Education modifies the relation of vascular pathology to cognitive function: cognitive reserve in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

A clinical impact of cognitive reserve (CR) has been demonstrated in Alzheimer's disease, whereas its role in vascular cognitive impairment (VCI) is largely unknown. In this study, we investigated the impact of CR in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a genetic variant of pure VCI. A total of 247 NOTCH3 mutation carriers from a two-center study were investigated using detailed neuropsychological and neuroimaging protocols. CR was operationalized as years of formal education. Brain pathology was assessed by MRI using normalized brain volume and lacunar lesion volume as proxies. Multivariate analyses were done for each structural measure with scores of processing speed, executive function, and memory as dependent variables. Additional linear regression models were conducted with interaction terms for education × brain volume and education × lacunar lesion volume. Education had an independent impact on cognitive performance in subjects with mild and moderate degrees of brain pathology, whereas there was no significant influence of education on cognition in patients with severe MRI changes. This interaction was found for processing speed, the cognitive domain most impaired in our patients. Our findings demonstrate an interaction of education and brain pathology in regard to cognitive impairment: the effect of education seems most pronounced in early disease stages but may ultimately be overwhelmed by the pathological changes. The results extend the concept of CR to VCI.     

Left atrial ligation alters intracardiac flow patterns and the biomechanical landscape in the chick embryo

Background: Hypoplastic left heart syndrome (HLHS) is a major human congenital heart defect that results in single ventricle physiology and high mortality. Clinical data indicate that intracardiac blood flow patterns during cardiac morphogenesis are a significant etiology. We used the left atrial ligation (LAL) model in the chick embryo to test the hypothesis that LAL immediately alters intracardiac flow streams and the biomechanical environment, preceding morphologic and structural defects observed in HLHS. Results: Using fluorescent dye injections, we found that intracardiac flow patterns from the right common cardinal vein, right vitelline vein, and left vitelline vein were altered immediately following LAL. Furthermore, we quantified a significant ventral shift of the right common cardinal and right vitelline vein flow streams. We developed an in silico model of LAL, which revealed that wall shear stress was reduced at the left atrioventricular canal and left side of the common ventricle. Conclusions: Our results demonstrate that intracardiac flow patterns change immediately following LAL, supporting the role of hemodynamics in the progression of HLHS. Sites of reduced WSS revealed by computational modeling are commonly affected in HLHS, suggesting that changes in the biomechanical environment may lead to abnormal growth and remodeling of left heart structures. Developmental Dynamics 243:652–662, 2014. © 2013 Wiley Periodicals, Inc.     

Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients

Objective

Patients' beliefs about their disease have been associated with emotional adjustment and outcomes in several severe illnesses. The aim of the present study was to investigate whether illness perceptions before pulmonary rehabilitation influence exercise capacity and quality of life after rehabilitation in patients suffering from chronic obstructive pulmonary disease (COPD).

Methods

Ninety-six patients with COPD (GOLD III/IV) were approached on admission to rehabilitation and reassessed before discharge. Assessment included medical measures of FEV?% predicted, and exercise capacity (6 min walk test). Additionally, depressive symptoms (Hospital Anxiety and Depression scale), anxiety (COPD specific anxiety questionnaire) and quality of life (Short Form 36 health survey (SF-36)) were assessed. Illness beliefs were measured by the Revised Illness Perception Questionnaire (IPQ-R).

Results

Exercise capacity and psychological well-being (SF-36) of patients improved after rehabilitation programme, while physical functioning (SF-36) did not change. Additionally, patients showed significantly lower levels of depressive symptoms, COPD specific anxiety and negative perceptions of their illness after pulmonary rehabilitation compared to baseline. In the hierarchical multiple regression analyses, after controlling for socio-demographic data, psychological variables, illness severity and baseline scores of the corresponding variables, it was shown that illness perceptions before rehabilitation predicted exercise capacity and psychological well-being, both assessed at the end of treatment.

Conclusion

COPD patients' perceptions about their illness before rehabilitation influence exercise capacity and quality of life (psychological well-being) after treatment. Therefore it might be relevant to identify and change maladaptive illness perceptions in order to improve medical and psychological outcome in COPD.