Factores de riesgo vascular y rendimiento cognitivo en personas de 50 a 65 años

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

INTRODUCTION

Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.

AIM

To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.

METHODS

We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.

RESULTS

Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.

CONCLUSIONS

Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

Multidimensional Evaluation of Awareness in Prader-Willi Syndrome

There are no studies about insight or awareness of illness in patients with Prader-Willi Syndrome (PWS). The objective of this study was to explore the level of awareness of the disorder, of the need for medication, and of the social consequences of the disease, as well as of its main symptoms in PWS. We also aimed to explore relationships between awareness and sociodemographic and clinical characteristics, and to compare all data with a matched sample of patients with psychosis. Insight was assessed by an Adapted version of the Scale of Unawareness of Mental Disorder in a cross-sectional pilot study at a University Hospital. Thirty-six individuals with PWS (58.3% women) were included. Results showed that PWS patients had a good awareness of the illness and of the effects of medication, in contrast to a lack of awareness of illness' social consequences. Awareness of obesity/overweight was excellent, as was the awareness of excessive appetite. Awareness of excessive food intake was only mild. Insight correlated with age and functionality, but not with BMI. PWS patients showed a better insight into the illness but a similar awareness of the effects of the medication and of the social consequences of the disease as compared to schizophrenia-spectrum patients. This profile of insight may have relevant clinical implications.

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

INTRODUCTION

Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.

AIM

To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.

METHODS

We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.

RESULTS

Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.

CONCLUSIONS

Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

Relationship between menarche and psychosis onset in women with first episode of psychosis

AIM

The aim of this study was to explore the relationship between age at menarche and age at first episode of psychosis, as well as clinical severity and outcome, in a population of women with first-episode psychosis.

METHODS

Clinical and socio-demographical data, age at menarche and at first-episode psychosis, parental history of psychosis and cannabis-use habits were obtained from 42 subjects with a first episode of psychosis. Positive and Negative Syndrome Scale, Clinical Global Impression, Global Assessment Function, Disability Assessment Schedule, Wechsler Adult Intelligence Scale and Wechsler Intelligence Scale for Children, European Quality of Life, and Lewis and Murray Obstetric Complication Scales were administered. Statistical analysis was performed by means of zero-order correlations and Mann-Whitney U and Kruskal-Wallis tests using SPSS version 17.0.

RESULTS

We found no significant correlation between age at menarche and age at first-episode psychosis, or with the clinical scores performed. We observed that subjects with earlier age at menarche had more parental history of psychosis.

CONCLUSIONS

Our negative results do not support the theory of a possible protective role of oestrogen, which seems to be more complex than previously thought. We would suggest that further research is needed to investigate developmental influences of sex steroids on the onset of psychosis and potentially therapeutic benefits based upon oestrogen.

Insight and gender in schizophrenia and other psychoses

This study aimed to evaluate gender differences in the deficit of insight in psychosis and determine influences of clinical, functional, and sociodemographic variables. A multicenter sample of 401 adult patients with schizophrenia and other psychotic disorders who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Positive and Negative Syndrome Scale Lindenmayers' Factors. Insight and its dimensions were assessed by means of the Scale of Unawareness of Mental Disorder. Significant differences were apparent neither between men and women in the three dimensions of insight, nor in the total awareness, nor in the total attribution subscales. However, statistically significant differences were found in awareness and attribution of particular symptoms. Women showed a worse awareness of thought disorder and alogia and a higher misattribution of apathy. Higher cognitive and positive symptoms, early stage of the illness, and having been married explained deficits of insight dimensions in women. In men, other variables such as lower functioning, higher age, other psychosis diagnosis, and, to a lower extent, higher scores in cognitive, positive, and excitative symptoms, explained deficits of insight dimensions. These data could help to design gender-specific preventive and therapeutic strategies.

Three-factor model of premorbid adjustment in a sample with chronic schizophrenia and first-episode psychosis

BACKGROUND

The dimensionality of premorbid adjustment (PA) has been a debated issue, with attempts to determine whether PA is a unitary construct or composed of several independent domains characterized by a differential deterioration pattern and specific outcome correlates.

AIMS

This study examines the factorial structure of PA, as well as, the course and correlates of its domains.

METHOD

Retrospective study of 84 adult patients experiencing first-episode psychosis (FEP) (n=33) and individuals with schizophrenia (SCH) (n=51). All patients were evaluated with a comprehensive battery of instruments including clinical, functioning and neuropsychological variables. A principal component analysis accompanied by a varimax rotation method was used to examine the factor structure of the PAS-S scale. Paired t tests and Wilcoxon rank tests were used to assess the changes in PAS domains over time. Bivariate correlation analyses were performed to analyse the relationship between PAS factors and clinical, social and cognitive variables.

RESULTS

PA was better explained by three factors (71.65% of the variance): Academic PA, Social PA and Socio-sexual PA. The academic domain showed higher scores of PA from childhood. Social and clinical variables were more strongly related to Social PA and Socio-sexual PA domains, and the Academic PA domain was exclusively associated with cognitive variables.

CONCLUSION

This study supports previous evidence, emphasizing the validity of dividing PA into its sub-components. A differential deterioration pattern and specific correlates were observed in each PA domains, suggesting that impairments in each PA domain might predispose individuals to develop different expressions of psychotic dimensions.

Baroreflex sensitivity, vascular risk factors, and cognitive function in a healthy elderly population: the PROOF cohort

OBJECTIVES

To assess the role of the cardiac autonomic nervous system (ANS), as measured according to spontaneous cardiac baroreflex sensitivity (BRS), in the type and degree of cognitive performance in healthy young-elderly individuals, taking into account the presence of other vascular risk factors.

DESIGN

Community-based cross-sectional study.

SETTING

In-home and clinical settings.

PARTICIPANTS

A subset of participants, aged 66.9±0.9, from a prospective study that aimed to assess the influence of ANS activity on cardiovascular and cerebrovascular morbidity and mortality (N=916).

MEASUREMENTS

All subjects underwent a clinical interview, neuropsychological testing, and autonomic and vascular measurements. Three cognitive domains were defined: attentional (Trail-Making Test Part A, Stroop code and parts I & II), executive (Trail-Making Test Part B, Stroop part III, verbal fluency and similarity tests), and memory (Benton visual retention test, Grober and Buschké procedure). Subjects were stratified according to their scores into normal, low, and impaired performers.

RESULTS

After adjustments to demographic and vascular data, participants with moderate autonomic dysregulation (3<BRS≤6) were determined to be 1.82 times as likely to have memory impairment (odds ratio (OR)=1.82, 95% confidence interval (CI)=1.13-3.17, P=.02) and those with severe autonomic dysregulation (BRS≤3) to be 2.65 as likely (OR=2.65, 95% CI=1.40-5.59, P=.006) as participants with normal BRS (>6).

CONCLUSION

In older individuals without dementia, autonomic dysregulation seems to have a direct, gradual, and independent effect on memory. Future studies are needed to evaluate the long-term effects of BRS and other markers of the ANS on cognitive decline.

Cognitive profiles of three clusters of patients with a first-episode psychosis

OBJECTIVE

The primary objective was to identify specific groups of patients with a first-episode psychosis based on family history, obstetric complications, neurological soft signs, and premorbid functioning. The secondary objective was to relate these groups with cognitive variables.

METHOD

A total of 62 first-episode psychoses were recruited from adult and child and adolescent mental health services. The inclusion criteria were patients between 7 and 65 years old (real range of the samples was 13-35 years old), two or more psychotic symptoms and less than one year from the onset of the symptoms. Premorbid functioning (PAS), soft signs (NES), obstetric complications and a neuropsychological battery (CPT, TMTA/TMTB, TAVEC/TAVECI, Stroop, specific subtest of WAIS-III/WISC-IV) were administered.

RESULTS

We found three clusters: 1) higher neurodevelopment contribution (N=14), 2) higher genetic contribution (N=30), and 3) lower neurodevelopment contribution (N=18). Statistical differences were found between groups in TMTB, learning curve of the TAVEC, digits of the WAIS and premorbid estimated IQ, the cluster 1 being the most impaired.

CONCLUSIONS

A cluster approach could differentiate several groups of patients with different cognitive performance. Neuropsychological interventions, as cognitive remediation, should be addressed specifically to patients with more impaired results.