS. No relationship was detected between cognitive dysfunction and prior central nervous system disease. We noted a significant association between cognitive dysfunction and livedo reticularis (P = .004) as well as between cognitive dysfunction and the presence of white matter lesions on the findings of brain magnetic resonance imaging (P=.01). No difference was detected in cognitive performance between the disease control group and healthy individuals (P=.86). CONCLUSIONS: Cognitive deficits may often be found among patients with APS, independent of any history of central nervous system involvement. Livedo reticularis and the presence of white matter lesions on brain magnetic resonance imaging are associated with an increased risk for cognitive dysfunction in APS.

Adult↗

PubMedDate not supplied

Postoperative cognitive function as an outcome of regional anesthesia and analgesia.

BACKGROUND AND OBJECTIVES: It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium. METHODS: Studies were identified by searching the PubMed database of the National Library of Medicine (1966 to 2003) for terms related to cognitive dysfunction after surgery. Inclusion criteria were a comparison of intraoperative neuraxial anesthesia versus general anesthesia, and the outcome of postoperative cognitive dysfunction. A total of 196 abstracts were identified, and 24 articles were analyzed. Each article was reviewed, and data were extracted from tables or text or extrapolated from figures as needed. RESULTS: Of the 24 trials obtained, 19 were randomized and 4 were observational (nonrandomized) trials (1 trial was a combination of randomized and observational data). The age of patients studied was typically greater than 60 years, and a wide range of neuropsychometric tests were used to evaluate cognitive function. The majority of trials (23/24 of all trials and 18/19 of randomized trials) did not demonstrate a benefit from neuraxial anesthesia in decreasing the incidence of postoperative cognitive dysfunction. CONCLUSIONS: The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.

Analgesia, Epidural↗

PubMed2001

[Postoperative cognitive disorders in the elderly].

TWO DISTINCT CATEGORIES: Postoperative cognitive disorders include delirium and long-term cognitive dysfunction. DELERIUM: Delirium is an acute state occurring early during the postoperative period. It may be considered as an acute cerebral insufficiency which may be consecutive both to the negative effects of aging and chronic illness on cognitive function, and to the cerebral impact of operative stress. In addition, precipitating postoperative medical factors may facilitate cerebral failure. Only a few studies have been devoted to prevention programs aimed at reducing the risk of postoperative delirium. Nevertheless, we can hypothesize that a preoperative gerontology assessment would be effective in determining risk factors of delirium in old patients and thus enable proposing individual postoperative management. LONG-TERM COGNITIVE DYSFUNCTION: The definition of this clinical picture is less precise than delirium. Long-term cognitive dysfunction corresponds to a loss of cognitive performance in the weeks and months after anesthesia. The IPOCD1 study conducted in a large cohort of elderly patients has shown that postoperative cognitive dysfunction was present in 25.8% of patients 1 week after surgery and in 9.9% 3 months after surgery. One to two years after surgery, cognitive dysfunction was observed in 10.4% of patients compared with 10.6% in a control population of non-operated patients. We would suggest that in many cases, postoperative cognitive dysfunction may result from preoperative dementia unmasked by surgery.

Aged↗

PubMed2004

The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial.

BACKGROUND: Retrospective trials have reported that chemotherapy-induced cognitive dysfunction was experienced by a subset of patients with breast carcinoma. However, recent evidence indicated that a subset also exhibited impaired cognitive function at baseline, before the start of chemotherapy. A prospective, longitudinal trial that incorporates baseline neuropsychologic evaluations is necessary to determine to what extent cognitive dysfunction is attributable to chemotherapy in this population. METHODS: Eighteen women with breast carcinoma underwent a comprehensive neuropsychologic evaluation before treatment and at short-term and long-term intervals after chemotherapy. The incidence, nature, severity, and chronicity of cognitive dysfunction developing in patients with breast carcinoma treated with a standard dose of adjuvant chemotherapy were assessed. RESULTS: Before the start of systemic therapy, 33% of women in the current cohort exhibited cognitive impairment. At the short-term postchemotherapy time point, 61% of the cohort exhibited a decline relative to baseline in 1 or more domains of cognitive functioning and reported greater difficulty in maintaining their ability to work. The most common domains of cognitive dysfunction were related to attention, learning, and processing speed. At the long-term postchemotherapy time point, approximately 50% of patients who experienced declines in cognitive function demonstrated improvement, whereas 50% remained stable. Self-reported ability to perform work-related activities also improved over this interval. Neither impairment at baseline nor subsequent treatment-related cognitive decline exhibited any statistically significant correlation with affective well-being or with demographic or clinical characteristics. CONCLUSIONS: The current study is the first longitudinal trial to report evidence of an association between cognitive dysfunction and chemotherapy in a subgroup of women with nonmetastatic breast carcinoma. The importance of using prospective research designs, appropriate cognitive measures, and statistical methods to evaluate subgroup effects was discussed. Identification of mechanisms associated with cognitive dysfunction and of risk factors contributing to subgroup vulnerability is necessary.

Adult↗

PubMed2005

Negative cognitive styles, dysfunctional attitudes, and the remitted depression paradigm: a search for the elusive cognitive vulnerability to depression factor among remitted depressives.

Results from studies using a behavioral high-risk design and approximations to it generally have corroborated the cognitive vulnerability hypothesis of depression, whereas results from remitted depression studies typically have not. Suspecting that design features of previously conducted remitted designs likely precluded them from detecting maladaptive cognitive patterns, the authors conducted a study featuring the remitted design that has been successful in studies of a biological vulnerability for depression. Participants' current depressive symptoms, negative cognitive styles (hopelessness theory), dysfunctional attitudes (Beck's theory), and lifetime prevalence of clinically significant depression were assessed. Participants who had remitted from an episode of clinically significant depression had more negative cognitive styles, but not greater levels of dysfunctional attitudes, than did never depressed individuals.

Adult↗

PubMed2006

Cognition in the early stage of multiple sclerosis.

OBJECTIVE: Cognitive dysfunctions may contribute to limitation of everyday activities of patients with multiple sclerosis (MS). Recent studies have demonstrated that 45 to 65% of MS-patients are cognitively impaired. The profile of MS-related cognitive dysfunctions varies greatly. It includes memory and learning deficits, attention deficits, executive dysfunctions and visuo-spatial deficits. Most studies of cognition in MS examined patients in later stages, often including MS-patients with marked physical disabilities. Studies of cognitive dysfunctions in the early stage of the disease are rare. This study specifically aimed at evaluating and characterizing cognitive impairments in the early stage of MS, and determining specific patterns of cognitive dysfunction. METHODS: 21 MS patients, experiencing their first neurological symptoms not more than two years previously, and 22 healthy controls were compared. A comprehensive neuropsychological test-battery was used to evaluate MS-related cognition. The battery consisted of memory and learning tests, executive functioning tests and a visuo spatial functioning test. A computerized attention test-battery was also included, which assess accuracy and speed of test responses. In addition depression and intellectual capabilities were assessed. RESULTS: Compared with healthy controls, MS-patients in the early stage of the disease performed significantly lower on each neuropsychological assessment, except for verbal short-term memory. In particular, MS-patients showed a lengthened reaction time for simple and focused attention (19-38%), impaired non-verbal memory function (RVDLT recognition: 33%) and a planning deficit (24%). Associations between information processing speed and disease course and the employment situation were additionally found. However, patients did not have clinically relevant depression rates on the ADS-L and visuo spatial abilities remain preserved. CONCLUSION: Our findings revealed discrete cognitive dysfunction in MS-patients within the early stage of the disease.

Adult↗

PubMed1988

Magnetic resonance imaging of cerebral lesions in patients with the Sjögren syndrome.

Thirty-eight patients with the primary Sjögren syndrome, 16 with active neuropsychiatric manifestations and 22 without clinical evidence of central nervous system involvement had magnetic resonance (MR) imaging. Eight patients had focal neurologic deficits (6 of these also had psychiatric, or cognitive dysfunction), and 8 had psychiatric or cognitive abnormalities alone. Magnetic resonance imaging showed abnormal results in 12 of 16 (75%; 95% CI, 48 to 93) patients with active central nervous system disease (67 focal lesions predominantly within the subcortical and periventricular white matter), and in 2 of 22 (9%; 95% CI, 1 to 29) patients without clinical evidence of central nervous system disease (P less than 0.0001). Seven of eight patients with focal neurologic deficits and 5 of 8 patients with psychiatric or cognitive dysfunction alone had abnormal results on MR imaging. Magnetic resonance imaging was more sensitive in the subgroup with focal deficits, (sensitivity, 88%; 95% CI, 44 to 97) than computerized axial tomography or cerebral angiography. Magnetic resonance imaging detects focal cerebral lesions in patients with the Sjögren syndrome and central nervous system involvement, including patients with psychiatric and cognitive dysfunction alone.

Adult↗

PubMed1997

Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery.

BACKGROUND: Coronary bypass surgery often leads to short-term cognitive dysfunction, whereas coronary angioplasty does not. Perioperative cognitive dysfunction usually resolves, although a subgroup of surgical patients may continue to exhibit long-term cognitive dysfunction. The purpose of this study was to compare cognitive function 5 years after randomization to a strategy of either initial coronary surgery or initial angioplasty. METHODS AND RESULTS: Five centers in the Bypass Angioplasty Revascularization Investigation participated in this ancillary study. Patients with multivessel coronary disease randomized to angioplasty or surgery were eligible at the time of their 5-year clinic visit. A battery of five measures previously shown to be sensitive to perioperative changes in cognitive function was administered, including the Logical and Figural Memory Scales from the Wechsler Memory Scale, the Digit Symbol and Digit Span subtests from the Wechsler Adult Intelligence Scale, and Part B of the Reitan Trail Making Test. The 125 study patients were generally similar to the 133 patients who were eligible but did not participate, although study participants were significantly younger (P=.003). The 64 patients randomly assigned to angioplasty had baseline characteristics similar to those of 61 patients randomly assigned to surgery. Cognitive function scores were not significantly different between angioplasty or surgery patients in an intention-to-treat analysis (P=.57). There also was no difference in cognitive function scores when the data were analyzed according to whether the patient had ever undergone bypass surgery (P=.59). CONCLUSIONS: Long-term cognitive function is similar after coronary bypass surgery and coronary angioplasty in the majority of patients.

Adult↗

PubMed1997

Motor/psychomotor dysfunction in normal aging, mild cognitive decline, and early Alzheimer's disease: diagnostic and differential diagnostic features.

To determine the association between cognitive dysfunction and motor behavior in older adults, 41 cognitively normal elderly (NL), 25 nondemented patients exhibiting mild cognitive impairment (MI) and at risk for future decline to dementia, and 25 patients with mild (early) Alzheimer's disease (AD) were examined using a wide array of motor/psychomotor and cognitive assessments. The three groups were recruited from an aging and dementia research center and were composed of well-characterized physically healthy volunteers, with similar ages and gender distributions. The outcome measures included 16 motor/psychomotor tests categorized a priori into gross, fine, and complex, as well as eight cognitive tests of memory and language. Relative to the NL group, MI individuals performed poorly on cognitive, fine, and complex motor measures but not on gross motor tests; AD patients performed worse on cognitive and all motor domains. Differences in complex motor function persisted after adjustment for performance on cognitive and on less complex motor tests. Classification analyses showed similar accuracies in discriminating NL from MI and NL from AD cases for both complex motor (79% and 92% accuracy, respectively) and cognitive tests (80% and 93% accuracy, respectively). Less complex motor tests produced poorer accuracies. Among nondemented subjects, education correlated with several cognitive scores but no motor scores. These results indicate that motor impairment is an important aspect of cognitive decline in older adults. Motor/psychomotor assessments were found to be comparably sensitive to traditional tests of cognitive function in identifying persons affected by the earliest stages of AD pathology and may improve identification of at-risk nondemented elderly, especially among diversely educated individuals.

Aged↗

PubMed2005

A functional MRI comparison of patients with obsessive-compulsive disorder and normal controls during a Chinese character Stroop task.

Recent functional neuroimaging and neuropsychological studies have suggested that abnormal activity in the anterior cingulate cortex (ACC) might cause an action-monitoring dysfunction in obsessive-compulsive disorder (OCD). To identify the relationship between brain dysfunction and cognitive dysfunction, we examined regional brain changes in OCD with functional magnetic resonance imaging (fMRI) during the performance of a cognitive task. Participants comprised 24 patients with OCD and 14 normal controls. First, we compared the cognitive function in the two groups as assessed by several neuropsychological tests. Then we used fMRI to explore brain correlates of their performance during the Chinese character version of the Stroop test, a task that is strongly related to action-monitoring function. The two groups did not differ on the neuropsychological tests. Both groups also showed similar activation pattern on fMRI. The patients, however, showed weaker activation than the normal controls in the ACC and the right caudate nucleus.

Adult↗

PubMed2005

The PHC-cog: a brief cognitive function screening test for the elderly.

BACKGROUND: Cognitive dysfunctions such as dementia have emerged as a leading public health problem among the elderly. Its early detection is important for the management of patients, and for the educational support of other family members. Although cognitive dysfunction screening tests are available, they have not been widely utilized in community or primary care settings. AIM: To validate the PHC-cog (Public Health Center Cognitive Dysfunction Test) and to assess it as a simple and brief method for massive screening of cognitive dysfunctions in the primary care setting. MATERIALS AND METHODS: The study comprised 137 community-dwelling patients with dementia and 134 age, sex, and education-matched controls. The PHC-cog was made combining patients' and informants' questionnaires to improve performance. The PHC-cog patient's section briefly assessed the patient's cognition. RESULTS: The PHC-cog Patient's Section had a sensitivity and specificity of 0.75 and 0.92, respectively. The PHC-cog Informants' Section had a sensitivity and specificity of 0.79 and 0.83, respectively. The total method of administering the PHC-cog had a sensitivity and specificity of 0.96 and 0.82, and the two-stage method had a sensitivity and specificity of 0.92 and 0.76, respectively. CONCLUSIONS: The PHC-cog test is a simple, accurate and reliable, performance-based tool in the screening for cognitive dysfunction. The PHC-cog test is quick, and easy-to-use, and will hopefully become widely used in the cognitive screening of the aging population in the primary public medical institutions of Korea.

Aged↗

PubMed2004

[Introduction of cognitive-behavioral therapy for alcoholic inpatients at Kurihama National Hospital].

A new inpatient treatment program for alcoholism based on cognitive-behavioral therapy was introduced at Kurihama National Hospital in March 2000. We have classified the dysfunctional cognitions frequently exhibited by alcoholics into eight categories. The therapy is premised on the notion that the presence of one or more of the dysfunctional cognitions can trigger worsening of an alcoholic's drinking problem. We have devised a cognitive model in which the patients themselves examine their dysfunctional cognitions and recover from the vicious cycle of alcoholism. Cognitive-behavioral therapy is conducted at Kurihama National Hospital based on these hypotheses. The cognitive-behavioral therapy employed at Kurihama National Hospital is administered in group therapy in an inpatient treatment setting. Since the treatment is provided on an inpatient basis, dropouts from the program as a result of the patient starting to drink again can be prevented. Furthermore, since group therapy are used, cognitions of alcohol are examined not just in the context of the relationship between patient and therapist, but also in the context of the relationships among patients. It thus becomes easier to examine dysfunctional cognitions from a multifaceted perspective. It will be easier for patients to examine their future drinking behavior concretely through the introduction of cognitive-behavioral therapy, and improvements in outcome should be achieved. However, the relationship between change in cognitions and prognosis needs to be studied in the future.

Alcohol Drinking↗

PubMed1987

A comparison of discharge teaching on the consequences of brain injury.

Cognitive dysfunction is a common consequence of brain injury. Frequently, however, this phenomenon is not discussed with family caregivers before the patient's discharge from the acute care setting. A discharge teaching videotape was developed, which presented how the most common cognitive dysfunctions experienced postbrain injury affect activities of daily living. The ability to extrapolate appropriate patient care techniques after receiving discharge instructions on cognitive dysfunctions was tested by a posttest only experimental design study using a control and experimental group. The results indicated that family caregivers who received instruction on cognitive dysfunction were more informed about brain injury-induced behavior and better prepared to help loved ones compensate for cognitive dysfunctions.

Activities of Daily Living↗

PubMed2005

Hypericum extract reverses S-ketamine-induced changes in auditory evoked potentials in humans - possible implications for the treatment of schizophrenia.

BACKGROUND: Auditory evoked potentials (AEP) provide a correlate of cognitive dysfunction in schizophrenia. Both cognitive dysfunction and AEP-characteristics might be related to reduced glutamatergic neurotransmission as induced by glutamate-antagonist like ketamine. Hypericum extract LI160 has demonstrated a ketamine-antagonising effect. We examined whether LI160 reverses changes of a low dose ketamine on AEP in healthy subjects. METHODS: We performed a double-blind randomized treatment with either 2 x 750 mg LI 160 or placebo given one week, using a crossover design, in 16 health subjects. A test-battery including AEPs, the oculodynamic test (ODT) and a cognitive test were performed before and after an infusion with 4 mg of S-ketamine over a period of 1 hour. RESULTS: S-ketamine lead to a significant decrease in the N100-P200 peak to peak (ptp) amplitude after the placebo treatment, whereas ptp was significantly increased by S-ketamine infusion in the LI160 treated subjects. The ODT and the cognitive testing revealed no significant effect of ketamine-infusion and therefore no interaction between treatment groups. CONCLUSIONS: AEP measures are sensitive means to assess the effect of low dose ketamine. Provided that ketamine mimics cognitive deficits in schizophrenia, LI160 might be effective to treat these symptoms.

Adult↗