Sensitivity of P300 auditory event-related potentials for assessing cognitive impairment in elderly type 2 diabetic patients

BACKGROUND：In previous studies, cognitive function in elderly type 2 diabetic patients was evaluated by psychometric tests. These studies have confirmed that P300 event-related potential is an objective way of assessing cognitive function. OBJECTIVE： To analyze the objectivity of P300 for assessment of cognitive function in elderly type 2 diabetic patients. DESIGN, TIME AND SETTING： This case-control experiment was performed at the Department of Endocrinology of the Fourth Affiliated Hospital, Guangxi Medical University from January 2004 to December 2006. PARTICIPANTS： Seventy-two patients （38 males and 34 females） with type 2 diabetes mellitus were enrolled in this study. The patients were divided according to those with diabetes alone （diabetes alone group） （n=38） and those with diabetes and cerebral ischemia （diabetes and cerebral ischemia group） （n=34）. A further 31 healthy individuals （16 males and 15 females）, who received health examinations over the same period, were included as normal controls （normal control group）. METHODS： All subjects were assessed by Mini-Mental State Examination （MMSE）. Abnormalities in cognitive functions were identified by analyzing the auditory P300 event-related potentials. MAIN OUTCOME MEASURES： Auditory event-related potentials and MMSE scores. Multiple linear regression analysis was conducted using the ＂enter method＂ with the 72 elderly patients with type 2 diabetes mellitus. P3 latency, P3 amplitude and N2 latency served as dependent variables. Age, sex, education, course of the disease, glycosylated hemoglobin, and ischemic brain damage were used as independent variables. RESULTS： No significant difference in scores of MMSE was detected between the diabetes alone and normal control groups （P 〉 0.05）. MMSE score was significantly lower in the diabetes and cerebral ischemia group （P 〈 0.01） than in the normal control group. N2 and P3 latencies of auditory event-related potential were significantly longer, and P3 a     

Serum high-sensitivity C-reactive protein levels are positively associated with cognitive impairments in patients with first-episode schizophrenia

BackgroundTo clarify the controversy regarding the relationship between serum high-sensitivity C-reactive protein (hs-CRP) levels and cognitive impairments in first-episode schizophrenic patients and examine whether hs-CRP is a potential objective biological indicator for evaluating cognitive impairment in first-episode schizophrenic patients.MethodsSerum hs-CRP levels were measured in 58 first-episode schizophrenic patients and 31 healthy controls using immunofluorescence. The Brief Psychiatric Rating Scale (BPRS) and the P300 event-related potential were assessed. The relationship between serum hs-CRP levels and both BPRS scores and P300 were analyzed.ResultsSerum hs-CRP levels and BPRS scores were significantly higher in the study group than in the control group. The incubation period of P3 was longer, and the amplitude of P3 was larger in the study group than in the control group. Correlation analysis showed that in the study group, serum hs-CRP levels were positively correlated with BPRS total scores. Serum hs-CRP levels were also positively correlated with the incubation period of P3 and negatively correlated with P3 amplitudes.ConclusionsSerum hs-CRP levels were positively associated with cognitive impairment in first-episode schizophrenic patients and potentially represent an objective biological indicator for the rapid evaluation of cognitive impairment in first-episode schizophrenic patients.     

Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome

Objectives: To identify non-demented individuals with cognitive impairment due to a cerebrovascular etiology among those coming to observation of a memory clinic and to describe their clinical features and outcome. Methods: Patients were enrolled in a prospective study on early cognitive impairment carried out in a Memory Clinic. Mild cognitive impairment of the vascular type (MCI-V) was defined based on modified criteria for subcortical vascular dementia (SVD) by Erkinjuntti and colleagues. Twenty-nine patients with MCI-V (age 78 ± 7, Mini Mental State Exam (MMSE) 24 ± 3) were compared with 14 with mild cognitive impairment of degenerative etiology (MCI) based on the Mayo Clinic criteria (age 72 ± 9, MMSE 25 ± 2), and to 21 patients with frank SVD (age 80 ± 6, MMSE 21 ± 3). Patients were followed over time for 32 ± 8 months. Results: MCI-V patients had a neuropsychological profile characterized by poor performance on frontal tests (Wisconsin card sorting and word fluency) and neurological features of parkinsonism without tremor (impairment of balance and gait). Of those followed for at least 40 months, 50 % of patients with MCI-V and SVD had died, while all MCI patients were still alive (P = 0.03). Of those alive, 68 % of the MCI-V, 52 % of the SVD, and 17 % of the MCI patients had reached one of the following outcomes at 40 months: nursing home placement, functional loss, and cognitive deterioration (P = 0.02). Conclusions: Patients with MCI-V have a distinctive clinical picture and can be identified in a clinical setting. Because of the high frequency of adverse outcomes, very early preventive measures need to be devised. Received: 27 July 2001, Received in revised form: 22 February 2002, Accepted: 22 April 2002 Correspondence to Giovanni B. Frisoni, MD     

Usefulness of the University of California San Diego Performance-Based Skills Assessment for the evaluation of cognitive function and activities of daily living function in patients with cognitive impairment

Objectives: To assess the usefulness of the University of California San Diego Performance-Based Skills Assessment (UPSA) as a new diagnostic method and tool for the assessment of cognitive function and activities of daily living function in patients with cognitive impairment.

Method: In total, 35 patients with cognitive impairment and 35 healthy controls were recruited for this study. The Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Global Deterioration Scale (GDS) were used for the evaluation of cognitive function, while the Barthel Activities of Daily Living Index (BADL), Instrumental Activities of Daily Living Index (IADL), and UPSA were used for the evaluation of activities of daily living function.

Results: UPSA scores were significantly lower in patients with cognitive impairment than in controls. The UPSA total score was significantly correlated with MMSE, CDR, GDS, and IADL scores. With regard to the detection of cognitive impairment, UPSA exhibited a greater determination power (R² = 0.593) compared with BADL (R² = 0.149) and IADL (R² = 0.423) and higher sensitivity and specificity compared with IADL.

Conclusion: Our results suggest that UPSA is a useful tool for the evaluation of cognitive function and activities of daily living function in patients with cognitive impairment.     

军人创伤后应激障碍患者认知性电位变化及其与精神症状的关系

目的　探讨军人创伤后应激障碍(PSTD)患者认知性电位(CEP)的特征和治疗缓解后变化及其与精神症状的关系。方法　应用美国Nicolet Bravo型脑诱发电位仪,对 66 例发病期及其 60 例康复期 PTSD患者进行关联性负变(CNV)、视觉诱发电位(VEP)和听觉诱发电位(AEP)测定,并进行症状自评量表(SCL -90)和事件影响量表(IES)评定。结果　患者组发病期与对照组比较,CNV/M1、VEP/P2 和 AEP/N2 潜伏期延迟(P<0.01或0.05),CNV/M2 和AEP/P3 波幅增高(P<0.01),命令信号后负变化(PINV)出现率增高(P<0.01),SCL-90和IES总分及其部分因子分升高(P<0.01),且 CEP指标与 SCL 90 及 IES总分及其部分因子分显著相关(P<0.01 或 0.05)。患者组康复期 CNV/M1、VEP/P2 和 AEP/N2 潜伏期,CNV/M2、AEP/P3 波幅,PINV出现率以及SCL- 90和IES总分及其部分因子分均恢复至正常值内(与发病期比较P<0.01或0.05,与对照组比较 P>0.05)且治疗前后 CEP指标差值与 SCL 90 及 IES总分及其部分因子减分率显著相关(P<0.01或0.05)。结论　CNV、VEP与AEP的变化可能是PTSD的状态标志。     

Gender-specificities in Alzheimer's disease and mild cognitive impairment

Background Amnestic Mild Cognitive Impairment (MCI) is a condition with an increased risk for developing Alzheimer's disease (AD). Presently, gender differences are neglected in the assessment of MCI and AD. Methods We examined verbal and visuospatial episodic memory in 143 subjects diagnosed as healthy controls (HC; N = 48, Mini-Mental State Examination (MMSE) 29.2 ± 1.0 (mean ± standard deviation)), MCI (N = 43,MMSE 28.5 ± 1.4), and AD (N = 49, MMSE 25.1 ± 2.2). Findings Female HC and MCI subjects performed better on verbal episodic memory tasks than males. In contrast, visuospatial episodic memory was better in male than female AD patients. Conclusions We interpret the results in light of a genderspecific cognitive reserve and conclude that the gender-specificity of neuropsychological performance needs to be accounted for in clinical diagnosis of Alzheimer’s disease.     

草酸艾司西酞普兰对抑郁症患者事件相关电位P300的影响

目的:探讨草酸艾司西酞普兰对抑郁症患者的事件相关电位P300影响。方法:随机将年龄在18～65岁之间符合中国精神障碍分类与诊断标准第3版抑郁症诊断标准患者30例作为研究组,选择30例性别年龄健康者作为对照组。研究组予草酸艾司西酞普兰治疗。两组分别予听觉P300检测,比较P300潜伏期及波幅的差异。结果:研究组Fz、Pz点潜伏期分别为(319±23)ms、(315±20)ms均比对照组分别为(300±22)ms、(299±21)ms延长,研究组Fz、Cz、Pz点分别为(2.5±1.8)μV、(2.6±2.4)μV、(2.5±3.3)μV波幅均比对照组分别为(3.8±2.0)μV、(3.7±1.9)μV、(4.1±3.0)μV降低(P<0.05或P<0.01)。治疗8周后,研究组Fz、Pz点潜伏期分别为(301±19)ms、(305±19)ms]明显缩短,Fz、Cz、Pz点分别为(3.5±1.8)μV、(3.7±2.1)μV、(3.6±3.5)μV波幅明显升高(P<0.05)。结论:抑郁症患者存在P300异常,草酸艾司西酞普兰具有改善这种异常现象的作用。     

Faster rate of cognitive decline in essential tremor cases than controls: a prospective study

Background: Mild cognitive deficits have been reported in essential tremor (ET). However, these cognitive deficits have been assessed in cross‐sectional rather than longitudinal analyses. Objective: To determine whether decline in cognitive test scores occurs at a faster rate in ET cases than controls. Methods: In a population‐based study of older people (≥ 65 years) in central Spain (Neurological Disorders in Central Spain, NEDICES), non‐demented ET cases and controls were followed prospectively. Participants with baseline or incident Parkinson’s disease or dementia were excluded as were participants who developed incident ET. At baseline (1994–1995) and at follow‐up (1997–1998), a 37‐item version of the mini‐mental state examination (37‐MMSE) was administered. Results: A total of 2319 participants (72.4 ± 5.8 years) included 135 prevalent ET cases and 2184 controls. At baseline, the mean 37‐MMSE in cases was 28.8 ± 5.8 vs. 30.2 ± 4.8 in controls (P = 0.02). During the 3‐year follow‐up period, the 37‐MMSE declined by 0.70 ± 3.2 points in cases vs. 0.11 ± 3.8 points in controls (P = 0.03). In analyses that adjusted for age, education, and other potential confounders, the case–control difference remained robust. Discussion: In this population‐based, prospective study of non‐demented elders, baseline cognitive test scores were lower in ET cases than controls; moreover, during the 3‐year follow‐up period, these scores declined at a rate that was seven‐times faster in ET cases. This study provides evidence that cognitive deficits in ET are not static, and they appear to be progressing at a faster rate than in elders without this disease.     

Effects of APOE haplotypes and measures of cardiovascular risk over gender-dependent cognitive and functional changes in one year in Alzheimer's disease

Background: Illiteracy, high cerebrovascular risk and copies of APOE-?4 are risk factors for Alzheimer's disease dementia (AD). We aimed to investigate the impacts of gender, education, coronary heart disease (CHD) risk and creatinine clearance variations, body mass index (BMI) and APOE haplotypes over the rates of cognitive and functional decline of AD in one year.

Methods: Consecutive outpatients with late-onset AD were assessed for gender, schooling, BMI and APOE haplotypes, variations in one year of creatinine clearance and Framingham projections of the 10-year absolute CHD risk, and prospective scores of the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating Sum-of-Boxes (CDR-SOB), the Index of Independence in Activities of Daily Living (ADL) and Lawton's Scale for Instrumental Activities of Daily Living (IADL).

Results: For 191 patients, mean age at AD onset was 73.26 ± 6.4 years-old, earlier for APOE-?4/?4 carriers (p = 0.0039). For women, higher BMI led to improvements in CDR-SOB (β = ?0.091; p = 0.037) and MMSE (β = 0.126; p = 0.017) scores, while increased creatinine clearance was associated with improvements in ADL (β = 0.028; p = 0.012) and MMSE (β = 0.043; p = 0.039) scores and higher schooling led to faster worsening of IADL (β = ?0.195; p = 0.022) scores. No variables impacted cognitive or functional decline for men, whereas copies of APOE-?4 and the CHD risk had no significant effects whatsoever.

Conclusions: Higher BMI and creatinine clearance are protective regarding cognitive and functional decline for women, whereas higher cognitive reserve may lead to faster decline in instrumental functionality. APOE haplotypes affected the age at AD onset, but not cognitive or functional decline.     

事件相关电位在轻度认知功能障碍诊断中的意义

目的探讨轻度认知功能障碍和阿尓茨篋〉氖录喙氐缥?ERP:N100、P300)变化。方法根据Peterson制订的MCI诊断标准,筛选出21例MCI患者(MCI组),22例正常对照者(NC组)以及20例阿尓茨篋?AD)组患者,分别用英国OXFORD脑电生理仪记录事件相关电位(ERP:N100,P300)和视觉诱发电位(VEP)情况。结果(1)AD组MMSE评分(16.52±2.17分)及MCI组(24.33±1.34分)低于正常对照组[(26.57±1.43)分,P<0.01]。(2)AD组与MCI组靶波幅P3和非靶波幅P2均见降低,与NC组比较也有显著性差异(P<0.05、P<0.01)。(3)N100潜伏期、波幅变化不是很大(P>0.05)。(4)AD组P300靶刺激中的P2、P3波潜伏期与MMSE分值呈负相关(P<0.05、P<0.01)。结论AD和MCI患者的P300有多项指标异常对于临床诊断AD和MCI患者有一定价值。事件相关电位与认知功能存在明显相关性,提示事件相关电位可以客观反映AD和MCI患者的认知功能障碍。     

ERP联合DTI对脑小血管病相关认知功能障碍的初步研究

目的 探讨事件相关诱发电位(Event-related potential,ERP)联合弥散张量成像(Diffusion tensor imaging,DTI)在脑小血管病(Cerebral small vessel disease,CSVD)相关认知功能障碍评估中的应用价值。方法 选取2020年1月-2021年1月本院收治的CSVD患者100例,采用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)对患者的认知功能进行评估,根据MoCA评分将患者分为认知功能障碍组(MoCA<26分,n=50)和对照组(MoCA≥26分,n=50); 所有患者均接受ERP和DTI检查,比较2组患者的一般资料、实验室指标水平、ERP和DTI相关参数水平的差异,评估ERP,DTI及其联合检测对CSVD相关认知功能障碍的诊断价值。结果 认知功能障碍组的高血压病的发生率明显高于对照组,MoCA、简易精神状态量表(Mini-mental state examination,MMSE)评分明显低于对照组,血清碱性磷酸酶(Alkaline phosphatase,ALP)、同型半胱氨酸水平明显高于对照组(P<0.05)。认知功能障碍组患者的P300潜伏期明显长于对照组,P300波幅明显小于对照组(P<0.05); 认知功能障碍组双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的各向异性分数(Fractional anisotropy,FA)值均明显小于对照组(P<0.05),双侧半卵圆中心、双侧额叶的平均弥散率(Mean diffusivity,MD)值明显大于对照组(P<0.05); 患者P300潜伏期、双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的FA值与MoCA,MMSE评分呈正相关(r≥0.203,P<0.05); P300波幅、双侧半卵圆中心、双侧额叶的MD值与MoCA,MMSE评分呈负相关(r≤-0.038,P<0.05); 患者双侧额叶FA值与P300潜伏期呈负相关(r=-0.274、-0.318,P<0.05),与P300波幅呈正相关(r=0.248、0.256,P<0.05); 双侧额叶MD值与P300潜伏期呈正相关(r=0.213、0.207,P<0.05),与P300波幅呈负相关(r=-0.327、-0.318,P<0.05)。结论 CSVD患者认知功能障碍的发生与脑微结构病变及电生理改变有关,ERP联合DTI检查或可作为CSVD相关认知功能障碍早期诊断的定量评估指标。     

尼莫地平对Alzheimer病患者认知功能和听觉事件相关电位P300的影响

目的 观察尼莫地平对Alzheimer病(AD)患者认知功能和听觉事件相关电位P300的影响.方法 将65例AD患者随机分成两组,尼莫地平治疗组(尼莫地平组,32例):尼莫地平注射液治疗;吡拉西坦对照组(吡拉西坦组,33例):吡拉西坦注射液治疗.应用简易精神状态检查量表(MMSE)评定两组患者治疗前后认知功能状况,并进行治疗前后P300检查.同时记录药物不良反应.结果 两组各30例进入结果分析.治疗前两组MMSE评分、P300的潜伏期及波幅差异无显著性(均P＞0.05).治疗14 d、30 d时,两组MMSE评分显著提高(均P＜0.01),P300潜伏期均有缩短,波幅均有提高(尼莫地平组P＜0.01,吡拉西坦组P＜0.05);治疗90 d时,尼莫地平组MMSE评分显著提高、P300潜伏期显著缩短、波幅显著提高(均P＜0.01).治疗后14 d时认知功能改善尼莫地平组明显优于吡拉西坦组(总有效率分别为76.67%,70%)(P＜0.05).两组治疗期间无严重不良反应.结论 尼莫地平注射液能够改善AD患者的认知功能,比吡拉西坦更有效;这可能与尼莫地平的脑保护作用有关.     

游离脂肪酸与老年2型糖尿病患者轻度认知功能障碍的研究

目的探讨游离脂肪酸(FFA)与老年2型糖尿病(T2DM)患者轻度认知功能障碍(MCI)的关系。方法选择85例老年T2DM患者,应用蒙特利尔认知评估(MoCA)量表评定认知功能,分为T2DM认知功能正常组(T2DM-NC)45例和T2DM认知功能障碍组(T2DM-MCI)40例,另选择糖耐量正常且认知功能正常者35例为对照组(NC)。测定3组FFA、糖化血红蛋白(HbA1c)、血脂等。结果 T2DM-MCI组FFA水平(7.45±0.13)mmol/L高于T2DM-NC组(6.32±0.13)mmol/L及NC组(4.56±0.11)mmol/L。T2DM-MCI患者的MoCA评分与糖尿病病程(r=-0.507,P=0.001)、FPG(r=-0.581,P0.001)、HOMA-IR(r=-0.360,P=0.022)、HbA1c(r=-0.533,P0.001)、TC(r=-0.358,P=0.023)、TG(r=-0.408,P=0.009)、LDL-C(r=-0.377,P=0.016)、FFA水平(r=-0.566,P0.001)呈负相关,与HDL-C(r=0.365,P=0.021)呈正相关。多重线性回归分析结果示,FPG(β=-0.290,P=0.015)、HbA1c(β=-0.272,P=0.019)、FFA(β=-0.375,P=0.001)、病程(β=-0.248,P=0.037)是MoCA评分的危险因素。结论血清FFA是T2DM患者MCI的危险因素。     

Uncinate fasciculus-correlated cognition in Alzheimer's disease: a diffusion tensor imaging study by tractography

Background: Neuroimaging studies show increased diffusivity and decreased anisotropy in Alzheimer's disease (AD) patients by diffusion tensor imaging (DTI). Previous reports have analyzed a correlation with cognitive function and DTI parameters, but their results are inconsistent. A reason for this might be a region of interest (ROI) method, used to calculate parameters for DTI, because this method has various usages of how to place a ROI and includes summations of values for various neuronal fiber tracts, resulting in contamination of unintended fibers. To improve the instability with ROI placement, a tractography‐based method might be useful. Our coworker reported decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) of uncinate fasciculus (UF) in patients with AD by tractography. To confirm whether DTI parameter values are related to severity of cognitive function in patients with AD, we measured mean diffusion anisotropy and diffusivity of coregistered voxels along the tracking lines (i.e. tract of interest) of UF. Methods: The subjects were 30 patients with probable AD (NINCDS‐ADRDA criteria). Assessment of cognitive function was carried out according to the Mini‐Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale‐cognitive component‐Japanese version (ADAS‐Jcog). A 1.5‐T clinical magnetic resonance unit was used to obtain diffusion tensor images. Diffusion tensors were computed and fiber‐tract maps were created using ‘dTV II’ DTI software developed by Masutani et al. We measured mean FA and ADC values along the bilateral UF. Results: FA values were positively correlated with MMSE score (r= 0.67) and were negatively correlated with ADAS‐Jcog score (r=?0.62), while ADC values were negatively correlated with MMSE score (r=?0.58) and were positively correlated with ADAS‐Jcog score (r= 0.59). Conclusion: FA and ADC values might reflect the severity of cognitive dysfunction. The tract‐of‐interest method might be a useful tool for objectively evaluating DTI parameters in AD.     

Circulating free nitrotyrosine and cognitive decline

Coppola L, Pastore A, Adamo G, Coppola A, Manzella D, Gombos I, Luongo M, Mastrolorenzo L. Circulating free nitrotyrosine and cognitive decline.
Acta Neurol Scand: 122: 175–181.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To determine if the circulating nitrotyrosine level significantly correlates with parameters measuring cognitive abilities. Materials and methods – One‐hundred and twelve community‐living subjects (ranging in age from 27 to 98 years) were evaluated for cognitive abilities [Mini Mental State Examination (MMSE) score] and circulating free nitrotyrosine plasma level, as well as for several variables that might influence cognitive abilities (age, education) and nitrotyrosine level (body mass index, haematological parameters, cardiovascular and inflammatory indices). Results – In the sub‐group of cognitively impaired subjects (score at MMSE <23.9), but not in that of cognitively not impaired subjects, a significant inverse correlation exists between nitrotyrosine level and MMSE score (r = ?0.378; P < 0.02). Conclusions – The finding, if confirmed by longitudinal studies, could play a role in the management of the subjects with Mild Cognitive Impairment, the clinical condition considered as a transitional state between the changes of cognitive ability in normal aging and dementia.     

Impact of regional white matter lesions on cognitive function in subcortical vascular cognitive impairment

Abstract

Objectives:

Exact characterization and localization of white matter lesions (WMLs) as they relate and contribute to vascular cognitive impairment is highly debated. The purpose of this study was to investigate the impact of WML on cognitive function by using a new anatomy-based classification method.

Methods:

We detected WML accurately by using a three-dimensional fluid-attenuated inversion recovery (3D FLAIR) imaging technique and subsequently segmented WMLs by using an anatomy-based method. Participants included 56 consecutive patients diagnosed with subcortical vascular cognitive impairment (SubVCI). The volume of WMLs in different anatomic regions was measured. The volume of the hippocampus, the corpus callosum (CC), any lacunar infarcts, total gray matter (GM), and total brain volumes were also calculated.

Results:

Hippocampal (P = 0·005) as well as temporal WML volumes (P = 0·039) were both independently associated with mini-mental state examination (MMSE) score. Only the parietal WML volume (P = 0·000) was independently associated with Montreal Cognitive Assessment (MoCA) score. Frontal WMLs were independently correlated with executive function. Occipital WMLs were independently associated with visuospatial and recall function. Language impairment was independently correlated with both parietal GM and parietal WML volume. Functions related to orientation were independently associated with parietal WML volume.

Discussion:

The volume of WMLs in the temporal region as well as in the hippocampus were both independently associated with MMSE score. For the MoCA score, however, only parietal WML volumes were independently correlated. White matter lesions within different anatomic regions were separately correlated with different subdomains of cognitive function.     

Screening of cognitive impairment in chronic obstructive pulmonary disease

Cognitive dysfunction is common and clinically important in severe chronic obstructive pulmonary disease (COPD). We investigated the diagnostic accuracy of the Mini Mental State Examination (MMSE) and Instrumental Activities of Daily Living (IADL) scale in screening severe cognitive dysfunction in 149 patients with COPD, mean age 69.3+/-8.5 years, forced expiratory volume in 1 s=36.6+/-17.8% of the predicted. Patients underwent the MMSE and an in-depth neuropsychological assessment based upon the Mental Deterioration Battery (MDB). The 5-item IADL scale was assessed. The sample was randomly divided into a training (n=73) and a testing (n=76) population. The diagnostic accuracy of MMSE, IADL scale or both versus cognitive dysfunction corresponding to abnormal performance in 3 or more MDB tests was assessed in the training population and the model obtained was tested in the testing population. The combination of MMSE<24 and dependence in at least 1 IADL had better diagnostic accuracy than either MMSE or IADL, with sensitivity=52.4, specificity=82.7, positive predictive value=55.0% and negative predictive value=81.1% in the testing population. MMSE and the 5-item IADL scale can be used to exclude, but not to detect cognitive dysfunction in COPD patients. A confirmatory cognitive test should be administered to patients with an MMSE score of <24 and who are dependent in at least 1 IADL.     

Functional correlates of lower cognitive test scores in essential tremor

Although motor features have been the defining element of essential tremor (ET), lower neurocognitive test scores are increasingly being recognized. However, the clinical correlates, if any, of these lower test scores remain largely unexplored. The aim of this study was to determine whether cognitive test scores in ET have any functional correlates. The Modified Mini Mental Status Examination (MMSE), Katz Activities of Daily Living (ADL) scale and Lawton Instrumental (I) ADL scale were administered to 95 cases. The Katz ADL score (rho = 0.26, P = 0.01) and Lawton IADL score (rho = 0.32, P = 0.001) were correlated with MMSE scores, such that poorer cognitive performance indicated greater dysfunction. Furthermore, cognitive test scores were a better predictor of functional disability than was tremor severity. Poorer cognitive performance in ET was associated with greater functional deficit. Cognition should enter the clinical dialog with ET patients as an issue of clinical significance. © 2010 Movement Disorder Society     

ERPs changes during neuroleptic treatment in schizophrenia--a vulnerability marker in schizophrenia]

P300 amplitude reduction and P300 latency prolongation are consistent findings in schizophrenia, but it is unclear if these abnormalities were the effect of current or past neuroleptic treatment or were present at the onset of illness. We previously recorded ERPs in drug free schizophrenic patients (45 neuroleptic-naive and 56 previously treated with neuroleptics). In that study, P300 amplitude reduction was observed in both the neuroleptic-naive and the previously treated patients. However, both N200 and P300 latencies were prolonged only in the previously treated schizophrenic patients. In this study, we investigated ERPs in 60 drug free schizophrenic patients before and after neuroleptic treatment was begun. According to DSM-IV, schizophrenia subtype classification, 26 cases were paranoid type, 14 were disorganized, 2 catatonic and 18 undifferentiated. Twenty six of the patients were neuroleptic-naive and 34 had been previously treated. Sixty gender- and age-matched healthy controls were also investigated. ERPs were recorded during an auditory oddball task. The scalp EEGs were recorded from AgAgCl electrodes at 16 sites according to the international 10-20 system. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Before treatment, all schizophrenic patients displayed larger N200 amplitudes than the controls; however, increases in N200 amplitudes were not observed after neuroleptic treatment was begun. Both N200 and P300 latencies in the patients before treatment were prolonged only in those previously treated. Neuroleptic-naive patients demonstrated prolongation of both N200 and P300 latencies only after treatment. P300 amplitudes in patients were increased by neuroleptic treatment; but patients had smaller P300 amplitudes than the controls even after treatment. The change in P300 amplitudes (Pz) and the change in total BPRS scores by neuroleptic treatment were positively correlated in the patients whose duration of illness was six months or less (mean: 2.4 months). However, no correlation was observed for patients whose duration of illness was over six months (mean: 49.7 months). There were no significant differences in ERPs changes among subtypes. These results suggested that the P300 amplitude should be considered a vulnerability marker in schizophrenia and that both N200 and P300 latencies might be markers for neuroleptic exposure.     

Association between oxidized low‐density lipoprotein and cognitive impairment in patients with ischemic stroke

Background and purpose

The association between oxidized low‐density lipoprotein (oxLDL) and cognitive impairment is unclear. This study aimed to investigate the potential association between oxLDL and cognitive impairment among patients with acute ischemic stroke.

Methods

We measured the levels of oxLDL and recorded the Mini‐Mental State Examination (MMSE) score in patients with acute ischemic stroke who were recruited from the Study of Oxidative Stress in Patients with Acute Ischemic Stroke. Cognitive impairment was defined as an MMSE score of <24. The association between oxLDL and cognitive impairment was assessed by multivariate logistic or linear regression analysis. Other clinical variables of interest were also studied.

Results

A total of 3726 patients [1287 (34.54%) female] were included in this study, with a mean age of 63.62 ± 11.96 years. After adjusting for potential confounders in our logistic regression model, each SD increase in oxLDL was associated with a 26% increase in the prevalence of cognitive impairment (odds radio, 1.26; 95% confidence interval, 1.13–1.39; P < 0.0001). Similarly, higher oxLDL was associated with lower MMSE scores, with a 0.56‐point decrease in MMSE score for every SD increase in oxLDL in a linear regression analysis (β = ?0.56; 95% confidence interval, ?0.81 to ?0.32; P < 0.0001). There were no significant interactions between oxLDL and age, sex or education levels for cognitive impairment (all interactions, P > 0.05).

Conclusions

Elevated levels of oxLDL were associated with a higher prevalence of cognitive impairment in patients with ischemic stroke.