颈动脉狭窄与认知功能

颈动脉狭窄是脑血管病的重要危险因素之一.许多研究显示,颈动脉狭窄可能会导致认知损害,但具体机制尚不明确.颈动脉内膜切除术和支架置入术能解除颈动脉狭窄,提高脑灌注量,进而可能改善患者认知功能,但干预后的并发症和长期效果仍有待进一步研究.     

上海市市民对口腔实习门诊认知度和认可度的调查分析

目的:了解上海市市民对口腔实习门诊认知度和认可度的现状,探讨口腔临床实习教学的改进方案.方法:随机抽取上海市5个区县各一个大型卖场,分别发放100份调查问卷,共502份,回收498份,其中有效卷475份,有效率为94.62％.对结果进行整理分析.结果:10.32％的被调查者知晓并了解实习门诊,56.84％的被调查者愿意对其加以了解;40.21％的被调查者会选择专家门诊就医,但也有37.68％的被调查者愿意接受实习医师的诊治;对实习医师的总体满意度为65.43％.结论:市民对口腔实习门诊的认知度和认可度均有待提高,医院、学校应加大宣传力度,在提升实习门诊认知度的同时提高认可度,推进实践教学的开展.     

Association of prion protein with cognitive functioning in humans

Objectives

Recent animal studies have suggested a key role for cellular prion protein (PrPc) in the pathological consequences of amyloid plaque formation, the hallmark of Alzheimer's disease. This epidemiological study investigated whether serum concentrations of PrPc are associated with cognitive functioning in humans.

Design, Setting, Participants

Cross-sectional study of 1,322 participants from the elderly general population in Germany, aged 65 + years at baseline (2000–2002).

Measurements

Cognitive functioning was assessed by the COGTEL phone interview 5 years after baseline. Serum PrPc was determined by a commercial immunoassay.

Results

In multiple linear regression adjusted for important confounders, subjects in higher PrPc quintiles appeared to have lower cognitive functioning scores than those in the lowest PrPc quintile. Spline regression suggested pronounced non-linearity with an inverse association between PrPc and cognitive functioning levelling off beyond median PrPc. Cognitive subdomain-specific models produced somewhat heterogeneous results.

Conclusion

The findings are suggestive of an independent association of PrPc with cognitive functioning in humans. Confirmatory and longitudinal studies are needed to elucidate the potential of PrPc for applications in early risk stratification for cognitive impairment.     

What are the correlates of cognition and participation to return to work after first ever mild stroke?

Abstract

Background:

The percentage of working age people with mild stroke has risen. Evidence indicates that even mild stroke impact cognition, executive functioning, and daily functioning, consequently affecting participation, quality of life (QoL) and return to work (RTW).

Objectives:

(1) Compare cognition, participation and QoL between people 3 months post-mild stroke who RTW and those who did not; and (2) To determine the correlates of these variables to RTW of participants 3 months post-stroke.

Methods:

We visited at home 163 stroke survivors (117 men, 46 women) 3 months post-mild stroke ranging from 50 to 89 years. Participants who returned to work (n?=?114) and those who did not (n?=?49). Data collection at home included measures for cognitive status (MoCA), executive functions (EFPT, DEX), depression (GDS), participation (RNL), and QoL (SIS recovery).

Results:

Significant differences were found between RTW participants and those who did not RTW in measures of cognition, depression, participation and QoL (t?=?2.36 to ??5.62, P?<?0.022–0.001). No difference was found on age or gender. Stepwise regression showed that significant correlates of RTW were participation (RNL), executive functions (EFPT), and QoL (SIS recovery).

Conclusions:

To enable RTW after mild stroke, participation, executive functions and QoL must be considered in planning interventions.     

Cognitive correlates of visual hallucinations in non-demented Parkinson's disease patients

BackgroundVisual hallucinations (VH) in Parkinson's disease (PD) are associated with PD dementia and have been related to cognitive impairments in non-demented PD patients. Reports on the specific cognitive domains affected are conflicting. The aim of the present study was to investigate the presence of specific cognitive impairments in non-demented PD patients with VH, compared to those without VH.MethodsWe compared the clinical characteristics and neuropsychological test scores of 31 non-demented PD patients with VH with those of 31 PD patients without VH that were carefully matched for sex, age, disease duration and educational level. Several non-motor symptoms, including depression, anxiety and sleep disturbances, were also taken into account, as these may influence cognitive performance.ResultsThe PD with VH group performed significantly worse on the Trail Making Test part A (p = 0.01) and the Rey Auditory Verbal Learning Test, immediate recall (p = 0.01). In addition, PD patients with VH were more anxious, more depressed and reported more sleep disturbances. Verbal learning scores were not associated with levels of anxiety, depression or sleep disruption, whereas worse Trail Making Test A performance was associated with concomitant sleep disturbances.ConclusionsIn non-demented PD patients, the presence of VH is associated with a cognitive profile characterized by impairments in verbal learning and probably attention. Since these cognitive functions are believed to be non-dopaminergic mediated functions, the present results support the hypothesis that multiple neurotransmitter systems, other than dopamine, contribute to the pathophysiology of VH in PD.     

The functions of the orbitofrontal cortex

Parkinson's disease is commonly accompanied by cognitive issues that limit participation in activities of daily living. Unfortunately, most current treatment paradigms and pharmacotherapeutics fail to address the cognitive impairment demonstrated in this population. Mounting evidence in healthy older adults suggests that aerobic exercise may improve cognitive function. This article describes a patient with Parkinson's disease prescribed 8 weeks of aerobic exercise. Despite very high performance at baseline, the participant improved on several cognitive measures post exercise. The results of this investigation mimic the research in healthy older adults. We therefore suggest that future large scale randomized trials are warranted to evaluate the efficacy of aerobic exercise for ameliorating declines in cognitive performance in persons with PD.     

Early cognitive impairment in a subset of patients with presumed low-grade glioma

We investigated the presence of cognitive impairment, in adults with presumed low-grade glioma at early stage of disease prior to major treatments, in relation to neurological symptoms and radiological characteristics of the tumour. Sixteen patients were evaluated. A subset of patients was identified with clearly impaired cognition. Patients with cognitive impairment often had large tumours in the left frontal lobe, were relatively young, and most of them were males. We conclude that cognitive dysfunction may be present already at early stage of disease, and that early identification of patients at risk is warranted.     

Differential diagnosis between schizophrenia and autism in adulthood: A case report

The clinical distinction between autism spectrum disorders (ASD), also called pervasive developmental disorders (PDD), and schizophrenia is often difficult to make. Here we describe a case of an adult patient presenting with a diagnosis of schizophrenia based on a history of functional deterioration and presumed persecutory delusions. A psychiatric and psychological assessment conducted from a developmental perspective, in association with direct observation and neuropsychological evaluation for intellectual disabilities and autism, led to a diagnosis of PDD not otherwise specified, with revision of the initial diagnosis of schizophrenia.