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Comparison of the effects of zolpidem and flunitrazepam on sleep structure and daytime cognitive functions. A study of untreated unsomniacs.

The effects of zolpidem 10 mg, flunitrazepam 1 mg, and placebo, administrated at bedtime, were studied in 12 healthy male insomniac patients. The assessments included polygraphic sleep recordings during the night and a battery of cognitive tests (sign crossing test, dichotic listening test, digit span test, visual recognition test and free recall test during four times during the following day. Compared with placebo, both active drugs improved sleep parameters. However, with zolpidem, the results were not statistically different from placebo. Zolpidem dit not alter sleep architecture in contrast to flunitrazepam, which significantly increased stage 2 and decreased slow wave sleep and REM sleep. No significant interaction was found between time of day for the evaluation of cognitive function. Flunitrazepam significantly impaired attention and memory compared with zolpidem and placebo, while zolpidem did not differ from placebo. These results indicate that zolpidem 10 mg preserved sleep structure and daytime cognitive functions in contrast to flunitrazepam.

Adult↗

Daytime sleepiness and cognitive functioning in sleep apnea.

Our earliest findings relating sleepiness to cognitive function revealed that, among patients with the symptom of excessive somnolence, sleep apneics were the most impaired on cognitive tasks. Although the multiple sleep latency test (MSLT) has been the standard diagnostic test for assessing daytime sleepiness, the maintenance of wakefulness test (MWT) has clinical advantages over the MSLT when the assessment of daytime alertness is the primary goal. A number of studies on patients with sleep apnea and narcolepsy indicate that the MWT is more sensitive to treatment-related improvements in sleepiness. However, sleep tendency, as measured by the MSLT, and ability to remain awake, as measured by the MWT, probably represent the same physiological process viewed from different perspectives. Some patients, particularly those who have received suboptimal treatment, will show no treatment-related improvement in daytime sleepiness if they are evaluated only by the MSLT. We believe that the MWT and MSLT measure different aspects of the central problem of abnormal sleep tendency. The MWT may be a useful adjuvant daytime test in clinical situations where it is necessary to quantify degree of impairment or effectiveness of treatment.

Cognition Disorders↗

Cognitive function of children with cystic fibrosis: deleterious effect of early malnutrition.

OBJECTIVE: Patients who have cystic fibrosis (CF) and experience delayed diagnosis by traditional methods have greater nutritional insult compared with peers diagnosed via neonatal screening. The objective of this study was to evaluate cognitive function in children with CF and the influence of both early diagnosis through neonatal screening and the potential effect of early malnutrition. METHODS: Cognitive assessment data were obtained for 89 CF patients (aged 7.3-17 years) during routine clinic visits. Patients had been enrolled in either the screened (N = 42) or traditional diagnosis (control) group (N = 47) of the Wisconsin CF Neonatal Screening Project. The Test of Cognitive Skills, Second Edition was administered to generate the Cognitive Skills Index (CSI) and cognitive factor scores (Verbal, Nonverbal, and Memory). RESULTS: Cognitive scores in the overall study population were similar to normative data (CSI mean [standard deviation]: 102.5 [16.6]; 95% confidence interval: 99.1-105.9). The mean (standard deviation) CSI scores for the screened and control groups were 104.4 (14.4) and 99.8 (18.5), respectively. Significantly lower cognitive scores correlated with indicators of malnutrition and unfavorable family factors such as single parents, lower socioeconomic status, and less parental education. Our analyses revealed lower cognitive scores in patients with low plasma alpha-tocopherol (alpha-T) levels at diagnosis. In addition, patients in the control group who also had vitamin E deficiency at diagnosis (alpha-T < 300 microg/dl) showed significantly lower CSI scores in comparison with alpha-T-sufficient control subjects and both deficient and sufficient alpha-T subsets of screened patients. CONCLUSION: Results suggest that prevention of prolonged malnutrition by early diagnosis and nutritional therapy, particularly minimizing the duration of vitamin E deficiency, is associated with better cognitive functioning in children with CF.

Adolescent↗

Estrogen and cognitive functioning in women.

Findings from basic neuroscience have elucidated mechanisms of action of estrogen on the structure and function of brain areas known to be critically involved in memory. Controlled clinical studies of the administration of estrogen to postmenopausal women have found that estrogen enhances verbal memory and maintains the ability to learn new material. These findings are supported by those from investigations of healthy, elderly, women and by results of a study in which younger women received a gonadotropin releasing-hormone analog that suppressed ovarian function. The specificity of the estrogenic effect on cognitive functions is consistent with known sex differences in cognitive abilities and suggests that, in adulthood, estrogen serves to activate neural pathways established under the influence of this steroid hormone during prenatal life.

Adult↗

Schooling, educational achievement, and cognitive functioning among young Guatemalan adults.

Quantity and quality of schooling obtained and the resulting skills and knowledge acquired are important components of human capital. We describe the distribution of selected measures of schooling, educational achievement, and cognitive functioning among individuals who participated as children in a nutrition supplementation trial in Guatemala and were followed up in 2002-04. Among 1,469 respondents (response rate 80%), who were 26-41 years of age in 2003, more than 90% of men and women had attended at least some school; more than half of men and more than one-third of women had completed sixth grade. Schooling attainment of both men and women has increased across birth cohorts but the schooling gap between men and women has increased. Parental socioeconomic status, as measured in 1975, is a strong predictor of schooling attainment. Basic literacy is high among those studied, with more than 80% able to read simple sentences. The gap in educational achievement favoring men narrowed across birth cohorts due to increases among younger women. The greater performance among men on the Raven's Progressive Matrices test persisted despite increased scores in the younger birth cohorts for both men and women. Migrants to Guatemala City have completed more years of school and scored higher on the tests of educational achievement and cognitive functioning than have cohort members who have remained in the study villages.

Adult↗

[Evaluation of cognitive functions in patients with chronic renal insufficiency].

Fifteen undialyzed and thirteen dialyzed patients affected by chronic renal failure were studied by means of an extensive neuropsychological battery with the aim of assessing the incidence of a deterioration of cognitive functions. Mean performances scores obtained by the two groups of patients were compared with analogous scores obtained by a group of control subjects similar as for literacy and age. The comparisons among the three groups did not reveal any difference as for performance scores obtained to various tasks nor for the global assessment derived for the entire battery. Furthermore our data do not point out any significative correlation between global performances on neuropsychological battery and blood levels of creatinine and urea nitrogen or duration of dialytic treatment of renal subjects. In conclusion, the results of our study do not show evidence of cognitive impairment in subjects affected by chronic renal failure and do not confirm the hypothesis of a detrimental effect of prolonged periods of dialytic treatment on cognitive functions.

Blood Urea Nitrogen↗

Cognitive functioning in patients with familial bipolar I disorder and their unaffected relatives.

BACKGROUND: Impairments in verbal learning and memory, executive functions and attention are manifest in some euthymic patients with bipolar disorder (BPD). However, evidence is sparse on their putative role as aetiologically important genetic vulnerability markers for the disorder. This population-based study examined the cognitive functions of affected and unaffected individuals in families with BPD. The aim was to discover whether any cognitive function would indicate genetic liability to the disorder and could thus be regarded as endophenotypes of BPD. METHOD: A diagnostic interview and a neuropsychological test battery were administered to 32 familial bipolar I disorder patients, 40 of their unaffected first-degree relatives and 55 controls, all representing population-based samples. RESULTS: Unaffected first-degree relatives showed impairment in psychomotor performance speed and slight impairment in executive function. Bipolar patients were impaired in verbal learning and memory compared with unaffected relatives and controls. They also differed from controls in tasks of executive functions. There were no difference between the groups in simple attention and working memory tasks. CONCLUSIONS: Impaired psychomotor performance speed and executive function may represent endophenotypes of BPD, reflecting possible underlying vulnerability to the disorder. Verbal memory impairments appear to be more related to the fully developed disorder.

Bipolar Disorder↗

Screening for impaired cognitive function among the elderly in Spain: reducing the number of items in the Short Portable Mental Status Questionnaire.

The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.

Aged↗

Raloxifene hydrochloride, a selective estrogen receptor modulator: safety assessment of effects on cognitive function and mood in postmenopausal women.

Raloxifene hydrochloride (HCl) is a selective estrogen receptor modulator with estrogen agonist effects on bone and lipid metabolism and estrogen antagonist effects on reproductive tissues. Animal studies suggest that raloxifene may affect brain function as well, although the effects of raloxifene on the human brain remain to be established. This paper presents an early safety assessment of raloxifene effects on cognition and mood in postmenopausal women participating in a randomized, double-blind osteoporosis treatment trial. Psychometric test batteries were administered to postmenopausal women at baseline and 1, 6, and 12 months after initiating treatment with raloxifene (60 and 120 mg/day). The Memory Assessment Clinics (MAC) battery and Walter Reed Performance Assessment Battery (PAB) were used to assess multiple and independent aspects of cognitive function, while mood was assessed with the Geriatric Depression Scale (GDS). After 12 months of treatment, there were no significant differences between the raloxifene groups and placebo on performance in either the MAC battery or the PAB. The only significant difference observed was a slight increase in performance favoring the raloxifene 120 mg/day group in an assessment of verbal memory on the MAC battery after 1 month of treatment. Scores on the GDS and the self-reported incidence of mood-related events were not different between treatment groups at any of the assessment periods. These data do not suggest that raloxifene impairs cognition or affects mood in postmenopausal women treated for 1 year. Studies to further assess the safety and potential efficacy of raloxifene with respect to cognitive function are ongoing.

Adult↗

Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings.

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

Animals↗

Xlr3b is a new imprinted candidate for X-linked parent-of-origin effects on cognitive function in mice.

Imprinted genes show differential expression between maternal and paternal alleles as a consequence of epigenetic modification that can result in 'parent-of-origin' effects on phenotypic traits. There is increasing evidence from mouse and human studies that imprinted genes may influence behavior and cognitive functioning. Previous work in girls with Turner syndrome (45,XO) has suggested that there are X-linked parent-of-origin effects on brain development and cognitive functioning, although the interpretation of these data in terms of imprinted gene effects has been questioned. We used a 39,XO mouse model to examine the influence of the parental origin of the X chromosome on cognitive behaviors and expression of X-linked genes in brain. Our findings confirm the existence of X-linked imprinted effects on cognitive processes and identify a new maternally expressed imprinted gene candidate on the X chromosome, Xlr3b, which may be of importance in mediating the behavioral effects.

Animals↗

Anemia in the oncology patient: cognitive function and cancer.

Cancer-related anemia often develops from the infiltration of marrow by malignant cells, impaired hemoglobin (Hb) production related to chemotherapy or radiation therapy, iron deficiency, or low endogenous erythropoietin levels. Patients with cancer-related anemia may experience cognitive dysfunction including decreased mental alertness, poor concentration, and memory problems. Anemia-mediated cerebral hypoxia may cause symptoms such as headache, vertigo, tinnitus, and dizziness. These symptoms often are exacerbated in the elderly patient with cancer and related to underlying low Hb concentrations. Restoring Hb levels via the administration of iron supplements, blood transfusions, or, more recently, erythropoiesis-stimulating therapy (epoetin alfa) results in significant improvement of cognitive function. The use of epoetin alfa as a treatment option for patients with chemotherapy-associated anemia and an Hb concentration less than 10 g/dL has been recommended by the American Society of Clinical Oncology and the American Society of Hematology. Erythropoiesis-stimulating therapies are a promising treatment option for cancer-related anemia that may improve cognitive function and quality of life for patients with cancer.

Aged↗

Non-right handedness among ELBW and term children at eight years in relation to cognitive function and school performance.

The relationship between handedness, neurological and cognitive deficits, and school difficulties was investigated in 114 extremely low-birthweight (ELBW) children and 145 term controls at eight years. The prevalence of non-right handedness (left and mixed) was 31 per cent for ELBW children and 19 per cent for controls. ELBW children with neurological impairments were significantly more likely to be non-right handed. No significant differences were noted between right-handed and non-right handed ELBW children and controls on tests of cognitive function, school performance and prevalence of learning difficulties. These findings suggest an association between neurological impairment and non-right handedness, but do not support the hypothesis of early brain insult resulting in subtle cognitive deficits and suboptimal school performance among non-right handed ELBW children.

Achievement↗

[Cognitive function of geriatric ophthalmology patients after local and general anesthesia].

Since there will be an increase in the number of geriatric patients who undergo surgery and anesthesia over the next few years, studies comparing the effects of general and local anesthesia on cognitive functioning in elderly persons are mandatory. One hundred eleven ophthalmological patients, all over the age of 64 years, were assessed preoperatively, on the first and on the fourth postoperative day using a battery of standardized cognitive tests. Of the initial sample, 47 patients undergoing local and 54 undergoing general anesthesia completed the assessment. The performance of the patients in six tests did not change perioperatively. In both anesthesia groups, two tests revealed a cognitive deficit postoperatively, which only became evident on the first postoperative day. The two other tests showed a significant difference between the two anesthesia groups on the first postoperative day. The performance of patients with general anesthesia decreased transiently and returned to the initial levels within 3 days. We conclude from our results that postoperative cognitive deficits may occur in geriatric patients. However, general anesthesia poses no more risk to cognitive function than local anesthesia.

Aged↗

Assessing cognitive functioning of the elderly with the 'Inventory of Piaget's Developmental Tasks'.

The purpose of this study was to examine the reliability, validity, and utility of the 'Inventory of Piaget's Developmental Tasks' (IPDT) with elderly persons. The IPDT is a paper-pencil assessment of levels of cognitive functioning. Seventy elderly adults responded to a battery of instruments. Reliability and validity estimates for the IPDT were acceptable. Data indicated that the IPDT has promise as a clinical assessment of cognitive functioning. Implications for patient teaching by nurses is discussed and suggestions for clinical use are made.

Aged↗

[Dynamics of the personality profile and cognitive functions in finlepsin treatment of partial epilepsy].

The aim of modern antiepileptic therapy is not only to decrease frequency of the seizures and to prevent their rise, but to decrease negative consequences of the treatment too. It is, first of all, to decrease the influence of the antiepileptic preparations on the cognitive functions and, therefore, on quality of the patients' life. During therapy of 40 patients (8-57 year-olds) with partial epilepsy the severity of the seizures as well as emotional and cognitive functions of the patients were evaluated. A significant decrease of the severity of the seizures was observed during therapy with finlepsin-retard (p < 0.002). These changes correlated both with a decrease of anxiety according to MMPI questionnaire (p < 0.0001) and with an increase of the volume of the short-term imaginary memory. Finlepsin-retard is effective therapy for epilepsy.

Adolescent↗

Early brain injury in children: development and reorganization of cognitive function.

Children who sustain congenital or acquired brain injury typically experience a diffuse insult that impacts many areas of the brain. Yet research has only recently begun to examine the development of these children, who often provide excellent examples of the presence or absence of neural plasticity. Development and recovery after such injuries reflects both restoration and reorganization of cognitive functions. To understand these processes, research should focus on questions and assessment paradigms oriented toward the acquisition (rather than the recovery) of cognitive functions. Outcomes may appear similar across types of insults, even when the sources of difficulties and their neural correlates are different. Comparisons of outcomes involving intellectual functions, memory and learning, reading, and language/discourse in children who sustain congenital injury (spina bifida meningomyelocele) and acquired injury (traumatic brain injury) illustrate these principles and the value of research on diffuse brain injury in children.

Brain Injuries↗

Changes in specialized cognitive function following changes in hormone levels.

Increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in men by injection of luteinizing hormone releasing hormone (LHRH) prevented improvement in a spatial orientation test relative to a placebo condition. By contrast, performance on a fluency task was significantly increased after LHRH injection relative to the placebo condition. These data support between-subject results where FSH was negatively correlated with visuospatial skills and positively correlated with fluency. There was no change in cognitive function in males following injection of testosterone. There were also no fluctuations in cognitive function that coincided with hormonal fluctuations of the menstrual cycle in women.

Adolescent↗