Cognitive impairment in chronic obstructive pulmonary disease

Some analogy exists between cognitive impairment in hypoxemic patients with chronic obstructive pulmonary disease (COPD) and Alzheimer's disease (AD). We purposed to verify whether the analogy extends to the cerebral perfusion pattern. Ten normal subjects, 15 COPD patients with and 18 without hypoxemia, and 15 patients with mild AD matched for age and educational level underwent brain perfusion single photon emission computed tomography (SPECT) and neuropsychological assessment. Normal subjects and non hypoxemic COPD patients had comparable perfusion patterns. The average perfusion decreased from non hypoxemic to hypoxemic COPD and, then, to AD patients. Hypoperfusion of associative areas was the hallmark of AD, whereas the average perfusion of anterior cortical and subcortical regions did not distinguish AD and hypoxemic COPD patients. Both COPD groups scored higher than AD patients (p 相似文献   

Cognitive impairment in chronic kidney disease: clinical findings,risk factors and consequences for patient care

Cognitive deficits have a high prevalence in elderly patients with chronic kidney disease (CKD). The clinical picture consists of cognitive slowing, executive, memory and language deficits, and is attributed to cerebral white matter disease and clinically often silent brain infarcts. In the meantime, robust evidence exists that low estimated glomerular filtration rate, a measure of CKD severity, predisposes to cognitive deficits, cerebral white matter lesions, and ischemic brain infarcts in addition to demographic factors, vascular risk factors and diseases which also contribute to CKD-related cognitive deficits. In terminal CKD, cerebral blood flow is compromized during hemodialysis sessions, resulting in oxygen desaturation, cognitive deterioration and—in the longer run—brain atrophy. Kidney transplantation improves cognitive deficits in terminal CKD. At all stages, vascular risk factors and associated diseases should stringently be treated according to therapeutic guidelines.     

Cognitive impairment associated with acute or chronic disease

Cognitive impairment in connection with acute or chronic disease may complicate the diagnosis, management, and treatment of general hospital inpatients. Consulting psychiatrists may be called upon to evaluate cognitive and intellectual impairment associated with organic brain syndromes versus psychiatric disorders due to other causes. To assist the psychiatrist in formulating a differential diagnosis, the standard mental status examination and various objective neuropsychologic tests can be used. In addition, the author suggests a method of cognitive measurement using content and form analysis of five-minute speech samples. Impaired cognitive function may be caused or exacerbated by conditions such as alcohol abuse or psychoactive drug abuse which may not be revealed by the patient during the history taking.     

Cognitive impairment and celiac disease

OBJECTIVE: To characterize the clinical, radiological, and electrophysiological laboratory profiles and histological features of patients who developed cognitive impairment temporally associated with celiac disease. DESIGN: Case series. SETTING: Referral center. PATIENTS: Patients with the onset of progressive cognitive decline within 2 years of symptomatic onset or with a severe exacerbation of biopsy-proved adult celiac disease were identified from the Mayo Clinic medical records from January 1, 1970, to December 31, 2005. Patients were excluded if an alternate cause of their cognitive impairment was identified. RESULTS: Thirteen patients (5 women) were identified. The median age at cognitive impairment onset was 64 years (range, 45-79 years), which coincided with symptom onset or exacerbation of diarrhea, steatorrhea, and abdominal cramping in 5 patients. Amnesia, acalculia, confusion, and personality changes were the most common presenting features. The average initial Short Test of Mental Status score was 28 of a total of 38 (range, 18-34), which was in the moderately impaired range. The results of neuropsychological testing suggested a trend of a frontosubcortical pattern of impairment. Ten patients had ataxia, and 4 of them also had peripheral neuropathy. Magnetic resonance imaging of the head showed nonspecific T2 hyperintensities, and electroencephalography showed nonspecific diffuse slowing. Deficiencies in folate, vitamin B(12), vitamin E, or a combination were identified in 4 patients, yet supplementation did not improve their neurological symptoms. Three patients improved or stabilized cognitively with gluten withdrawal. A detailed histological analysis revealed nonspecific gliosis. CONCLUSIONS: A possible association exists between progressive cognitive impairment and celiac disease, given the temporal relationship and the relatively high frequency of ataxia and peripheral neuropathy, more commonly associated with celiac disease. Given the impact for potential treatment of similar cases, recognition of this possible association and additional studies are warranted.     

Cognitive impairment in Parkinson's disease

Background

Cognitive impairment plays a role in Parkinson''s disease (PD) and has important consequences for patient management. However, many aspects of cognitive impairment in PD remain unclear because of the use of different and often invalid measurement instruments. In this study, a reliable and valid instrument, the SCales for Outcomes in PArkinson''s disease‐COGnition (SCOPA‐COG), was used.

Aim

To evaluate cognitive functioning in a large cohort of patients with Parkinson''s disease and to assess the relations with demographic, disease related and clinical variables.

Methods

A cohort of 400 patients with PD was evaluated for cognition, motor and non‐motor domains, as well as for demographic and disease related characteristics. Results were compared with 150 controls matched for overall age, sex and education distribution.

Results

Patients with PD scored significantly lower on all cognitive subdomains compared with controls, with the largest differences for executive functioning and memory. After correction for age and years of education, 22% of patients had impaired cognition, as measured by the total SCOPA‐COG score, compared with controls. Across all patients, more severe cognitive impairment was associated with significantly more impairment in motor, autonomic, depressive and psychotic domains. Patients with the postural instability gait difficulty (PIGD) dominant phenotype showed more cognitive impairment compared with patients with the tremor dominant phenotype. Contrary to tremor scores, PIGD scores significantly worsened with increasing disease severity.

Conclusions

Cognition is an important domain of the clinical spectrum of PD and poorer cognitive performance is associated with greater impairment in motor and non‐motor domains in PD. The difference in cognitive scores between PIGD dominant patients and tremor dominant patients likely reflects more advanced disease.Parkinson''s disease (PD) is predominantly characterised as a movement disorder, but over the past years there has been an increasing awareness that the clinical spectrum of PD is much broader, also encompassing many non‐motor domains, including cognition.¹ Cognitive decline is a predictor of dementia in PD (PDD),^2,3 which has important consequences for patient management.^2,4,5 The reported prevalence of dementia in PD varies greatly (2–81%) between studies.³ Consistency in the relation between cognitive impairment/PDD and demographic or clinical characteristics has only been found for age and motor impairment. Factors that have contributed to the variability between studies are sample characteristics (selection procedure, source population, sample size), applied criteria of dementia and cognitive impairment and the use of different methods for the evaluation of cognition in PD. Most studies to date have been performed on small populations and samples selected from tertiary care clinics. Additionally, several studies in PD have relied on the use of measurement instruments that have been developed for screening of dementia (Mini‐Mental State Examination (MMSE)) or Alzheimer''s disease. These instruments generally lack discriminative ability to capture the specific aspects of cognitive impairment in PD. Moreover, many of these instruments include items that are sensitive to motor symptoms and may thus affect the results of cognitive assessment in PD.Based on compelling evidence that memory, attention and executive and visuospatial functioning are important aspects of cognitive impairment in PD, a reliable and valid quantitative PD specific instrument (SCales for Outcomes in PArkinson''s disease‐COGnition (SCOPA‐COG)) was developed in 2003.⁶ In the current study, we used this instrument to evaluate the characteristics of cognitive impairment in patients with PD and its associations with demographic and clinical characteristics.     

帕金森病认知障碍

帕金森病（PD）为多见于中老年人的慢性神经系统变性疾病，患者不仅有严重的运动功能障碍，而且认知障碍亦十分突出；发展到疾病的中晚期常致痴呆，对患者生存质量有明显影响。     

Cognitive impairment in Parkinson's disease

Although Parkinson's disease (PD) has been regarded as a condition in which disordered movement is the main feature there is now evidence that a substantial proportion of sufferers also show cognitive impairment. Some subjects are so severely affected that their impairment fulfils criteria for dementia. Research in the field presents many methodological problems: these are reviewed together with the nature, origins and neuropathology of impairment. PD has been the subject of research partly because it provides a model for the examination of brain function.The occurrence of dementia in PD is one of the factors that has lead to the re-examination of the nature of neurodegenerative disorders more widely. Cognitive impairment in PD has major implications for clinical management and for survival.     

帕金森病相关认知功能障碍

帕金森病认知功能障碍起病隐匿,是帕金森病常见非运动症状,包括帕金森病轻度认知损害和帕金森病痴呆,尤以执行功能障碍突出,亦可见视空间能力、记忆力和言语功能等认知域损害。主要危险因素包括男性、高龄、低受教育程度、严重运动症状、基线认知功能较差和白天过度嗜睡。主要病理改变是脑组织路易小体形成,也可见阿尔茨海默病样病理改变。脑脊液总α-突触核蛋白和β-淀粉样蛋白1~42水平降低作为生物学标志物的价值尚存争议。相关基因研究较少且无法获得肯定结论。PET显像发现多巴胺能通路和乙酰胆碱能通路均参与帕金森病认知功能障碍的发生;MRI研究发现皮质及皮质下结构萎缩与帕金森病认知功能障碍有关。嗅觉障碍可能是帕金森病认知功能障碍的预测因素之一。帕金森病痴呆与路易体痴呆具有共同的生物学特性,二者鉴别诊断困难。胆碱酯酶抑制剂和美金刚有助于改善临床症状,应注意个体化治疗。认知行为疗法具有潜在临床价值,尚待更多研究。     

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment

Background

Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition.

Methods

Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives.

Results

A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce.

Conclusions

There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.     

Cognitive and behavioural impairment in Parkinson's disease

Although Parkinson's disease (PD) has been considered to primarily affect motor abilities, increasing emphasis is being placed on cognitive and behavioural impairment in this disorder. Depression, dementia, psychosis and impulse control disorders have a major impact on quality of life for both patients and families. This article reviews cognitive and behavioural disturbances in PD and their relation to affective and motor symptoms, treatment of dementia associated with PD, and treatment approaches to psychosis in PD. We also discuss similarities between the dementia of PD and dementia with Lewy bodies.     

Cognitive and behavioural impairment in Parkinson's disease

Although Parkinson's disease (PD) has been considered to primarily affect motor abilities, increasing emphasis is being placed on cognitive and behavioural impairment in this disorder. Depression, dementia, psychosis and impulse control disorders have a major impact on quality of life for both patients and families. This article reviews cognitive and behavioural disturbances in PD and their relation to affective and motor symptoms, treatment of dementia associated with PD, and treatment approaches to psychosis in PD. We also discuss similarities between the dementia of PD and dementia with Lewy bodies.     

Cognitive impairment and dementia in Parkinson's disease

Relatively subtle cognitive disturbances may be present from the initial stages of Parkinson's disease (PD) that progress in many patients to a more severe cognitive impairment and dementia. Several of the initial deficits are ascribed to failure in the frontal-striatal basal ganglia circuits and involve executive defects in planning, initiation, monitoring of goal-directed behaviors and working-memory. Other non-demented PD patients also exhibit visuospatial and memory deficits more representative of posterior cortical functioning and fail performing naming or copying tasks. Major differences in the overall rate of cognitive decline among PD patients support the co-existence of at least two patterns of involution, differentiating a relatively slow decline of fronto-striatal deficits from a more rapid decline of posterior-cortical deficits, with different pathophysiological substrates, genetics, prognosis and response to drugs used to treat the motor symptoms of PD.     

Cognitive impairment in motor neuron disease

A systematic investigation of the cognitive functions of 22 patients affected with motor neuron disease (MND) compared to 36 controls matched for age and education was performed. The MND group showed cognitive performances slightly but significantly lower than the control group; 6 MND patients, however, had decidedly pathological values. Cognitive impairment was stereotyped and global, with sparing of memory. There was no significant difference between patients with isolated involvement of the lower motor neuron and those with associated pyramidal involvement. Our neuropsychological findings are in agreement with previous clinical, neuroradiological and pathological reports indicating extra-motor cerebral involvement in MND.