Adjunctive treatment of behavioral disorders in patients with cognitive deficit The article provides an overview of the pharmacotherapy of behavioural and psychological symptoms of dementia (BPSD) in the context of evidence-based medicine. Its goal is to provide readers with a practical and educational overview of managing these symptoms. Cognitive disorders, including dementia, result from the disruption of higher cortical functions of the brain. Dementia often manifests not only through cognitive dysfunction but also through BPSD, such as agitation, aggression, anxiety, psychosis, and sleep disturbances. These symptoms affect up to 97% of patients with dementia and significantly reduce the quality of life for both patients and caregivers. BPSD are often more stressful for patients and caregivers than the cognitive symptoms themselves. Behavioural symptoms include a wide range of manifestations from non-aggressive forms such as pacing and repetitive movements to aggressive and agitated behaviour (verbal and physical). Psychological symptoms can include depression, anxiety, and psychotic symptoms such as paranoia and delusions. The causes of BPSD can be varied, as well as their risk factors (including e.g. co-medication, comorbidities, the patient's personality traits, inappropriate communication by caregivers, and environmental influences). The pharmacotherapy of BPSD is complex and often involves the use of antipsychotics, antidepressants, benzodiazepines, or acetylcholinesterase inhibitors and memantine. Due to the diversity of manifestations and causes of BPSD, a unified pharmacotherapeutic approach cannot be applied. Non-pharmacological approaches should always be preferred, except in cases of severe depression, psychosis, or aggression that may endanger the patient or someone else. In practice, many medications indicated for BPSD therapy are used off-label. The pharmacotherapy of BPSD should only begin after ruling out other causes of BPSD. Furthermore, it should only be initiated after considering all risks and potential benefits, starting with low geriatric doses, monitoring side effects, regularly reassessing effectiveness, and administering medications for the shortest possible duration should be also applied.
- Klíčová slova
- behavioural and psychological symptoms of dementia, dementia., psychopharmacology,
- MeSH
- antipsychotika terapeutické užití MeSH
- demence * komplikace MeSH
- duševní poruchy farmakoterapie MeSH
- kognitivní poruchy etiologie farmakoterapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antipsychotika MeSH
OBJECTIVE: Our objective was to assess cognitive functioning across multiple cognitive domains using a standardised neuropsychological battery in patients with motor functional neurological disorders (mFND). METHODS: Thirty patients with clinically established mFND and 30 age-, sex- and education-matched control subjects underwent a thorough neuropsychological assessment evaluating (1) attention including processing speed, (2) executive functions including working memory, (3) short-term memory, (4) speech and language and (5) visuospatial functions. Performance validity tests (PVT) and self-report measures of depression, anxiety and cognitive complaints were included in the assessment. Only patients with valid test performance were included in the analysis. RESULTS: Three patients scored below the cut-off scores in PVT. Patients performed significantly worse than controls in the following areas: (1) the attention domain which included a slow processing speed (p = 0.005, Cohen's d = 0.89), (2) executive functions (p = 0.01, Cohen's d = 0.88) and (3) speech and language domains (p = 0.025, Cohen's d = 0.77). Patients with mFND showed greater intra-individual variability in cognitive performance (p = 0.005, Cohen's d = 0.94). Cognitive impairments were independent of depressive symptoms, which were higher in mFND patients. CONCLUSION: This study revealed both subjective and objective cognitive impairment in patients with mFND. The neuropsychological profile in mFND was characterised primarily by attentional impairment including a slow processing speed and a high intra-individual variability in cognitive performance. Cognitive impairment was associated with a valid test performance, highlighting that the deficits observed were not likely to be explained by a lack of effort in the patient group. Attention is considered to play a key role in mFND pathophysiology, and the results suggest that such impairments are objectively measurable.
- Klíčová slova
- Attention, Cognitive functions, Motor functional neurological disorders, Neuropsychological profile, Performance validity,
- MeSH
- exekutivní funkce fyziologie MeSH
- kognice fyziologie MeSH
- kognitivní dysfunkce * komplikace etiologie MeSH
- kognitivní poruchy * diagnóza etiologie MeSH
- konverzní poruchy * MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- pozornost fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
In the Czech Republic, due to the population aging, the prevalence of cognitive dysfunction is increasing. Researchers estimate that by 2050 the number of patients with dementia in the Czech Republic will more than double. Since dementia cannot be cured, it is important to prevent the cognitive dysfunction development by influencing modifiable risk factors. Arterial hypertension (AH) is one of the main risk factors for the development of cognitive dysfunction and dementia. Elevated blood pressure values in youth are associated with a higher risk of cognitive decline in middle age and with the development of dementia in old age. Blood pressure control in low-risk patients with stage I hypertension reduces the risk of dementia development, including Alzheimers disease. Therefore, improving the AH control in the population since younghood will be needed to influence the emerging cognitive dysfunction pandemic.
- Klíčová slova
- arterial hypertension, blood pressure control, cognitive dysfunction, dementia, prevention, treatment,
- MeSH
- antihypertenziva terapeutické užití MeSH
- demence * epidemiologie komplikace farmakoterapie MeSH
- hypertenze * komplikace MeSH
- kognitivní dysfunkce * etiologie komplikace MeSH
- kognitivní poruchy * etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- pandemie MeSH
- péče o sebe škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antihypertenziva MeSH
Patients with Parkinson's disease (PD) suffer from a wide range of non-motor symptoms, including cognitive deficits and impairment of emotional processing. The present study aimed to explore in PD patients compared to healthy adults the relationship between cognitive performance and emotional creativity (EC), defined as a set of cognitive abilities and personality traits related to originality and appropriateness of emotional experience. PD patients (n = 22) and healthy controls (n = 40) underwent a complex neuropsychological assessment and were administrated with the self-reported Emotional Creativity Inventory (ECI) questionnaire. To explore the relationship between cognitive tests and the ECI, a regression analysis was conducted. PD patients and healthy controls differed significantly in the EC component Preparedness as well as in the neuropsychological test battery scores. PD patients showed lower scores in cognitive tests and a lower score in Preparedness compared to healthy adults. The output of the regression analysis showed that the extent to which the neuropsychological tests relate to the ECI components is low.
- Klíčová slova
- Aging, Parkinson's disease, cognitive functions, emotional creativity,
- MeSH
- dospělí MeSH
- kognice MeSH
- kognitivní dysfunkce * diagnóza MeSH
- kognitivní poruchy * diagnóza etiologie MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- Parkinsonova nemoc * komplikace diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a brief, standardized assessment of cognitiveimpairment inamyotrophic lateral sclerosis. OBJECTIVE: We aimed to createa normative dataset for the ECAS Czech version (ECAS-CZ) in order to make the assessment applicable for clinical settings. METHOD: Included were 102 healthy participants (mean age: 54.92 ± 14.55; education: 14.52 ± 2.44; 54:48 females/males) that fulfilled rigorous exclusion criteria and controlled for depressive symptoms. RESULTS: The internal consistency of ECAS-CZ was acceptable (Cronbach's α = .69). We found medium correlations (rho ≈ .5) of age and education with ECAS-CZ Total score but not with gender. Cut-offs with -2 SD's threshold are presented for the differentiation of cognitive impairment. We report percentile values for ECAS-CZ Total including all subscales. CONCLUSION: We provide normative values for ECAS-CZ that are well suited for the detection of cognitive impairment in clinical settings especially for patients with ALS.Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2021.1978553 .
- Klíčová slova
- Cognition, ECAS, behaviour, normative data, screen,
- MeSH
- amyotrofická laterální skleróza * diagnóza MeSH
- dospělí MeSH
- kognice MeSH
- kognitivní dysfunkce * MeSH
- kognitivní poruchy * diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: Diagnosing autoimmune encephalitis (AIE) is difficult in patients with less fulminant diseases such as epilepsy. However, recognition is important, as patients require immunotherapy. This study aims to identify antibodies in patients with focal epilepsy of unknown etiology, and to create a score to preselect patients requiring testing. METHODS: In this prospective, multicenter cohort study, adults with focal epilepsy of unknown etiology, without recognized AIE, were included, between December 2014 and December 2017, and followed for 1 year. Serum, and if available cerebrospinal fluid, were analyzed using different laboratory techniques. The ACES score was created using factors favoring an autoimmune etiology of seizures (AES), as determined by multivariate logistic regression. The model was externally validated and evaluated using the Concordance (C) statistic. RESULTS: We included 582 patients, with median epilepsy duration of 8 years (interquartile range = 2-18). Twenty patients (3.4%) had AES, of whom 3 had anti-leucine-rich glioma inactivated 1, 3 had anti-contactin-associated protein-like 2, 1 had anti-N-methyl-D-aspartate receptor, and 13 had anti-glutamic acid decarboxylase 65 (enzyme-linked immunosorbent assay concentrations >10,000IU/ml). Risk factors for AES were temporal magnetic resonance imaging hyperintensities (odds ratio [OR] = 255.3, 95% confidence interval [CI] = 19.6-3332.2, p < 0.0001), autoimmune diseases (OR = 13.31, 95% CI = 3.1-56.6, p = 0.0005), behavioral changes (OR 12.3, 95% CI = 3.2-49.9, p = 0.0003), autonomic symptoms (OR = 13.3, 95% CI = 3.1-56.6, p = 0.0005), cognitive symptoms (OR = 30.6, 95% CI = 2.4-382.7, p = 0.009), and speech problems (OR = 9.6, 95% CI = 2.0-46.7, p = 0.005). The internally validated C statistic was 0.95, and 0.92 in the validation cohort (n = 128). Assigning each factor 1 point, an antibodies contributing to focal epilepsy signs and symptoms (ACES) score ≥ 2 had a sensitivity of 100% to detect AES, and a specificity of 84.9%. INTERPRETATION: Specific signs point toward AES in focal epilepsy of unknown etiology. The ACES score (cutoff ≥ 2) is useful to select patients requiring antibody testing. ANN NEUROL 2021;89:698-710.
- MeSH
- autoimunitní nemoci diagnostické zobrazování imunologie psychologie MeSH
- autoprotilátky analýza MeSH
- chování MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- epilepsie parciální diagnostické zobrazování imunologie psychologie MeSH
- glutamát dekarboxyláza genetika imunologie MeSH
- kognitivní poruchy etiologie psychologie MeSH
- kohortové studie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- záchvaty diagnostické zobrazování etiologie imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Nizozemsko MeSH
- Názvy látek
- autoprotilátky MeSH
- glutamát dekarboxyláza MeSH
- glutamate decarboxylase 2 MeSH Prohlížeč
Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.
- MeSH
- cévní mozková příhoda komplikace patofyziologie terapie MeSH
- kognitivní poruchy etiologie patofyziologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- rehabilitace po cévní mozkové příhodě * metody MeSH
- studie proveditelnosti MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Chronic kidney disease (CKD) leads to profound metabolic and hemodynamic changes, which damage other organs, such as heart and brain. The brain abnormalities and cognitive deficit progress with the severity of the CKD and are mostly expressed among hemodialysis patients. They have great socio-economic impact. In this review, we present the current knowledge of involved mechanisms.
Experimental studies in animals provide relevant knowledge about pathogenesis of radiation-induced injury to the central nervous system. Radiation-induced injury can alter neuronal, glial cell population, brain vasculature and may lead to molecular, cellular and functional consequences. Regarding to its fundamental role in the formation of new memories, spatial navigation and adult neurogenesis, the majority of studies have focused on the hippocampus. Most recent findings in cranial radiotherapy revealed that hippocampal avoidance prevents radiation-induced cognitive impairment of patients with brain primary tumors and metastases. However, numerous preclinical studies have shown that this problem is more complex. Regarding the fact, that the radiation-induced cognitive impairment reflects hippocampal and non-hippocampal compartments, it is highly important to investigate molecular, cellular and functional changes in different brain regions and their integration at clinically relevant doses and schedules. Here, we provide a literature review in order support the translation of preclinical findings to clinical practice and improve the physical and mental status of patients with brain tumors.
- MeSH
- centrální nervový systém patologie účinky záření MeSH
- ionizující záření MeSH
- kognitivní poruchy etiologie patologie MeSH
- lidé MeSH
- nádory mozku patologie radioterapie MeSH
- nemoci mozku etiologie patologie MeSH
- radiační poranění etiologie patologie MeSH
- sekundární malignity etiologie patologie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Ozanimod, a sphingosine 1-phosphate receptor modulator, selectively binds to receptor subtypes 1 and 5 with high affinity. The RADIANCE phase 2 study showed that ozanimod had better efficacy than placebo on MRI measures, with a favourable safety profile, in participants with relapsing multiple sclerosis. The SUNBEAM study aimed to assess the safety and efficacy of ozanimod versus intramuscular interferon beta-1a in participants with relapsing multiple sclerosis. METHODS: SUNBEAM was a randomised, double-blind, double-dummy, active-controlled phase 3 trial done at 152 academic medical centres and clinical practices in 20 countries. We enrolled participants aged 18-55 years with relapsing multiple sclerosis, baseline expanded disability status scale (EDSS) score of 0·0-5·0, and either at least one relapse within the 12 months before screening or at least one relapse within 24 months plus at least one gadolinium-enhancing lesion within 12 months before screening. Participants were randomly assigned 1:1:1 by a blocked algorithm stratified by country and baseline EDSS score to at least 12 months treatment of either once-daily oral ozanimod 1·0 mg or 0·5 mg or weekly intramuscular interferon beta-1a 30 μg. Participants, investigators, and study staff were masked to treatment assignment. The primary endpoint was annualised relapse rate (ARR) during the treatment period and was assessed in the intention-to-treat population. Safety was assessed in all participants according to the highest dose of ozanimod received. This trial is registered at ClinicalTrials.gov, number NCT02294058 and EudraCT, number 2014-002320-27. FINDINGS: Between Dec 18, 2014, and Nov 12, 2015, 1346 participants were enrolled and randomly assigned to ozanimod 1·0 mg (n=447), ozanimod 0·5 mg (n=451), or interferon beta-1a (n=448). 91 (6·8%) participants discontinued the study drug (29 in the ozanimod 1·0 mg group; 26 in the ozanimod 0·5 mg group; and 36 in the interferon beta-1a group). Adjusted ARRs were 0·35 (0·28-0·44) for interferon beta-1a, 0·18 (95% CI 0·14-0·24) for ozanimod 1·0 mg (rate ratio [RR] of 0·52 [0·41-0·66] vs interferon beta-1a; p<0·0001), and 0·24 (0·19-0·31) for ozanimod 0·5 mg (RR 0·69 [0·55-0·86] vs interferon beta-1a; p=0·0013). Few ozanimod-treated participants discontinued treatment because of adverse events (13 [2·9%] who received ozanimod 1·0 mg; seven [1·5%] who received ozanimod 0·5 mg; and 16 [3·6%] who received interferon beta-1a). No first-dose, clinically significant bradycardia or second-degree or third-degree atrioventricular block was reported. The incidence of serious adverse events was low and similar across treatment groups (13 [2·9%] participants who received ozanimod 1·0 mg; 16 [3·5%] who received ozanimod 0·5 mg; and 11 [2·5%] who received interferon beta-1a). No serious opportunistic infections occurred in ozanimod-treated participants. INTERPRETATION: In participants with relapsing multiple sclerosis treated for at least 12 months, ozanimod was well tolerated and demonstrated a significantly lower relapse rate than interferon beta-1a. These findings provide support for ozanimod as an oral therapy for individuals with relapsing multiple sclerosis. FUNDING: Celgene International II.
- MeSH
- atrioventrikulární blokáda chemicky indukované MeSH
- bradykardie chemicky indukované MeSH
- dospělí MeSH
- imunosupresiva škodlivé účinky terapeutické užití MeSH
- indany škodlivé účinky terapeutické užití MeSH
- interferon beta 1a škodlivé účinky terapeutické užití MeSH
- kognitivní poruchy etiologie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek patologie MeSH
- neurozobrazování MeSH
- oxadiazoly škodlivé účinky terapeutické užití MeSH
- progrese nemoci MeSH
- receptory sfingosin-1-fosfátu antagonisté a inhibitory MeSH
- relabující-remitující roztroušená skleróza farmakoterapie patologie psychologie MeSH
- šedá hmota patologie MeSH
- stupeň závažnosti nemoci MeSH
- velikost orgánu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Názvy látek
- imunosupresiva MeSH
- indany MeSH
- interferon beta 1a MeSH
- oxadiazoly MeSH
- ozanimod MeSH Prohlížeč
- receptory sfingosin-1-fosfátu MeSH
