Risultati per: Gestione delle complicanze psichiatriche e cognitive nel Parkinson

Introduction
The presence of cognitive dysfunction notably affects the quality of life in individuals diagnosed with Parkinson’s disease (PD) and is often recognised as a non-motor symptom. Comprehensive studies have shown the possible advantages of hyperbaric oxygen therapy (HBOT) in alleviating cognitive deficits in these individuals. This systematic review aims to investigate the practicality of incorporating HBOT within a more extensive therapeutic framework for PD, with a specific focus on cognitive symptoms.

Methods and analysis
A comprehensive literature review will be conducted utilising various databases such as PubMed and Cochrane Library and so on. The duration of the search will encompass the entire timeline from the initiation of each database up to 1 April 2024. This investigation seeks to uncover randomised controlled trials that explore the efficacy and safety of HBOT in patients with PD who are facing cognitive impairments. The authors’ autonomous screening and extraction of data will facilitate the attainment of impartial results. The assessment of possible biases will be conducted using the Cochrane risk-of-bias tool, while statistical analyses will be executed with RevMan V.5.3 and Stata V.15.0.

Ethics and dissemination
As this review synthesises and evaluates previously conducted studies, the requirement for ethical approval is not applicable. The findings from this review will be shared via academic publications, comprehensive reports and presentations at pertinent conferences.

PROSPERO registration number
CRD42024504763

Araldi, ‘con MedMal Report identifichiamo aree più a rischio’

Stroke, Ahead of Print. As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.

Introduction
Postoperative delirium (POD) is a common neurological complication after surgery among older patients, characterised by acute disturbances in consciousness, attention and cognition, usually occurring within 24–72 hours after surgery. POD has a significant impact on the prognosis of older patients undergoing major cardiovascular surgery, including increased length of hospital stay, hospital costs and readmission rates, with an incidence rate as high as 26%–52%. Computerised cognitive training (CCT) refers to difficulty-adaptive training in cognitive domains such as attention, memory and logical reasoning, using systematically designed tasks. Existing studies have shown that CCT has reduced the risk of delirium in non-cardiac surgery patients with at least minimal compliance. The purpose of this study is to investigate the effects of preoperative CCT on the incidence of POD in older patients undergoing elective cardiac surgery, to clarify the dose–effect relationship between different training time of preoperative CCT and POD and to explore the minimum effective time target that can significantly lower the incidence of POD.

Methods and analysis
This is a prospective, single-blind, randomised controlled trial that aims to enrol 261 older patients scheduled for elective cardiac surgery at the Affiliated Hospital of Xuzhou Medical University. The patients will be randomised into three groups: group C will be the routine care group (no CCT prior to surgery); group L will be the low-dose time group (with a total of 5 hours of CCT prior to surgery) and group H will be the high-dose time group (with a total of 10 hours of CCT prior to surgery). The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include postoperative mild neurocognitive disorder (NCD) and postoperative major NCD (30 days up to 1 year), time of onset and duration and severity of delirium, and all-cause mortality within 1 year after surgery. The results of this study are of significant importance for establishing effective, patient-centred and low-risk prevention strategies for POD/postoperative NCD.

Ethics and dissemination
This study protocol has been approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Ethics Number: XYFY2023-KL149-01). All participants will provide written informed consent, and the results of the study will be published in international peer-reviewed academic journals and presented at academic conferences.

Trial registration number
ChiCTR2300072806.

I moderni dispositivi permettono di adattare la terapia insulinica alle esigenze individuali di ciascun paziente, migliorando l’efficacia del trattamento

Cherubini (Siedp) “evitabili in oltre 450 bimbi ogni anno”

Circulation, Volume 150, Issue Suppl_1, Page A4138835-A4138835, November 12, 2024. Background:Recent evidence suggests the efficacy and safety of sodium-glucose transporter 2 inhibitors (SGLT-2is) in heart failure (HF) patients. However, there still remain concerns in their use among patients with physical or cognitive frailty.Methods:West Tokyo Heart Failure (WET-HF) Registry is an ongoing prospective multicenter registry in Japan enrolling all patients who were hospitalized for acute decompensated heart failure. We retrospectively analyzed the impact of physical or cognitive frailty-related factors (FF) on the association of SGLT-2i prescription with long-term outcomes using the data of WET-HF (2018-23, n=5106). Patients without data of SGLT-2i prescription at discharge were excluded. Primary endpoint (PE) was defined as the composite of cardiac death and HF rehospitalization during 2 years after discharge.Results:At baseline 3208 of 4845 patients (66%) had FF defined by any of following 5 factors: BMI

Circulation, Volume 150, Issue Suppl_1, Page A4146361-A4146361, November 12, 2024. Introduction:Coronary artery bypass surgery (CABG) is the most common cardiac surgery in adults, yet it is associated with a range of complications including stroke, cognitive impairment, and dementia. Despite the critical importance of cognitive outcomes, cognition remains understudied in CABG surgery trials, and recruitment for cardiac-related cognitive studies faces substantial challenges.Objective:Identify barriers to recruitment in a cognitive auxiliary study in the international Randomized Comparison Of The Clinical Outcome Of Single Vs Multiple Arterial Grafts (ROMA) trial.Methods:Semi-structured interviews were conducted with research staff (n=12) involved in the ROMA trial to explore themes related to recruitment barriers into ROMA:Cognition. The average interview length was approximately 25 minutes. Qualitative data were analyzed using a directed content analysis approach, and inter-rater reliability was assessed with Cohen’s kappa score based on the five most frequently applied codes.Results:Twelve participants were recruited, with a mean age of 48 years. Of these, 90% were female, 60% were from North America, and 30% were from Europe. Key themes identified included: (1) misconceptions of cognition as equivalent to psychiatric disorders, (2) gaps in understanding the importance of measuring cognition for a cardiac-related study, (3) distrust in international data sharing practices, and (4) stigma and apprehension surrounding cognitive decline and mental health issues (Table 1).Conclusion:Educational interventions are crucial to improve patient understanding of the importance of cognitive assessments in the context of cardiac surgery. Addressing misconceptions and reducing stigma related to cognitive testing can enhance patient recruitment and engagement in cognitive auxiliary studies. Emphasizing the brain-heart connection and distinguishing cognitive assessment from psychiatric evaluation are essential steps to ensure comprehensive postoperative care and improve outcomes for CABG patients.

Circulation, Volume 150, Issue Suppl_1, Page A4122290-A4122290, November 12, 2024. Background:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure and cardiovascular mortality. However, SGLT2i therapy’s potential effects on the risks of dementia and Parkinson’s disease are not well established, with conflicting results based on observational studies.Objective:We sought to evaluate the association between SGLT2i and the risk of dementia and Parkinson’s disease in patients with type 2 diabetes mellitus (T2DM), heart failure, or chronic kidney disease.Methods:We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until March 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model.Results:A total of 12 RCTs with 74, 442 patients (40784 in the SGLT2i group and 33658 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control was 65.3 and 65.2 years respectively. The mean follow-up duration was 2.9 years. Pooled analysis showed that there is no significant association between SGLT2i and the risk of dementia (OR, 1.37 (95%CI: 0.70-2.69),P=0.36, I2=0%), dementia Alzheimer’s type (OR, 2.62 (95%CI: 0.47-14.49),P=0.27, I2=0), vascular dementia (OR, O.52 (95%CI: 0.09-2.98),P=0.46, I2=0%), and Parkinson’s disease (OR, 0.75 (95%CI: 0.25-2.25),P=0.61, I2=0%) was comparable between SGLT2i and control groups.Conclusion:Our study suggest that there is no significant association between SGLT2i and the risk of dementia, its subtypes, and Parkinson’s disease. Further large-power randomized trials are needed to strengthen the understanding of neuropsychiatric beneficial effects of SGLT2i.

Circulation, Volume 150, Issue Suppl_1, Page A4115222-A4115222, November 12, 2024. Background:Poor self-care in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) leads to increased diabetes complications and health costs. While the goal of self-management for patients with T1DM and T2DM is to maintain normal blood glucose levels, the major methods for achieving this differ (exogenous insulin delivery vs. a combination of self-care techniques, respectively). This implies that factors associated with self-care in the two groups may differ.Hypothesis:Distinct demographic, cognitive, and psychosocial factors are associated with overall self-care, diet, exercise, blood glucose testing, foot care, and smoking in patients with T1DM and T2DM, in separate models.Methods:In this cross-sectional, correlational study, data were collected from 148 patients with T1DM (n = 64, mean age: 51.3 years) or T2DM (n = 84, mean age: 62.5) using REDCap during 2023. The participants were recruited from various organizations, institutions, and ResearchMatch in the United States. Several multiple regression analyses were done to test the hypothesis.Results:Patients with T1DM had better self-care, including overall diabetes self-care, exercise, and blood glucose testing than the T2DM group. Older age (p = .003), lower body mass index (BMI) (p = .040), and stronger knowledge (p = .028) in the T1DM group (F[10,53]= 2.290, p = .026, R2= .302), while lower BMI (p = .045) and higher levels of self-efficacy (p < .001) in the T2DM group were associated with better overall diabetes self-care (F[10,73] = 3.219, p = .002, R2= .306). Older age, lower BMI, stronger knowledge, stronger resilience, and lower self-esteem were associated with better self-care in diet, blood glucose testing, and/or foot care in the T1DM group, while lower BMI, stronger knowledge, higher levels of self-efficacy, and less severe depressive symptoms were associated with better self-care in diet, exercise, and/or blood glucose testing in the T2DM group. None were associated with smoking in both groups. Diabetes distress, self-compassion, and social support were not associated with any types of self-care.Conclusions:Factors associated with self-care differed based on types of self-care and types of diabetes, thus, supporting the hypothesis. When healthcare providers provide interventions to improve diabetes self-care in individual patients with diabetes, they need to consider types of diabetes, types of self-care, and distinct factors associated with each type of self-care.

Circulation, Volume 150, Issue Suppl_1, Page A4145278-A4145278, November 12, 2024. Background:Metabolic syndrome (MetS), a cluster of risk factors, has been linked to higher risk of dementia in older adults. However, the composite impact of long-term variability of metabolic parameters from childhood on midlife cognitive function is unclear.Methods:We studied 1145 midlife participants of the Bogalusa Heart Study (age at enrollment: 12.2 ± 5.4 years, follow-up: 36.1 ± 3.4 years, age at last exam (midlife): 48.3 ± 5.0 years, 60.9% women, 33.7% Black participants) with ≥3 measurements of metabolic parameters (systolic blood pressure (SBP), fasting blood glucose (FBG), triglyceride (TG), high density lipoprotein (HDL), and body mass index (BMI)) across follow-up. MetS was defined by the National Cholesterol Education Program guidelines, but using BMI >30 kg/m2for abdominal obesity. Long-term variability of SBP, FBG, TG, HDL, and BMI from childhood were measured as the residual standard deviation (RSD). Repeated measurements of each parameter were fitted in random-effect models to obtain individual growth curves. Using the growth curves, RSD was obtained as the SD of the difference between each observed and predicted parameter level. A composite variability score (range, 0-10) was defined by 1) assigning 0 points to the lowest tertile of RSD and 2 points to the highest tertile for each parameter, then 2) summing the points for all 5 parameters. Midlife cognitive function was measured by 8 neuropsychological (NP) tests. NP test results were categorized into 3 distinct NP profiles (optimal, average, mixed-low) using cluster analysis. Associations between the composite variability score and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status. Sensitivity analysis excluding participants with MetS at midlife were also performed.Results:A total of 348 (30.4%) participants had MetS at midlife. The odds of having mixed-low cognitive function at midlife increased by 13.3% (OR 1.13, 95% CI 1.03, 1.24) for a 1-unit increase in the composite variability score, compared to optimal cognitive function, adjusted for education status. Sensitivity analysis showed consistent results in participants without MetS at midlife (OR 1.18, 95% CI 1.05, 1.33).Conclusions:A graded association was observed between composite long-term variability in metabolic parameters from childhood and poorer midlife cognitive function. Lowering variability of metabolic parameters may be beneficial to midlife cognitive function.