Is there an association between subjective and objective measures of cognitive function in patients with affective disorders?

Background: Patients with affective disorders experience cognitive dysfunction in addition to their affective symptoms. The relationship between subjectively experienced and objectively measured cognitive function is controversial with several studies reporting no correlation between subjective and objective deficits. Aims: To investigate whether there is a correlation between subjectively reported and objectively measured cognitive function in patients with affective disorders, and whether subjective complaints predict objectively measured dysfunction. Methods: The study included 45 participants; 15 with bipolar disorder (BD), 15 with unipolar disorder (UD) and 15 healthy individuals. Participants’ subjectively experienced cognitive function and objective cognitive function were assessed with the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the Screen for Cognitive Impairment in Psychiatry (SCIP), respectively. Patients were rated for affective symptoms with Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results: Patients demonstrated subjective and objective cognitive dysfunction relative to controls (P-values ≤ 0.01) but there were no differences between patient groups (P > 0.1). We found no correlation between subjectively experienced and objectively measured cognitive dysfunction in BD (P = 0.7), and a non-significant trend towards a correlation in UD (P = 0.06), which disappeared when controlling for gender (P = 0.1). Conclusion: Our results suggest that it is not necessarily patients who have cognitive complaints that are most impaired. If confirmed in a larger sample, our findings suggest that neuropsychological assessment is warranted to elucidate the potential role of cognitive dysfunction in patients’ everyday lives and to inform treatment strategies targeting these difficulties.     

Is there any association between disturbed gastrointestinal visceromotor and sensory function and impaired quality of life in functional dyspepsia?

Background Functional dyspepsia (FD) is now categorized into the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS). However, the role of disturbed gastric emptying and sensory function for the reduction of health‐related quality of life (HRQOL) has not yet been studied in EPS and PDS. Methods A total of 300 refractory FD patients and 450 healthy blood donors (BD) were studied. BD were stratified in subjects with (BD+) and without (BD?) concomitant FD symptoms. Gastric motor and sensory function, generic and disease‐specific HRQOL [physical (PCS) and mental component summary (MCS)] and affective disorders were assessed. Twenty randomly selected BD?, 50 BD+ (36 PDS, 72%), and 110 FD (95 PDS, 86.4%) patients had additional function testing. Key Results Health‐related quality of life was significantly reduced in FD patients (PCS = 40.7 ± 8.8, MCS = 39.7 ± 11.3, both P < 0.0001) compared to BD+ (PCS = 52.0 ± 7.6, MCS = 49.0 ± 9.4) and BD? (PCS = 56.0 ± 4.3, MCS = 52.8 ± 7.2). GET (t_½, min) was significantly (both P < 0.0001) longer in FD patients (143.0 ± 7.3) compared to BD+ (101.1 ± 6.3) and BD? (73.8 ± 7.6). FD patients scored significantly higher for ‘pain’ (P < 0.0001) and ‘nausea’ (P = 0.023), there was no difference for ‘fullness’ compared to BD. Impairment of GET was not associated with HRQOL. In FD patients, an augmented symptom response to the test meal (fullness, nausea) was associated with MCS, there was no difference between FD patients with EPS or PDS. Conclusions & Inferences In EPS and PDS, delayed gastric empting and altered sensory function are disease markers but not directly linked to the severity of HRQOL impairment or clinical presentation of FD.     

How does cognitive reserve impact on the relationships between mood,rumination, and cognitive function in later life?

Objectives: Higher levels of cognitive reserve (CR) are associated with better cognitive function in later life. In contrast, depressive symptoms, anxiety, and rumination are associated with diminished cognitive function. There has been limited research to date examining the influence of CR on the relationship between mood and cognitive function, and results are inconsistent. The aim of this study was to investigate the role CR plays in the relationships between mood, rumination, and cognitive function in later life.

Method: Two hundred and thirty-six healthy people aged 60+ completed measures of CR, depression, anxiety, rumination, recall, and verbal fluency. Participants were dichotomised at the median into those with lower and higher levels of CR.

Results: CR, mood, and rumination together accounted for between 13% and 15.6% of the variance in scores on the cognitive tasks in the sample as a whole. Mood and rumination explained a significant amount of variance in cognitive test scores in those with lower levels of CR, but not in those with higher levels of CR.

Conclusion: The way in which mood and rumination are related to cognitive function differs depending on the individual's level of CR. These results support the view that it is important to continue to build on CR as people move into later life in order to maintain cognitive health.     

Is there a relationship between elderly suicide rates and educational attainment? A cross-national study

Backgound: Suicides are associated with both high and low levels of intelligence and educational attainment in both individual-level and aggregate-level studies, but this has been rarely studied in the elderly.

Methods: A cross-national study examining the relationship between elderly suicide rates (y-axis) and educational attainment (x-axis) was undertaken with the ‘a priori’ hypothesis that the relationship would be curvilinear and follow a U-shaped curve with the quadratic equation Y = A + BX + CX ², where A, B and C are constants. Data on suicide rates for both sexes in the age-bands 65–74 years and 75+ years, and the Education Index (a proxy measure of educational attainment) were ascertained from the World Health Organisation and the United Nations websites, respectively.

Results: The main finding was the predicted curvilinear relationship between suicide rates, in both sexes in both the elderly age-bands, and the Education Index fitting the quadratic equation Y = A + BX + CX ².

Conclusions: Given the cross-sectional study design, a causal relationship cannot be assumed. The impact of educational attainment on elderly suicide rates may occur through interaction with other factors, mediation of the effects of other factors, or by its effects being mediated by other factors, and require further study.     

Is there any correlation between cerebral atrophy, EEG abnormalities and epileptic attacks in patients with multiple sclerosis?

Among 100 patients with MS, in 65 patients CT examination revealed cerebral atrophy (in 58 cortical and subcortical atrophy, in 7 patients only cortical). In 25 (25%) patients with cerebral atrophy EEG findings were focal type of paroxysmal activity. Only five patients with paroxysmal discharges had epileptic fits. Mean age in these 5 patients was 47 years, mean duration of the disease 17 years. This means that seizures in MS patients appeared in late period of the disease and no correlation was between cerebral atrophy and epileptic seizures. Paroxysmal discharges occurred more often in EEG examination, than clinical seizures.     

What sleep characteristics predict cognitive decline in the elderly?

BackgroundSleep is critical for optimal cognitive function, but as we age both cognitive impairment and sleep problems increase. Longitudinal, population-based studies can be used to investigate temporal relationships between sleep and cognition.MethodsA total of 2012 cognitively unimpaired individuals 65 years and over were drawn from the MRC Cognitive Function and Ageing Study (CFAS). They answered self-reported measures including: insomnia symptoms and age of onset, night time wakings, snoring, sleep onset latency, napping, daytime sleepiness and duration of night time sleep. Cognition was measured via the Mini-Mental State Examination.ResultsIt was found that daytime napping at baseline was associated with a lower risk of cognitive decline at two and 10 years, and that obtaining ?6.5 h of night-time sleep and excessive daytime sleepiness at baseline were associated with an increased risk at 10 years.ConclusionsDaytime napping, night-time sleep duration, and excessive daytime sleepiness may be modifiable behaviours open to intervention strategies, or, clinical indicators of future decline in older individuals.     

Is there a complex relation between social anxiety disorder,childhood traumatic experiences and dissociation?

Background: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

Aim: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

Method: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

Results: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p?p?Conclusions: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.     

Is lower cognitive function in one spouse associated with depressive symptoms in the other spouse?

This study examines whether lower cognitive function in one spouse is associated with depressive symptoms in the other spouse. The subjects were 528 community-dwelling spouse pairs aged 65+ who participated in the Chicago Health and Aging Project (CHAP), an ongoing longitudinal, bi-racial, population-based study of risk factors for incident Alzheimer's disease and other age-related chronic conditions. CHAP participants were assessed at 3-year intervals over a period of nearly ten years. The results show a cross-sectional association of wives' lower cognitive function at baseline with depressive symptoms in husbands; however, husbands' cognitive function was not associated with wives' depressive symptoms. There was no longitudinal association of cognitive function at baseline with increased depressive symptoms over time. Furthermore, change in cognitive function over time had no effect on depressive symptoms in either spouse. The relationship between cognitive function and depressive symptoms in spouse pairs is complex. Our findings suggest that husbands may be particularly psychologically vulnerable to the negative effects of their wives' cognitive impairment. This vulnerability may have a range of long-term health and caregiving implications.     

Is there any relationship between quality of life and polysomnographically detected sleep parameters/disorders in stable myasthenia gravis?

It is known that quality of life in myasthenia gravis is positively correlated with subjective sleep quality, still no data is available regarding the relationship between QOL and polysomnographically detected sleep parameters and disorders. In this study, we tried to highlighten this relationship, by performing polysomnography. Sleep-related complaints were evaluated in face-to-face interviews with 19 clinically stable MG patients and 26 healthy controls. During the interviews questionnaires assessing sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, and Turkish version of the MG-QOL 15-item scale [(MG-QOL15(T)] were administered and then an overnight polysomnography was performed. Sleep disorders, especially obstructive sleep apnea and fatigue were higher, whereas subjective sleep duration was significantly lower, in patients than controls. Excessive daytime sleepiness and poor sleep quality were not different between patients and controls. Other than percentage of sleep stage III, which was negatively correlated with MG-QOL15(T) scores, neither other sleep parameters nor sleep disorders were correlated with MG-QOL15(T) scores. MG composite, subjective sleep duration, fatigue severity and Hamilton depression rating scale scores were found to be positively correlated with MG-QOL15(T) scores. It was shown that decreasing disease severity and enhancing psychological well-being will improve patients’ quality of life. We recommend that our findings should be repeated in a large prospective cohort of MG patients.     

Exercise,sleep and cytokines: Is there a relation?

Physical exercise is a modality of non-pharmacological treatment for sleep disorders. Contradicting results are still found in studies of the effect of exercise on sleep. Among the substances that have been described as sleep modulators, cytokines produced during the recovery period after an acute exercise session are very important. Various studies have verified that physical exercise may alter the plasma concentration of the many pro-inflammatory cytokines that may in turn modulate sleep. A number of factors seem to mediate this effect of exercise, including duration, intensity, and form of exercise, in addition to temperature and metabolic alterations. The mechanisms through which exercise promotes alterations in sleep architecture remain to be clarified. Researchers speculate that many hormones and substances produced by metabolism may affect sleep. Therefore, the object of this review is to discuss the effects of exercise and cytokines on sleep, and the relation between these two sleep-regulating components, raising the hypothesis that the alterations in sleep promoted by exercise are mediated by cytokines, which, by increasing the nREM sleep phase, would stimulate the regenerating characteristics of sleep.     

Is there a link between sleep changes and memory in Alzheimer's disease?

Aging and Alzheimer's disease (AD) are both characterized by memory impairments and sleep changes. We investigated the potential link between these disturbances, focusing on sleep spindles, involved in memory consolidation. Two episodic memory tasks were given to young and old healthy participants, as well as to AD patients. Postlearning sleep was recorded. Sleep spindles were globally reduced in aging and AD. AD patients also exhibited a further decrease in fast spindles. Besides, mean intensity of fast spindles was positively correlated, in AD patients, with immediate recall performance. Our results are the first report of a specific decrease in fast spindles in AD, associated with learning abilities. They also give further hints for a functional differentiation between slow and fast spindles.