Postoperative cognitive dysfunction in geriatric patients

Postoperative cognitive dysfunction (POCD) is a severe long-term complication after surgical procedures. POCD is mainly seen among geriatric patients. Hospitalization, extent of surgery, and systemic inflammatory response might contribute to POCD. The possible influence of the type of anesthesia is discussed. POCD is often not recognized; thus, incidence rates are likely to be underestimated (19-40%). POCD is associated with major consequences for the individual patient, e.g., delayed long-term recovery, reduced quality of life, and an increased mortality rate. Multiple risk factors have been identified over the last decade. However, the exact etiology is still unknown. This mini-review summarizes the recent developments concerning POCD prevention, diagnosis, and treatment.     

血清CREG及CXCL16水平与急性心肌梗死后认知功能障碍的关系

目的:探讨血清E1A激活基因阻遏子(CREG)、巨噬细胞趋化因子配体16(CXCL16)水平与急性心肌梗死(AMI)患者认知功能障碍的关系。方法:选择AMI后认知功能障碍患者50例为认知功能障碍组,另选择同期AMI无认知障碍患者50例为无认知功能障碍组,采用酶联免疫分析法检测患者血清CREG、CXCL16水平,同时分析蒙特利尔认知评估量表(MOCA)各项评分与血清CREG、CXCL16水平的相关性。结果:认知功能障碍组血清CREG、CXCL16水平均显著高于无认知功能障碍组[(346. 56±24. 71) ng/mL vs (238. 64±18. 33) ng/mL,(2. 14±0. 43) mg/L vs (1. 58±0. 37) mg/L,均P 0. 05]。Spearman相关分析显示,认知功能障碍组血清CREG、CXCL16水平均与MOCA总分呈负相关(均P 0. 05);其中患者血清CREG、CXCL16水平均与视空间与执行能力、命名、注意与计算力、语言、延迟回忆呈负相关(均P 0. 05),但和抽象思维、定向力无关(均P0. 05)。结论:血清CREG、CXCL16水平与AMI后认知功能障碍紧密相关;血清CREG、CXCL16水平高表达可以促进AMI后认知功能障碍的发生及发展。     

Association between increased mortality and mild thyroid dysfunction in cardiac patients

BACKGROUND: The effects of subclinical thyroid dysfunction on cardiac outcome are not well defined. METHODS: To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). RESULTS: After mean follow-up of 32 months, there were 65 and 140 cardiac and overall deaths (3.4% and 7.3%), respectively, in euthyroidism, 15 and 27 (7.2% and 13.0%) in SCH, 8 and 9 (8.2% and 9.2%) in SCT, and 59 and 119 (6.5% and 13.1%) in low T3. Survival rates for cardiac death were lower in SCH, SCT, and low T3 than in euthyroidism (log-rank test; chi2 = 19.46; P < .001). Survival rates for overall death were lower in SCH and low T3 than in euthyroidism (log-rank test; chi2 = 26.67; P < .001). After adjustment for several risk factors, hazard ratios (HRs) for cardiac death were higher in SCH (HR, 2.40; 95% confidence interval [CI], 1.36-4.21; P = .02), SCT (HR, 2.32; 95% CI, 1.11-4.85; P = .02), and low T(3) (HR, 1.63; 95% CI, 1.14-2.33; P = .007) than in euthyroidism; HRs for overall death were higher in SCH (HR, 2.01; 95% CI, 1.33-3.04; P < .001) and low T3 (HR, 1.57; 95% CI, 1.22-2.01; P < .001) but not in SCT. CONCLUSION: A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease.     

Plasma homocysteine levels and cognitive status in long-term stay geriatric patients: a cross-sectional study

Many studies have established an association of total plasma homocysteine (Hcys) levels and the risk for dementia and Alzheimer disease. However, little is known on the relation between Hcys and cognitive status in long-term stay geriatric patients. This cross-sectional study was conducted in a long-stay geriatric center and included 186 eligible patients, staying for more than 6 months in the facility. We looked for patients' clinico-demographic data, as well as for laboratory data and cognitive status, evaluated by the mini-mental state examination (MMSE). Patients were divided into three groups according to Hcys levels and analyzed in order to explore potential association with cognitive levels, considering clinically important cofounders. Cognitive state of patients of the highest Hcys tertile was significantly impaired, compared with other groups (p < 0.0001) and characterized by a worse nutritional status. Pearson's correlation coefficient for Hcys and MMSE resulted -0.251 (p = 0.0005). The linear regression model for MMSE showed that homocysteine is significantly associated with MMSE: mean MMSE score of patients with homocysteine >13.7 was significantly lower than the mean MMSE of patients with homocysteine < or = 8.5, after controlling for all other parameters in the regression equation (beta = -2.7685, p = 0.007). We conclude that in our sample of patients, Hcys was associated with cognitive impairment. Hcys levels >13.7 micromol/l remained a significant independent parameter associated with the severity of cognitive impairment, after controlling for other confounders. A better understanding of the mechanisms underlying such interrelations may have research and interventional implications.     

The relationship between frailty and serum alpha klotho levels in geriatric patients

BackgroundFrailty is a medical syndrome resulting in loss of endurance, strength and physiological function. There is insufficient data to understand the process of frailty formation at the gene level, however one of the product of Klotho gene known as an anti-aging gene with many functions that prolong lifespan is alpha klotho protein. We aimed to investigate the relationship between frailty and the serum alpha klotho protein levels.MethodsIn this cross-sectional analysis, there were 89 patients aged 65 years old and older, 45 of whom were frail and 44 of whom were not frail, were included in the study. Within the scope of the study, a sociodemographic and clinical information form, the Turkish version of the FRAIL scale and a comprehensive geriatric assessment were evaluated. In addition to routine laboratory tests, plasma alpha klotho protein levels were measured.ResultsThe mean alpha klotho protein levels of the patients were 0.76 ± 1.01 ng/ml in the control group and 0.54 ± 0.61 ng/ml in the frail group, however, there was no statistically significant difference between the two groups (p = 0.286). C-reactive protein (CRP) levels were significantly higher and hemoglobin (Hb) levels were significantly lower in the frail patients compared to the control group (p < 0.05). It was observed that alpha klotho protein level was inversly correlated with increased CRP levels but association was weak (p = 0.022, R: −0.245). Hb levels (p = 0.018, R: 0.250) was weakly correlated with alpha klotho protein level.ConclusionNo significant relationship was found between frailty and alpha klotho protein levels in the geriatric patients. Further comprehensive studies are needed to explore this subject.     

Longitudinal association between cognitive depressive symptoms and D‐dimer levels in patients following acute myocardial infarction

BackgroundA prothrombotic tendency could partially explain the poor prognosis of patients with coronary heart disease and depression. We hypothesized that cognitive depressive symptoms are positively associated with the coagulation activation marker D‐dimer throughout the first year after myocardial infarction (MI).MethodsPatients with acute MI (mean age 60 years, 85% men) were investigated at hospital admission (n = 190), 3 months (n = 154) and 12 months (n = 106). Random linear mixed regression models were used to evaluate the relation between cognitive depressive symptoms, assessed with the Beck depression inventory (BDI), and changes in plasma D‐dimer levels. Demographics, cardiac disease severity, medical comorbidity, depression history, medication, health behaviors, and stress hormones were considered for analyses.ResultsThe prevalence of clinical depressive symptoms (13‐item BDI score ≥ 6) was 13.2% at admission and stable across time. Both continuous (p < .05) and categorical (p < .010) cognitive depressive symptoms were related to higher D‐dimer levels over time, independent of covariates. Indicating clinical relevance, D‐dimer was 73 ng/ml higher in patients with a BDI score ≥ 6 versus those with a score < 6. There was a cognitive depressive symptom‐by‐cortisol interaction (p < .05) with a positive association between cognitive depressive symptoms and D‐dimer when cortisol levels were high (p < .010), but not when cortisol levels were low (p > .05). Fluctuations (up and down) of cognitive depressive symptoms and D‐dimer from one investigation to the next showed also significant associations (p < .05).ConclusionsCognitive depressive symptoms were independently associated with hypercoagulability in patients up to 1 year after MI. Hypothalamic–pituitary–adrenal axis could potentially modify this effect.     

Absence of association between nailfold capillary findings and mild cognitive dysfunction in systemic lupus erythematosus

Clinical Rheumatology - The role of vascular damage in cognitive dysfunction (CD) in SLE is not entirely understood. Nailfold capillaroscopy (NFC) is a noninvasive method that may aid the...     

帕金森病患者认知障碍与血浆同型半胱氨酸水平的相关性研究

目的研究帕金森病(PD)患者认知障碍与血浆同型半胱氨酸(Hcy)水平的关系。方法选择PD患者90例.其中认知功能正常43例(认知正常组).伴认知功能障碍47例(认知障碍组)及健康体检者40例(对照组),比较3组血浆Hcy、叶酸、维生素B_(12)水平。结果认知正常组和认知障碍组患者血浆Hcy水平明显高于对照组[(1 5.70±4.38)μmol/L vs(1 6.20±5.53)μmol/L vs(1 3.51±3.59)μmol/L,P<0.05]。结论 Hcy水平可能与PD认知障碍无关。     

Religion and cognitive dysfunction in an elderly cohort

OBJECTIVES: This study examines whether attendance at religious services has an inverse association with cognitive dysfunction in an elderly cohort in whom it has already been shown that religious attendance has an inverse association with physical disability and that social engagement has an inverse association with cognitive decline. METHODS: The study population is a racially and religiously diverse sample of 2,812 community-dwelling men and women from New Haven, Connecticut; it was representative of New Haven in 1982, but not of the United States then or now. The primary study hypothesis proposes that attendance at religious services as measured in 1982 contributes to the prediction of lower levels of cognitive dysfunction in 1985 and 1988. A multivariate logistic regression analysis controlling for seven sociodemographic, four behavioral, and seven biomedical covariables is conducted. RESULTS: Study results show an inverse association between religious attendance in 1982 and cognitive dysfunction in 1985 (odds ratio = 0.64; 95% confidence interval = 0.49, 0.85). Religious attendance as measured in 1982 no longer contributes to the prediction of cognitive dysfunction in 1988. DISCUSSION: The short-term nature of the effect is partially explained by differential mortality. Persons with infrequent religious service attendance and with high levels of cognitive dysfunction in 1982 were more likely to die in the period from 1985 to 1988.     

Cross-sectional and longitudinal association between antihypertensive medications and cognitive impairment in an elderly population

BACKGROUND: The effect of antihypertensive medications on cognitive function has not been well studied. The authors' objectives were to investigate the cross-sectional and longitudinal association between the use of antihypertensive medications and cognitive function and to compare different antihypertensive medication classes with regard to this association in an elderly population. METHODS: The medical records of a convenience sample of patients (n = 993 cross-sectional and 350 longitudinal; mean age, 76.8 +/- 0.3 years; 74% women; 87% White) followed at a geriatric practice were reviewed. Data abstracted included demographics, medical history (Alzheimer's disease [AD] or vascular dementia [VaD]), use of antihypertensive medications, and results of cognitive assessments (the Mini-Mental Status Examination [MMSE] and the Clock Draw Test [CDT]). RESULTS: In the cross-sectional analysis, antihypertensive use was not associated with MMSE (p >.05), CDT (p >.05), or dementia diagnosis (odds ratio for AD, 0.8; 95% confidence interval [CI], 0.6 to 1.2; odds ratio for VaD, 1.6; 95% CI, 0.6 to 4.0). In the longitudinal analysis, antihypertensive use was associated with a lower rate of cognitive decline on the MMSE (-0.8 +/- 2 points in users vs -5.8 +/- 2.5 points in nonusers; p =.007) and on the CDT (-0.3 +/- 0.8 points in users vs -2.2 +/- 0.8 points in nonusers; p =.002), and with a lower risk for the development of cognitive impairment (odds ratio, 0.56; 95% CI, 0.38 to 0.83; p =.004). The trend was similar in patients with baseline AD (p =.02). Patients taking diuretics (p =.007), angiotensin-converting enzyme inhibitors (p =.016), and beta-blockers (p =.014) had a lower rate of cognitive decline, and patients taking angiotensin receptor blockers (p =.016) had improved cognitive scores. CONCLUSIONS: Antihypertensive use, particularly diuretics, angiotensin-converting enzymes inhibitors, beta-blockers, and angiotensin receptor blockers, may be associated with a lower rate of cognitive decline in older adults, including those with AD. Until a randomized clinical trial confirms our results, findings of this observational study should be interpreted with caution.     

Pancreatectomy in the chicken: Does an extra-pancreatic source of insulin exist?

The possibility of an extrapancreatic source of insulin in aves was studied in adult Single Comb White Leghorn chickens. The effect of partial pancreatectomy (99%) on plasma glucose and immunoreactive insulin (IRI) levels, as well as the tolerance of these depancreatized birds to a glucose load was estimated. Evaluation also was made of the action of tolbutamide in partially depancreatized, totally depancreatized, and sham-operated chickens.Results obtained indicate that partial pancreatectomy (99%) has only transient effects (several days) on plasma glucose and IRI levels. Also, surgical extirpation of the pancreas does not prevent tolbutamide-induced hypoglycemia secondary to insulin release, although such surgery does impair glucose tolerance concomitant with a diminished release of assayable IRI in response to an injected glucose load. Although remnant (1%) pancreatic tissue (splenic lobe) was observed to increase (up to 550%) in size 16 days after partial pancreatectomy, removal of this remnant in a second operation neither abolished circulating IRI 20 hr later nor did it prevent the characteristic hypoglycemic response to injected tolbutamide.The data presented herein suggest the existence of accessory β-islet tissue, yet to be located/described or, alternatively, the presence of a nonpancreatic source of insulin in the chicken.     

Retinol-binding protein levels are increased in association with gonadotropin levels in healthy women

Recent studies have demonstrated an association between retinol-binding protein (RBP4) and insulin resistance. Retinol-binding protein is decreased in women and elevated in polycystic ovary syndrome. However, prior studies have not investigated the relationship between RBP4, gonadal steroids, and gonadotropins in healthy women. The aim of this study was to determine the RBP4 levels in a cohort of healthy women with a range of body mass indices and glucose tolerances to investigate the relationship between RBP4, gonadotropin levels, and menopausal status. Serum RBP4 levels were measured by enzyme-linked immunosorbent assay and quantitative Western blot in 88 healthy women (aged 24-59 years) from the general community in a cross-sectional study. Retinol-binding protein was higher in postmenopausal compared with premenopausal women (26.1 ± 2.1 vs 19.3 ± 0.5 μg/mL, P = .001). In univariate analysis, RBP4 was associated with follicle-stimulating hormone (r = 0.37, P = .0004), luteinizing hormone (r = 0.3, P = .005), and sex hormone-binding globulin (r = −0.24, P = .03) and trended to significance with estradiol (P = .09) but not with free testosterone or dehydroepiandrosterone sulfate. Retinol-binding protein was also associated with insulin at 2 hours during an oral glucose tolerance test (r = 0.24, P = .03) and the area under the curve for insulin during the oral glucose tolerance test (r = 0.26, P = .02). In multivariate regression modeling, both follicle-stimulating hormone (P = .03) and luteinizing hormone (P = .04) remained significantly associated with RBP4 after controlling for estradiol, sex hormone-binding globulin, insulin area under the curve, cholesterol, triglycerides, waist-to-hip ratio, and tumor necrosis factor α. Retinol-binding protein was not associated with inflammatory markers or with carotid intima-media thickness. Therefore, RBP4 is higher in postmenopausal women and is associated with gonadotropin concentrations in healthy women.     

MTHFR基因多态性及血浆同型半胱氨酸水平与冠心病的关系

目的研究亚甲基四氢叶酸还原酶（m ethylenetetrahydrofolate reductase,MTHFR）基因677位单核苷酸多态性（C-T）与血浆同型半胱氨酸（homocyste ine,Hcy）水平及冠心病之间的关系。方法用多聚酶链式反应-限制性片段多态性（RFLP）方法检测122例冠心病患者（冠脉造影显示至少有1支血管狭窄≥50%）与56例对照组（冠脉造影未发现任何可辨认斑块或狭窄）的MTHFR 677位单核苷酸多态性（C-T）;用荧光衍生化后高效液相色谱法（h igh?perform ance liqu id chrom atography,HLPC）检测血浆总Hcy水平。结果①冠心病组Hcy浓度高于对照组（P<0.05）。②冠心病组中TT、TC、CC的基因型频率分别为30%、45%、25%;T等位基因频率为53%,C等位基因频率为47%。在对照组中TT、TC、CC的基因型频率分别为25%、32%、43%;T等位基因频率为41%,C等位基因频率为59%。两组基因型分布和等位基因频率分布差异有显著性（均P<0.05）。③两组的TT基因型者血浆Hcy浓度均显著高于CC和TC基因型者（P<0.05）,而后两者间无显著性差异。结论MTHFR基因C677T点突变对冠心病发病有一定的关系。MTHFR基因纯合突变是引起高Hcy血症的一个重要的遗传因素。