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PubMed2005

The diagnostic value of tau protein, beta-amyloid (1-42) and their ratio for the discrimination of alcohol-related cognitive disorders from Alzheimer's disease in the early stages.

BACKGROUND: Chronic and heavy alcohol abuse or dependence may result in impaired cognition and dementia. The increased risk of Alzheimer's disease (AD) in older individuals interferes with the differential diagnosis, especially when dealing with elderly patients with a long history of alcohol abuse. The aim of the present study was to evaluate the diagnostic value of the putative cerebrospinal fluid (CSF) biomarkers tau, beta-amyloid 1-42 (Abeta42) and their ratio in differentiating alcohol related cognitive disorder (ARCD) from AD. METHODS: Double-sandwich ELISA (Innotest htau antigen and beta-Amyloid (1-42), Innogenetics) were used to quantify the above markers in a total of 20 patients with ARCD, 33 AD patients with mild to moderate dementia and 50 mentally intact subjects. RESULTS: Tau protein successfully differentiated AD from normal ageing with 96% specificity and 93.9% sensitivity and from ARCD with 95% specificity, and 87.9% sensitivity. Abeta42 alone had a specificity of 88% and a sensitivity of 69.7% in differentiating AD from normal ageing, while the corresponding values for differentiating AD from ARCD were 80% and 84.8% respectively. The tau/Abeta42 ratio was better than tau alone for differentiating AD from normal ageing (specificity 94%, sensitivity 97%) and better than any of the candidate markers alone, for differentiating AD from ARCD (specificity 100%, sensitivity 97%). CONCLUSIONS: The combined use of CSF tau and Abeta42 may be a useful tool in the differential diagnosis of ARCD from AD, especially in the early stages, where diagnostic uncertainty is greater.

Aging↗
PubMedDate not supplied

Atypical cognitive disorders in a man with developmental surface dyslexia.

The neuropsychological profile of a man with a developmental surface dyslexia is presented here. This case study is of interest because J.C. exhibited a pattern of cognitive disorders rarely documented in previous data. Results showed that JC's difficulties in reading comprehension were closely related to complex memory disorders and were also associated with cognitive slowness. The present observations do not support the visual memory failure hypothesis. The data rather suggest that the core difficulty primarily lies with the nonautomatization of grapheme-phoneme correspondence rules, which in turn dramatically contributed to lexicon weaknesses. The hypothesis of a timing mechanism in reading disorders is discussed.

Adult↗
PubMed2002

[Cognitive disorders in adult epilepsy patients].

Cognitive deficits are frequent in epileptic patients and can be considered as epileptic behavioral markers. They are assessed by a neuropsychological exploration that requires the use of standardized psychometric tests with well-established goals, that will be discussed in this paper. The obtained neuropsychological data complement information provided by other investigations. The manifestation of cognitive deficits associated with epilepsy depends on a variety of factors in which some are specific to epilepsy. These disorders affect in certain cases the intellectual functioning as well as other aspects of cognition, as emphasised in this paper, and may be accentuated by medically intractable seizures.

Adult↗
PubMed1986

Cholinergic receptors in cognitive disorders.

Cholinergic receptors (muscarinic subtypes M1 and M2, and putative nicotinic binding) have been examined in the hippocampus obtained at autopsy from a variety of patients with cognitive disorders (Alzheimer's, Parkinson's, and Huntington's diseases, Down's Syndrome and alcoholic dementia) and compared with neurologically normal controls and cases of Motor Neuron disease. In all of the disorders associated with a pre-synaptic cortical cholinergic deficit reflected by an extensive loss of choline acetyltransferase (Alzheimer's disease, Parkinson's disease and Down's Syndrome) there was a substantial reduction in the binding of (3H) nicotine to the nicotinic receptor. By contrast reductions in both muscarinic subtypes (M1 and M2) were apparent to only a moderate extent in Alzheimer's disease, whereas in Parkinson's disease binding was significantly increased (apparently not in relation to anti-cholinergic drug treatment) in the non-demented but not demented cases. A further abnormality detected in Alzheimer's disease but not the other disorders investigated was a decrease in an endogenous inhibitor of nicotinic binding, the identity of which is as yet unknown but which may be a candidate for a possible endogenous modulator of the nicotinic receptor. These observations suggest that in Alzheimer's disease not only muscarinic but also nicotinic receptor function should be considered in relation both to future therapeutic strategies and, in the search for a clinical marker which might be of diagnostic value, to potential probes of the cortical cholinergic system.

Cognition Disorders↗
PubMed2004

The international classification of functioning, disability and health and its application to cognitive disorders.

PURPOSE: This paper describes the conceptual foundation and systematic framework of the International Classification of Functioning, Disability, and Health (ICF) as a mechanism for understanding the course and consequences of various health related states. The specific application of the ICF with persons with cognitive dysfunction is also presented. METHOD: A comprehensive literature review related to the conceptualization of the ICF, its classification scheme and coding process is presented. Information on cognitive disorders including prevalence, functional manifestations and the assessment of a person's cognitive functioning and the applicability of the ICF's holistic classification and coding of cognitive dysfunction within the components of body structure and function, activity and participation, and environmental attributes is also reviewed. CONCLUSION: The ICF has the potential to classify and interpret cognitive deficits on a global level and thereby reflects upon the overall health and functioning of the individual in major life activities. The coding system systematically organizes measures related to the person's cognitive status and the resulting functional outcomes. The ICF focuses on individuals' performance of activities in all aspects of life and validates the independence and well-being of persons with disabilities making it an important instrument to be used by rehabilitation professionals.

Activities of Daily Living↗
PubMed2002

Study on cognition disorder and morphologic change of neurons in hippocampus area following traumatic brain injury in rats.

OBJECTIVE: To explore the correlation between cognition disorder and morphologic change of hippocampal neurons after traumatic brain injury (TBI). METHODS: Wistar rat models with severe TBI were made by Marmarou's method. The histopathological change of the neurons in the hippocampus area were studied with hematoxylin-eosin (HE) staining and terminal deoxynucleotidyl transferase-mediated X-dUPT nick end labeling (TUNEL), respectively. The cognitive function was evaluated with the Morris water maze test. RESULTS: The comprehensive neuronal degeneration and necrosis could be observed in CA2-3 regions of hippocampus at 3 days after injury. Apoptotic positive neurons in CA2-4 regions of hippocampus and dentate gyrus increased in the injured group at 24 hours following TBI. They peaked at 7 days and then declined. Significant impairment of spatial learning and memory was observed after injury in the rats. CONCLUSIONS: The rats have obvious disorders in spatial learning and memory after severe TBI. Meanwhile, delayed neuronal necrosis and apoptosis can be observed in the neurons in the hippocampus area. It suggests that delay ed hippocampal cell death may contribute to the functional deficit.

Animals↗
PubMed1989

Acquired cognitive disorders of the elderly.

Many gaps still exist in our understanding of the etiology and the management of dementing disorders. However, there are fairly well established guidelines for the clinical diagnosis of Alzheimer's disease, the major cause of acquired cognitive disorders in the elderly. The management of patients with dementing disorders should involve the entire family. The medical needs pale beside the functional and psychosocial issues. Therefore, a multidisciplinary approach in a team setting is ideal, where goals can be established and coordinated and communication with the family, patient, and consultants can be facilitated. Patients and family members need to know that life beyond the diagnosis can be meaningful. With the help of support groups, they learn to maximize the positive aspects and can cope with the struggle ahead. It should not be forgotten, however, that not all families had good relationships before the onset of the decline and often are in great need of counseling to manage the anger and guilt they will often experience. Future research is needed not only on the search for better medical treatments but also on the establishment of guidelines for the physician and family to deal with complex social issues such as when one is no longer safe to drive an automobile. Prospective studies on victims of head injury could establish the link of trauma to Alzheimer's disease, that has been proposed. The role of physicians in public policy for prevention of high risk behaviors (such as boxing) is controversial, but at the very least, physicians should play a major role in educating their patients of these dangers. Because of the rapid aging of our population, pressure for research and policy changes in national health and long term care financing has been growing, largely due to the impressive efforts of the Alzheimer's Association. In order to give the kind of attention that is required in the care of these patients, there must be a change in the present system of reimbursement. This will never happen, unless it can be demonstrated that lower costs of health care can be achieved by anticipating the needs of these patients and their families. It is quite possible that costs can be reduced by delaying the need for nursing home placement or decreasing utilization of emergency medical care and hospitalization. However, these assumptions must be investigated further.

Aged↗
PubMed2001

[Permeability of hemato-encephalic barrier in Alzheimer's disease and parkinsonism with cognitive disorders].

The study was made of 17 patients with expected Alzheimer's disease (AD), 29 patients with Parkinson's disease (PD) and 7 with a expected dementia with Levy bodies (DLB). The severity of cognitive disorders was determined according to the following scales: Global Deterioration Rating Scale, Mini-mental State Examination, Mattis Dementia Rating Scale. Besides, the patients state was evaluated, in the whole, according to some scales. Permeability of hemato-encephalic barrier was evaluated according to the blood serum levels of 3 neurospecific proteins--neuron specific enolase, glial fibrillary protein and alpha-glycoprotein. Their determination was performed by ELISA method. The significant elevation of the levels of the proteins studied was found already on the early stages of the disease. Their levels were higher in the patients with the dementia as compared with the individuals without it. There were no differences in cortical, subcortical and combined types of dementia. The authors believe, that some of the proteins studied (neuron specific enolase, for example) may serve as non specific markers of cerebral degeneration.

Alzheimer Disease↗
PubMed2006

Mouse models of cognitive disorders in trisomy 21: a review.

Trisomy 21 (TRS21) is the most frequent genetic cause of mental retardation. Although the presence of an extra copy of HSA21 is known to be at the origin of the syndrome, we do not know which 225 HSA21 genes have an effect on cognitive processes. Mouse models of TRS21 have been developed using syntenies between HSA21 and MMU16, MMU10 and MMU17. Available mouse models carry extra fragments of MMU16 or of HSA21 that cover all of HSA21 (chimeric HSA21) or MMU16 (Ts16); some carry large parts of MMU16 (Ts65Dn, Ts1Cje, Ms1Cje), while others have reduced contiguous fragments covering the D21S17-ETS2 region or single transfected genes. This offers a nest design strategy for deciphering cognitive (learning, memory and exploration) and associated brain abnormalities involving each of these chromosomal regions. This review confirms the crucial but not exclusive contribution of the D21S17-ETS2 region encompassing 16 genes to cognitive disorders.

Animals↗
PubMed2004

Prevalence of cognitive disorders differs as a function of age in HIV virus infection.

OBJECTIVES: Ten per cent of all new cases of AIDS in the United States are in persons older than 50 years. This is particularly problematical in the case of the neuropsychiatric consequences of HIV, because there are neuropsychiatric disorders which become common in older individuals in the absence of HIV. The purpose of this report is to describe the prevalence and incidence of cognitive impairment in HIV-infected individuals enrolled in a community-based study. DESIGN: The study consisted of community-based, sentinel survey physician referrals of HIV-infected patients, with volunteer recruitment of risk-appropriate seronegative controls. One-year longitudinal follow-up study. METHODS: Detailed neuropsychiatric evaluations were performed at study entry and after one year. A brief, interim visit tracked incident change. Each subject's neuropsychological test performance was classified as normal, demented, or cognitive impairment (not demented). RESULTS: The prevalence of cognitive disorder among HIV-positive individuals over 50 years was significantly greater than in individuals younger than 50 years. Among older participants, dementia was the more common classification (23%), whereas among younger participants, a milder form of cognitive impairment was more prevalent (22%). Alcohol abuse/dependence was a significant risk factor for a disorder, whereas greater education was a protective factor. The one-year incidence of disorder in the sample overall was low (7.3%), and age was not a significant risk factor. However, HIV viral load at study entry was significantly higher among those participants who had developed cognitive impairment one year later. CONCLUSION: Age is a significant risk modifier for prevalent neuropsychological disorder.

Activities of Daily Living↗
PubMed1999

[Postoperative cognition disorders in elderly patients. The results of the "International Study of Postoperative Cognitive Dysfunction" ISPOCD 1)].

OBJECTIVE: Cognitive dysfunction is a known problem after operations and may be especially relevant in the elderly. The aim of this international multicentre study was to investigate short- and long-term cognitive dysfunction in elderly patients and to elucidate the relevance of hypoxaemia and hypotension as causative factors. METHODS: 1218 patients aged 60 years and older and scheduled for major non-cardiac surgery under general anaesthesia were investigated. Oxygen saturation was measured by continuous pulse oximetry before surgery and throughout the day of and the first 3 nights after surgery. Blood pressure was recorded every 3 minutes during the operation and every 15-30 min for the rest of that day and night. Cognitive testing was performed before and 1 week and 3 months after the operation. Cognitive dysfunction was identified with neuropsychological tests compared with controls recruited from the UK (n = 176) and the same countries as study centres (n = 145). RESULTS: Postoperative cognitive dysfunction was present in 25.8% of patients 1 week after surgery and in 9.9% 3 months after surgery, compared with 3.4% and 2.8%, respectively, of the UK controls. Increasing age and duration of anaesthesia, little education, a second operation, postoperative infections, and respiratory complications were the risk factors for early postoperative cognitive dysfunction, but only age was a risk factor for long-term postoperative cognitive dysfunction. Hypoxaemia and hypotension were not significant risk factors at any time. CONCLUSION: With this investigation long-term cognitive dysfunction could be proven definitively for elderly patients after major operations under general anaesthesia. No factors with prophylactic or therapeutic influence were detectable so that aetiology and pathophysiology of POCD could not be further determined.

Aged↗
PubMedDate not supplied

Group screening for cognition disorders in elderly persons.

Prevalence rates of cognitive impairment in persons aged 75 to 85 years are in the range of 10 to 19 percent, and 20 to 47 percent after the age of 85 years. Screening for dementia in persons aged 75 years and older would therefore identify a significant number of impaired persons. When screening for dementia, group testing would be more cost-effective than individual testing. We modified the Folstein Mini-Mental State examination (MMSE) for screening in a group setting. Community volunteers were tested at a geriatric health fair and at a special exercise class for the elderly. Subjects were subsequently tested individually using the standard Folstein MMSE. Analysis using Pearson correlation and a paired t-test indicates a high degree of concurrent validity between the two methods of administering the MMSE. This pilot study suggests that when screening elderly persons for dementia, a group-administered instrument can be a useful method to obtain a preliminary sample of cognitively impaired individuals.

Aged↗
PubMed2005

[Cognitive disorder in Parkinson's disease].

Over the course of Parkinson's disease, a substantial percentage of patients not only develop motor und vegetative disorders, but also significant cognitive deficits that can, in isolated cases, take on the proportions of dementia. Additionally, affective and emotional dysregulations extending to depressive disorders may become manifest. These impairments can be explained by the underlying neuropathology and the Parkinson-associated transmitter imbalances as well as by the changes this disease causes in the patients' daily lives. According to Gifford and Cummings [21], up to 75 percent of patients with moderate to severe dementia are not diagnosed by their general practitioners; this number proving much higher in patients with mild cognitive impairments and affective and emotional problems. Due to the masking symptoms of a Parkinson's condition, it can be assumed that these numbers are probably even higher in this patient group. Accordingly, cognitive, affective and emotional disorders should be included as an integral part of Parkinson's disease diagnostics.

Aged↗