OBJECTIVETo explore the curative effect and safety of acupuncture for mild cognitive disorders after stroke.

METHODSRandomized controlled trial was adopted and one hundred cases conforming to criteria were divided into a combined acupuncture and medication group (group A) and a medication group (group B), 50 cases in each group. The basic treatment of cerebrovascular disease was applied in two groups. The group A treated was with acupuncture at Baihui (GV 20), Shenting (GV 24) and Qucha (BL 4) etc. and oral administration of Nimodipine. In group B, Nimodipine was taken orally. The treatment lasted for 3 months, the scores of Mini-Mental State Examination (MMSE), modified Hasegawa Dementia Scale (HDS-R) and Barthel Index (BI) were observed before and after treatment in two groups.

RESULTSThe total effective rate in group A was 66.7% (32/48), which was superior to 30.4% (14/46) in group B (P < 0.05). The scores of MMSE, HDS-R and BI after treatment were apparently improved as compared with those before treatment in two groups (all P < 0.01). The improvements in group A were superior to those in group B (all P < 0.05). There was no adverse event reported during the treatment in two groups.

CONCLUSIONAcupuncture can improve activity of daily living and has significant effect in treating mild cognition disorders after stroke without adverse reactions.

Acupuncture Therapy ; Aged ; Cognition ; Cognition Disorders ; etiology ; psychology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo study the cognitive function, its correlation with and the impact on quality of life in epileptic children aged 6-13 years in regular school.

METHODCognitive function of 172 children with various types of epilepsy were measured using a computerized neuropsychological test battery including six items. Their scores across the neuropsychological measures were compared with 172 healthy control subjects from the general population strictly matched for age, sex and the region where education was accepted. The quality of life was measured in 105 cases by the Quality of Life in Epilepsy Inventory (QOLIE-31).

RESULT(1) After adjusting for age, gender, and education, children with epilepsy performed significantly worse than healthy control subjects on 5 of 6 cognitive tasks, including Raven's progressive matrices correct number (8.6 vs. 14.0), choice reaction time (620.4 ms vs. 489.5 ms), word-rhyming tasks (2796.9 ms vs. 2324.4 ms), simple substraction correct number (28.6 vs. 35.5)as well as number comparision (1002.4 ms vs. 803.1 ms), P < 0.01. When an impairment index was calculated, 44.2% patients had at least one abnormal score on the test battery, compared with 14.5% of healthy volunteers, there was statistically significant differences between the two groups, P < 0.001. (2) Children with new onset epilepsy before the treatment with anti-epilepstic drugs performed significantly worse than healthy controls on 5 of 6 cognitive tasks, including Raven's progressive matrices correct number (9.1 vs. 13.8), choice reaction time (625.8 ms vs.474.5 ms), word-rhyming tasks(3051.8 ms vs. 2575.4 ms), simple substraction correct number (28.9 vs. 35.3) as well as number comparison (942.4 ms vs. 775.8 ms), P < 0.01. (3) Cognitive performance was not related to the age of onset, type of epilepsy, therapy duration or comorbid emotional and behavior disorders, P > 0.05. (4) 105 cases filled in the QOLIE-31 questionaire, the total score of the quality of life in the group without cognitive impairment and psychical conditions was the highest (60.5 ± 0.9), and the lowest total score was found in group with cognitive impairment and psychical conditions (54.6 ± 1.5), there were highly significant differences between the groups, P < 0.001.

CONCLUSIONAlmost one-half of the children with epilepsy accepting regular education had at least one abnormal score in the battery tests. Newly diagnosed untreated patients with epilepsy are cognitively compromised before the start of antiepileptic drug medication. Cognitive impairment was not related to the epilepsy-related or psychiatric variables. Cognitive impairment and mental disorders require further attention and essential therapy, which is important to the improvement of the quality of life in epileptic children.

Adolescent ; Child ; Cognition ; physiology ; Cognition Disorders ; diagnosis ; epidemiology ; psychology ; Comorbidity ; Epilepsy ; complications ; psychology ; Female ; Humans ; Male ; Neuropsychological Tests ; Quality of Life ; Reaction Time ; Surveys and Questionnaires

OBJECTIVEType 2 diabetes has been recently recognized as an important risk factor for cognitive decline of patients with Alzheimer's disease (AD). But the roles of hyperinsulinemia (HI) and insulin resistance (IR) in the development of AD are still controversial. This study was designed to evaluate whether HI or IR influenced the cognitive functions of older cohort.

METHODSThe cognitive functions of 328 consecutive elderly patients were evaluated with a battery of cognitive rating scales. Their fasting blood glucose (FBG) and fasting insulin (FINS) were analyzed and IR was calculated with modified-Homa. The cognitive scores in different groups and the correlation of cognitive functions with HI or IR were analyzed.

RESULTSIn our study, there were 180 participants with HI and 148 without HI, and 192 with IR and 136 without IR. The participants with HI showed worse cognitive functions than those without HI in MMSE, MOCA, CDR, orientation, delayed memory, and attention/calculation domains. Similarly, the elderly with IR had lower cognitive scores than those without IR in MMSE, MOCA, CDR, GDS, orientation, delayed memory, and attention/calculation domains. The insulin levels and Homa IR had negative correlation with the scores of MMSE and delayed memory, not only in the model 1 adjusted for FBG and diabetes history, but also in the model 2 adjusted for all nine demographic characteristics.

CONCLUSIONHI and IR are important risk factors for cognitive decline of the elderly, especially for the dysfunctions in delayed memory domains.

Aged ; Aged, 80 and over ; Cognition ; Cognition Disorders ; blood ; etiology ; Female ; Homeostasis ; Humans ; Hyperinsulinism ; blood ; complications ; psychology ; Insulin ; blood ; Insulin Resistance ; Male

PURPOSE: The purpose of this study was to investigate if pain mediates or moderates the relationship between cognitive impairment and aggressive behaviors in nursing home residents with dementia based on the Need-driven Dementia-compromised Behavior model. METHODS: This was a secondary analysis of the Minimum Data Set assessment data on long-term care from the state of Florida during calendar year 2009. The data used in this study was the first comprehensive assessment data from residents with dementia (N = 56,577) in Medicare-certified or Medicaid-certified nursing homes. Path analysis using a series of hierarchical regression analyses and two-way analysis of variance was used to evaluate the mediating and moderating effect of pain on the relationship between the level of cognitive impairment and aggression. RESULTS: Results indicated that pain did not mediate the relationship between cognition and aggressive behaviors, but there was evidence of a significant moderating effect of pain only for residents with severe cognitive impairment. Only among the residents with severe cognitive impairment, those with pain had significantly more frequent aggressive behaviors than those without pain. CONCLUSION: A change in the frequency of aggressive behaviors in severely cognitively impaired residents should signal the possibility that the person is experiencing pain. Accurate but simple pain assessment in this population including these behavioral changes should be developed further, and pain should be well controlled to reduce these problematic behaviors.
Aged ; Aged, 80 and over ; *Aggression ; Cognition Disorders/*complications/psychology ; Dementia/*complications/psychology ; Female ; Florida ; Humans ; Long-Term Care ; Male ; Nursing Homes ; Pain/*complications/psychology ; Pain Measurement/methods ; Self Report ; *Social Behavior

OBJECTIVESTo explore the relationship between sleep architecture changes and cognitive impairment in patients with obstructive sleep apnea syndrome (OSAS).

METHODSThirty-six patients with OSAS and 18 controls were administered polysomnography and neuropsychological tests of visual regeneration, digital symbol, comprehensive memory and digital span.

RESULTSPerformances on the visual regeneration test and digital symbol test in patients with OSAS were impaired significantly compared with the control group (P < 0.01). Patients' performance on the visual regeneration test was significantly associated with slow wave sleep duration (r = 0.423, P < 0.05) and that on the digital symbol test was significantly associated with REM sleep duration (r = 0.378, P < 0.05).

CONCLUSIONSSlow wave sleep and REM sleep derivation may play a role in the cognitive impairment in patients with OSAS.

Adult ; Cognition Disorders ; etiology ; Humans ; Male ; Middle Aged ; Polysomnography ; REM Sleep Behavior Disorder ; etiology ; Sleep Apnea, Obstructive ; complications ; psychology ; Sleep Stages ; physiology ; Sleep, REM

This article reviews the clinical and experimental researches on cognitive impairment related to diabetes in the recent decade. Most clinical studies indicate that the cognitive impairment in patients with type 1 diabetes mellitus is related to recurrent hypoglycemia closely. There is little research about whether or not hyperglycemia is related to cognitive impairment in patients with type 1 diabetes mellitus. Most studies indicate that the cognitive impairment in type 2 diabetes involves multiple factors through multiple mechanisms, including blood glucose, blood lipid, blood pressure, level of insulin, medication, chronic complication, etc. But, there has been no large-scale, multi-center, randomized controlled clinical trial in China recently. And what is more, some problems exist in this field of research, such as the lack of golden criterion of cognitive function measurement, different population of studied objects, and incomprehensive handling of confounding factors. Experimental studies found that hippocampal long-term potentiation (LTP) was impaired, which were manifested by impairment of spatial memory and decreased expression of LTP, but it's relation to hyperglycemia, the duration of diabetes, learning and memory has always been differently reported by different researches. Thus, there are a lot of unknown things to be explored and studied in order to clarify its mechanism. TCM has abundant clinical experience in treating cerebral disease with medicine that enforces the kidney and promotes wit. However, there has been no research on treating diabetic cognitive impairment, which requires work to be done actively and TCM to be put into full play, in order to improve the treatment of diabetes and enhance living quality of patients.
Animals ; Cognition Disorders ; etiology ; pathology ; physiopathology ; Diabetes Mellitus, Experimental ; pathology ; physiopathology ; psychology ; Diabetes Mellitus, Type 1 ; pathology ; physiopathology ; psychology ; Diabetes Mellitus, Type 2 ; pathology ; physiopathology ; psychology ; Drugs, Chinese Herbal ; therapeutic use ; Hippocampus ; pathology ; physiopathology ; Humans ; Hyperglycemia ; complications ; Hypoglycemia ; complications ; Long-Term Potentiation ; Neuronal Plasticity

BACKGROUNDAging is an important risk factor for vascular dementia, and D-galactose (D-gal) injection can simulate the pathology of aging. Two-vessel occlusion of common carotid arteries (2VO) is the most popular model for vascular dementia. This study was aimed to investigate the possibility of D-gal injection plus 2VO simulating cognitive impairment of aging vascular dementia; and whether transplanted bone marrow stromal cells (BMSCs) can improve the cognitive function induced by D-gal injection plus 2VO.

METHODSTotally 30 male Sprague-Dawley rats were divided into 5 groups equivalently: control group, D-gal group, D-gal + 2VO group, D-gal + 2VO + saline water group, and D-gal + 2VO + BMSCs group. Aging hypoperfusion rats were created by subcutaneous injection of D-gal and occlusion of two common carotid arteries. BMSCs or saline water was stereotactically transplanted into the subventricular zone as treatment vehicles at 24 hours post operation. Two-way repeat analysis of variance (ANOVA) was used for significance analysis of 5 groups at 6 weeks post transplantation; moreover, Tamhane's test (equal variance not assumed) and least significant difference (LSD) test (equal variance assumed) were used for pairwise comparison in Morris water maze (MWM).

RESULTSTransplanted BMSCs distributed around the lateral ventricles and acquired the phenotypes of neurons and astrocytes. In terms of swimming path distance and escape latency in MWM, D-gal + 2VO + BMSC group showed significant improvement than the D-gal + 2VO group but was still obviously worse than the control group (both P < 0.05). There was no significant difference in swimming speed for all 5 groups.

CONCLUSIONSD-gal plus 2VO induces cognitive dysfunction. The engrafted BMSCs exhibit the beneficial effect on cognitive function via promotion interactively with host brain.

Aging ; Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; methods ; Carotid Stenosis ; complications ; Cognition Disorders ; surgery ; Dementia, Vascular ; psychology ; surgery ; Disease Models, Animal ; Galactose ; toxicity ; Male ; Rats ; Rats, Sprague-Dawley ; Stromal Cells ; cytology ; transplantation

BACKGROUNDStudies on postoperative cognitive dysfunction (POCD) have attracted extensive attention and achieved significant progress. However, the diagnosis of POCD is not very satisfactory as no specific biomarkers have been classified. The aim of the present study was to evaluate differences in serum protein composition between POCD and Non-POCD patients, identify potential biomarkers associated with early POCD, and study the mechanism underlying POCD.

METHODSSixty-eight elderly patients (age ≥ 65 years) received isoflurane inhalation anesthesia for arthroplasty surgeries. One day before and seven days after the surgery, these patients were subjected to a neuropsychological test and venous blood sample collection. Postoperative cognitive dysfunction was determined using Z test scores. Based on the results, the patients were divided into POCD and non-POCD groups. Twenty-five randomly chosen blood samples obtained seven days after the surgery from each group were analyzed on a Bruker ultraFlex(TM) time of flight (TOF)/TOF mass spectrophotometer. The resulting peptide fingerprints were compared with those from the pre-surgery samples to identify differences in serum protein composition. The model designed to distinguish between a non-POCD group and a POCD group were established and validated. Three proteins with the most significant changes were selected for further characterization.

RESULTSThirty-three cases were diagnosed as POCD. Using the Clinprotools software, 58 polypeptides were found to display differential expression (P < 0.05). Using a support vector algorithm method, seven differential peaks were isolated to establish a diagnostic model to distinguish POCD patients from normal individuals. The prediction rate and recognition rate were 96.89% and 100%, respectively. Validation of this model showed that the accuracy rates were 100% and 85% using samples from the POCD and non-POCD groups, respectively. Protein analysis also led to the identification of fibrinopeptide A (FPA) as a potential biomarker for POCD.

CONCLUSIONSArthroplastic surgery under isoflurane inhalation anesthesia causes differential serum protein expression in elderly patients. These differentially expressed proteins may contribute to the diagnosis of early POCD, which may provide a basis for identifying the underlying mechanism of POCD development.

Aged ; Anesthesia, Inhalation ; adverse effects ; Arthroplasty ; adverse effects ; Cognition Disorders ; blood ; diagnosis ; Female ; Humans ; Isoflurane ; adverse effects ; Male ; Middle Aged ; Neuropsychological Tests ; Postoperative Complications ; blood ; psychology ; Postoperative Period ; Proteomics ; methods

OBJECTIVE: To investigate the association between health related quality of life (HRQoL) and severity of depression in patients with major depressive disorder (MDD). METHODS: Short Form 36 Health Survey Questionnaire (SF-36) was administered to 103 MDD patients at the baseline and 6-week follow-up. Hamilton Depression Rating for Depression (HAMD) and Clinical Global Impression (CGI) were administered at the baseline, 2- and 6-week follow-up, respectively. RESULTS: All SF-36 component scores in the 6-week follow-up were significantly higher than those at the baseline (P<0.01). The overall and subscale scores of HAMD except weight and CGI scores at the 2- and 6-week follow-up were significantly lower than those at the baseline (all P<0.01). The role-emotion score of the clinical remission group was significantly lower than that of the non-remission group. After a 6-week antidepressant treatment, all SF-36 component scores in both groups were significantly higher than those at the baseline, except body pain in the non-remission group. While scores of role-physical, general health, vitality, social functioning, role-emotion and mental health were significantly higher in the remission group than those in the non-remission group (P<0.05 or P<0.01). A higher overall score of HAMD, scores of cognitive disturbance and CGI were significantly associated with a worse SF-36 at the baseline (P<0.05 or P<0.01). After the 6-week treatment, a worse health transition was significantly associated with higher scores of HAMD and sleep disturbance at the baseline (P<0.01), a worse general health and role-emotion were strongly associated with higher score of anxiety/somatization at the baseline (both P<0.05). Score of general health was positively associated with reduction rate of cognitive disturbance at the 2-week endpoint (P<0.05) and scores of vitality and reported health transition were positively associated with the reduction rate of sleep disturbance at the 2-week endpoint (both P<0.05). CONCLUSION The increasing severity of depression was significantly associated with a worse HRQoL in patients with MDD. A 6-week antidepressant treatment may result in comparable HRQoL improvements. The components of HRQoL vary with severity of various symptoms of depression at the baseline and their early improvement after the treatment.
Adolescent ; Adult ; Antidepressive Agents ; therapeutic use ; Cognition Disorders ; drug therapy ; etiology ; Depressive Disorder, Major ; complications ; drug therapy ; psychology ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Young Adult

PURPOSE: With a sample of cognitively impaired nursing home residents and nursing staff, the following were examined 1) the proportion and nature of aggressive behavior, 2) the frequency and types of aggressive behavior, 3) the difference between the residents who demonstrate aggressive behavior and those who do not demonstrate aggressive behavior (age, mental status, functional status, and pain, length of nursing home stay), and 4) nursing staff responses to aggressive behavior by residents. METHODS: A cross-sectional descriptive study design was used. Data were collected from cognitively impaired nursing home residents (N=205) and nursing staff (N=60) at two nursing homes using Ryden Aggression Scale I and II, Mini-Mental State Exam, Modified Barthel Index, Verbal Descriptor Scale, and aggressive behavior management questionnaire. Data were analyzed using descriptive statistics including t-test. RESULTS: About 62.9% residents were found to be aggressive and 38.5% were both physically and verbally aggressive. Pushing, making threatening gestures, hitting, slapping, cursing/obscene/vulgar languages, making verbal threats were occurred frequently. Aggressive residents were significantly older, had more cognitive impairment, had more pain, and stayed longer in the nursing home when compared with non-aggressive residents. Considerable proportion of nursing staff responded to aggressive behaviors inadequately. CONCLUSION: Aggressive behavior among cognitively impaired nursing home residents is prevalent thus needs to be prevented and reduced. Along with environmental modification, educational programs for nursing staff and family caregivers need to be developed and implemented so that they can have extensive knowledge and skills to manage aggressive behaviors.
Aged ; Aged, 80 and over ; *Aggression/psychology ; Attitude of Health Personnel ; Case-Control Studies ; Clinical Competence/standards ; Cognition Disorders/*complications/nursing ; Cross-Sectional Studies ; Education, Nursing, Continuing ; Female ; Geriatric Assessment ; Geriatric Nursing/education/organization & administration ; Health Services Needs and Demand ; Humans ; Inservice Training ; Korea/epidemiology ; Male ; Mental Competency ; *Nursing Homes ; Nursing Staff/education/psychology ; Prevalence ; Psychomotor Agitation/epidemiology/*etiology/prevention & control/psychology ; Questionnaires ; Risk Factors