Risultati per: Gestione delle complicanze psichiatriche e cognitive nel Parkinson

Colpisce 300mila italiani, anche contributo di Mollica

Progetto della Città della Salute e del Politecnico di Torino

Objectives
Cognitive impairments and cognitive complaints are commonly present in dialysis patients and can affect clinical, functional, occupational, and psychosocial well-being. It is important to screen for patients’ cognitive status as it offers a gateway to specialty referral, prevention or rehabilitation programmes, and personalisation of clinical care. The Patient’s Assessment of Own Functioning Inventory (PAOFI) is a comprehensive questionnaire that assesses patient-reported difficulties in memory, language, motor/sensory-perceptual skills and higher-level cognitive function. In the current study, we adopted network analysis to identify central cognitive complaints in dialysis patients and derived a PAOFI short form (PAOFI-SF) based on these core symptoms to improve screening efficiency in real-world renal settings.

Design
Multicentre, cross-sectional study.

Setting
Participants were recruited from 10 community-based dialysis centres in Singapore, from May to November 2022.

Participants
A total of 369 eligible haemodialysis patients were invited to join the study, and 268 completed the measures (response rate 72.6%).

Outcome measures
Cognitive assessment tools including the PAOFI and the Montreal Cognitive Assessment were administered.

Results
Based on the PAOFI measure, 98 participants (36.6%) endorsed the presence of three or more complaints, indicating clinically significant cognitive complaints. Network analysis identified five central cognitive complaints among dialysis patients: problem-solving difficulty, difficulty following instructions, forgetting how to do tasks, difficulty being understood, and forgetting people known years ago. These core items were combined into a five-item short form of PAOFI, which showed good reliability and validity, and an area under the curve of 83.4% in identifying clinically significant cognitive complaints. The optimal cut-off point of the short form was 11.5 (out of 30), with a specificity of 89.5%, sensitivity of 63.9%, positive predictive value of 77.5% and negative predictive value of 81.4%. This cut-off point also predicted objective cognitive performance even after controlling for sociodemographic and clinical confounders.

Conclusions
Pending future replication and external validation, the PAOFI-SF may be suitable for use in renal care settings as an initial screening tool to identify patients with cognitive complaints and increased risk of objective cognitive impairments.

91% interventi oncologici A in tempi previsti in primi 2 mesi’25

Objectives
Older people living with HIV (PLWH) globally are experiencing a combination of both communicable and non-communicable disease (NCD) morbidities. Vascular contributions to cognitive impairment and dementia (VCID) can contribute to adverse ageing brain health. This study aimed to measure VCID and HIV-related factors and evaluate their association with cognitive performance.

Design
A cross-sectional study.

Setting
Five cities in the country of Georgia.

Participants
We enrolled PLWH age ≥40 years. Recruitment and data collection were carried out between February and September 2023. We conducted face-to-face interviews and collected data on sociodemographic characteristics, medical history, HIV history, cardiovascular health, mental health, clinical measurements and cognitive performance.

Primary outcome measures
We calculated the estimated 10-year cardiovascular risk using the Framingham risk score (FRS). Descriptive analyses were conducted using the frequency distributions of relevant categorical variables and median and IQR for continuous variables. Multivariable linear regression analyses were conducted separately for each cognitive assessment score.

Results
A total of 125 PLWH aged ≥40 years were enrolled in the study. The median FRS was 9% (IQR: 4, 15), with 37 (30%) participants having intermediate risk and 17 (14%) with high risk of cardiovascular event. In univariate correlation analysis, FRS was associated with worse cognitive performance. The FRS remained associated with worse performance on the Trails Making Test B and Grooved Pegboard Test using multivariable models. On average, every 1 per cent increase in FRS corresponded to an increase of 1.65 s (95% CI: 0.11, 3.19, p=0.04) for completing the Trails Making Test B and an increase of 1.02 s (95% CI: 0.43, 1.60, p=0.001) for completing the Grooved Pegboard Test.

Conclusions
We found a high prevalence of cardiovascular risk and an association between this risk and cognitive performance in our sample. Our findings provide a baseline that can be further investigated in larger-scale studies with longitudinal assessment of cardiovascular risk factors and cognitive performance. Furthermore, it can inform the development of policies and programmes to mitigate adverse effects of VCID on the health of PLWH in Georgia and the Eastern Europe and Central Asia region.

Global temperatures are on the rise and have been associated with cognitive decline in older adults. A recent longitudinal observational study published in the Journals of Gerontology: Series A zoomed in on these effects indoors. It found that adults aged 65 years or older reported less difficulty maintaining attention on daily tasks when their home ambient temperature was 20 °C to 24 °C (68 °F-75 °F). But the likelihood of such cognitive difficulties doubled with a 4 °C (7 °F) increase or decrease from this range.

Stroke, Ahead of Print. BACKGROUND:It is unclear how poststroke cognitive trajectories differ by stroke type and ischemic stroke subtype. We studied associations between stroke types (ischemic and hemorrhagic), ischemic stroke subtypes (cardioembolic, large artery atherosclerotic, lacunar/small vessel, and cryptogenic/other determined causes), and poststroke cognitive decline.METHODS:We pooled participants from 4 US cohort studies (1971–2019). Outcomes were change in global cognition (primary) and changes in executive function and memory (secondary). Outcomes were standardized as T scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1 SD difference in cognition. The median follow-up for the primary outcome was 6.0 (interquartile range, 3.2–9.2) years. Linear mixed-effects models estimated changes in cognition after stroke.RESULTS:We identified 1143 dementia-free individuals with acute stroke during follow-up: 1061 (92.8%) ischemic, 82 (7.2%) hemorrhagic, 49.9% female, and 30.8% Black. The median age at stroke was 74.1 (interquartile range, 68.6–79.3) years. On average, ischemic stroke survivors showed declines in global cognition (−0.35 [95% CI, −0.43 to −0.27] points/y;P

Introduction
Mild cognitive impairment (MCI) and dementia impose a significant burden on individuals and their caregivers. Dyadic psychosocial education, which treats care recipients and their caregivers as a pair of active participants, has the potential to improve health outcomes for people with cognitive impairment and their caregivers. However, the results of recent studies on this subject are contradictory. We aim to evaluate the effectiveness of dyadic psychosocial education for people with MCI or dementia and their informal caregivers.

Methods and analysis
Six databases will be searched. We will include all randomised controlled trials that compare dyadic psychosocial education to usual care. The risk of bias will be assessed using the Cochrane Risk-of-Bias Assessment Tool (V.2). Meta-analyses, subgroup analyses and sensitivity analyses will be performed using Stata V.15.1. A narrative synthesis will be conducted if quantitative analysis is not feasible.

Ethics and dissemination
This study and subsequent systematic review will not collect individual-level data and, therefore, do not require ethics committee approval. Peer-reviewed publications will disseminate the study results.

PROSPERO registration number
CRD42024497554.

Objective
Older adults may require additional support to comprehend written information due to inadequate health literacy, which involves components of cognitive function including reaction time. This study tested the acceptability of web-based reaction time testing in the UK Women’s Cohort Study and possible sources of bias. Additionally, it assessed the association between health literacy and reaction time.

Design
A cross-sectional analysis was conducted using data from the UK Women’s Cohort Study, a prospective cohort study.

Participants
The study involved women aged 48–85 without cancer registration who participated in the 2010/2011 follow-up (n=768).

Setting
Postal questionnaires and web-based cognitive function tests were administered in participants’ homes.

Methods and analysis
Logistic regression identified predictors of volunteering for reaction time testing, used to calculate inverse probability weights for the primary analysis. Associations between health literacy and reaction time were estimated with linear regression models, adjusting for volunteer effects. Poisson regression models assessed associations between health literacy and choice reaction time errors.

Primary and secondary outcome measures
The primary outcome was acceptability of web-based testing (response rate, task distress, task difficulty). Secondary outcomes were sources of volunteer bias and the association between health literacy and reaction time.

Results
Web-based testing of cognitive function was attempted by 67% of women (maximum age 80), with little distress or difficulty reported. There was substantive volunteer bias. Women providing data on cognitive function were younger, had higher educational attainment and were higher in self-rated intelligence. Inadequate health literacy was associated with making fewer choice reaction time errors among those providing valid data but was also associated with not providing valid data. Health literacy was not associated with other aspects of reaction time (speed, variability). Additionally, selection bias may have restricted range on study variables, given that 2010/2011 volunteers were younger and more educated compared with those at recruitment in 1995/1998.

Conclusion
Brief web-based measures of cognitive function in the home are acceptable to women aged 48–80, but there are substantive selection effects and volunteer biases. Additionally, there are potentially vulnerable subgroups who provide poorer quality data.

Stroke, Ahead of Print. Subarachnoid hemorrhage is a critical neurological condition accounting for about 5% of all strokes, and survivors experience long-term cognitive deterioration and increased risk of dementia. The major processes involved in such decline include early brain injury, delayed cerebral ischemia, neuroinflammation, superficial siderosis, and hydrocephalus. These have emerging treatments that offer promise for the mitigation of effects such as inflammation, iron chelation, and microvascular dysfunction. Genetic predispositions have been associated with post-subarachnoid hemorrhage cognitive outcomes and emphasize a role for personalized care strategies. Management techniques reviewed include long-term cognitive health, such as endovascular coiling and surgical clipping. Other rehabilitation strategies that enhance cognitive reserve and pharmacological interventions are discussed about improving the quality of life in survivors. The review highlights the need for further research into targeted therapies, genetic markers, and innovative approaches to prevent cognitive decline, ultimately aiming to optimize long-term outcomes for individuals affected by subarachnoid hemorrhage.

Patients with cardiovascular disease can achieve very low levels of low-density lipoprotein (LDL) cholesterol with evolocumab without worrying about cognitive impairment, according to a study published in NEJM Evidence.

Introduction
Sexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women’s hazardous drinking and mental health comorbidities.

Methods and analysis
This two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders – 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study’s primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms.

Ethics and dissemination
The Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants.

Trial registration number
Registered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).

Propranolol reduced resting tremor both with and without a cognitive stressor, but levodopa remains the primary treatment for PD tremor.