ICU谵妄的预防：早期活动

ICU谵妄发生率高、识别率低,可显著延长ICU平均住院时间、增加病死率、加重转出ICU后认知功能障碍.但目前缺乏有效的谵妄预防措施.综合干预措施可降低谵妄的发生,其中早期活动是治疗的关键.ICU早期活动安全可行,可降低谵妄的发生及缩短谵妄的持续时间,改善患者预后.ICU中开展早期活动治疗是基于＆quot;ABCDE＆quot;集束化干预措施的前提下,中断镇静后尽早开始肢体功能锻炼和职业治疗,包括从先被动后主动的关节活动,到双腿下垂坐到床缘,进一步下床坐到轮椅上甚至步行活动,是早期活动的基本流程.     

Determinants of cognitive outcomes of perinatal and childhood stroke: A review

Our understanding of cognitive and behavioral outcomes of perinatal and childhood stroke is rapidly evolving. A current understanding of cognitive outcomes following pediatric stroke can inform prognosis and direct interventions and our understanding of plasticity in the developing brain. However, our understanding of these outcomes has been hampered by the notable heterogeneity that exists amongst the pediatric stroke population, as the influences of various demographic, cognitive, neurological, etiological, and psychosocial variables preclude broad generalizations about outcomes in any one cognitive domain. We therefore aimed to conduct a detailed overview of the published literature regarding the effects of age at stroke, time since stroke, sex, etiology, lesion characteristics (i.e., location, laterality, volume), neurologic impairment, and seizures on cognitive outcomes following pediatric stroke. A key theme arising from this review is the importance of interactive effects among variables on cognitive outcomes following pediatric stroke. Interactions particularly of note include the following: (a) age at Stroke x Lesion Location; (b) Lesion Characteristics (i.e., volume, location) x Neurologic Impairment; (c) Lesion Volume x Time Since Stroke; (d) Sex x Lesion Laterality; and (e) Seizures x Time Since Stroke. Further, it appears that these relationships do not always apply uniformly across cognitive domains but, rather, are contingent upon the cognitive ability in question. Implications for future research directions are discussed.     

Interpreting Errors in Temporal Orientation in Older Hospital Patients

Normal variation in temporal orientation has been examined in community dwelling, healthy older subjects but not in elderly hospital patients. We examined the validity of errors in different aspects of temporal orientation as a guide to the presence or absence of cognitive impairment orientation in elderly hospital patients in 150 consecutive patients on the day after admission to an acute geriatric unit. Cognitive impairment (delirium or dementia or both) was diagnosed without reference to temporal orientation. Optimum cutoffs for error scores on the different aspects of temporal orientation (date/year/month/day of the week/time of day) were calculated to maximize the sum of sensitivity and specificity for detection of cognitive impairment. Of the 150 patients, 45 (30%) had cognitive impairment. The best cutoffs for detection of cognitive impairment were an error of more than 3 days in the date; any error in the year, month, or day of the week; and an error of more than 1 h in identifying the time of day. Error in identifying the year had the highest positive likelihood ratio (6.4 [95% confidence interval 4.0–10.3]) for detecting cognitive impairment and the lowest negative likelihood ratio (0.1 [0.04–0.3]) for the exclusion of cognitive impairment. Failure to identify the year correctly is the aspect of temporal orientation most closely related to cognitive impairment.     

Neuropsychological profiles of six children with anoxic brain injury

Anoxic brain injury (ABI) often results in severe memory impairment and other cognitive and behavioral deficits, although limited information is available regarding pediatric cases. This study reported the neuropsychological outcomes in six children and adolescents who sustained ABI. Profiles were compared by mechanism of injury (ischemic vs. hypoxemic) and three cases were evaluated more than once. Severe intellectual, attention, memory, and behavioral impairments were observed in all six cases although academic achievement, internalizing behavioral problems, and visuospatial deficits were in general less severe than other cognitive and behavioral deficits. The longitudinal case studies varied but showed steady increases in memory and intellectual performance in the younger children with strongest improvement in nonverbal abilities and little change in parent-reported behavior. This study raises several possible hypotheses about specific cognitive and behavioral outcomes observed in pediatric ABI.     

Presentation of Mexican Americans to a Memory Disorder Clinic

Despite the rapidly growing nature of the Mexican American population in the United States, relatively little is known regarding cognitive aging among this minority group compared to non-Hispanic, white individuals. The current study was conducted to describe the nature of cognitive and affective characteristics of Mexican American patients with dementia or other cognitive disorders on initial presentation to a Memory Disorder Clinic. Archival data were reviewed from this specialty clinic for 219 patients who were evaluated for the first time over a 2-year period. Twenty-two Mexican American patients were identified, and a sample of 22 matched non-Hispanic white patients was derived for comparison. When compared to non-Hispanic white patients, Mexican Americans were found in fewer numbers, reported higher levels of anxiety and depression, and produced lower scores on neurocognitive assessments. Results support the notion that Mexican American patients present for cognitive assessment and treatment at a greater stage of impairment severity as compared to non-Hispanic whites.     

Repetition-lag training to improve recollection memory in older people with amnestic mild cognitive impairment. A randomized controlled trial

The results of a randomized controlled trial of repetition-lag training in older adults with amnestic mild cognitive impairment (aMCI) are reported. A modified repetition-lag training procedure with extended encoding time and strategy choice was used. The training required discriminating studied words from non-studied lures that were repeated at varying intervals during the test phase. Participants were assessed pre/post using untrained measures of cognition and self-report questionnaires. Primary outcome measures were recall of unrelated word pairs both immediately following presentation and following a delay. Secondary outcomes were a measure of attention, cognitive flexibility, and visual working memory. Participants were also asked to report on the frequency of cognitive failures and mood before and after training. Participants (N = 31) were randomized into either the treatment or a no-contact control group and attended the clinic twice per week over a four week period. Twenty-four participants completed the study (twelve in each group). Results indicated that the training group improved at recalling unrelated word pairs after a delay. There were no significant effects of training on other outcomes, self-reported cognitive failures or mood. The results are discussed along with suggestions for future research.     

Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review

Given projected increases in dementia prevalence, emphasising earlier stages of cognitive impairment in older adults enables targeted early intervention strategies. Strategy-based cognitive training (SCT) is a remedial approach involving guidance and practice in compensatory techniques to improve cognition, including memory and attention. It may also be effective for improving executive functions (EF) integral to everyday tasks. This review systematically evaluates SCT effects on EF in older adults without dementia. Following PRISMA guidelines, we reviewed eligible trials according to pre-defined criteria, differentiating SCT from other cognitive interventions and stipulating total EF-focused intervention time, study design and target population (healthy older adults or mild cognitive decline). We then evaluated trials according to design, methodological quality and outcomes. Unfortunately, with too few studies in mild cognitive impairment, we refocused our review only on healthy older adults. Thirteen studies with 4120 participants in total were included, primarily targeting inductive reasoning. Despite heterogeneous study designs and SCT programs, 11/13 trials reported significant EF improvements, generally of moderate effect size (Hedges’ g > 0.3). Four studies reported sustained benefits from one month to 10 years. There was some evidence of far transfer. We conclude that there is promising evidence for SCT as a targeted intervention for EF in healthy older adults and preliminary evidence for maintaining effects over time. Fewer trials have investigated far transfer (e.g. improved everyday functioning) or capacity to delay/prevent dementia, which are most relevant to clinical utility. Limitations include the inability to calculate effect sizes for four studies and absence of statistical meta-analysis.     

Cortisol,interleukins and S100B in delirium in the elderly

In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in repeated blood samples. 120 patients (mean age 84 years, 62 patients with delirium) were included. Highest levels of IL-8 (27.1, 95% Confidence Interval (CI): 13.6–53.1 pg/ml) and cortisol (666, 95% CI: 475–859 nmol/L) were before delirium, but of IL-6 (84.3, 95% CI: 46.5–151.4 pg/mL) and S100B (0.18, 95% CI: 0.12–0.24 μg/L) during delirium. In multivariable analysis cortisol, LogIL-6, and LogS100B were significantly associated with delirium, but adjusted for pre-existing cognitive impairment, only LogS100B remained significantly associated. Cortisol, IL-6 and S100B may have a role in the pathogenesis of delirium, but S100B is the strongest independent marker.     

Brain and cognitive-behavioural development after asphyxia at term birth

Perinatal asphyxia occurs in approximately 1-6 per 1000 live full-term births. Different patterns of brain damage can result, though the relation of these patterns to long-term cognitive-behavioural outcome remains under investigation. The hippocampus is one brain region that can be damaged (typically not in isolation), and this site of damage has been implicated in two different long-term outcomes, cognitive memory impairment and the psychiatric disorder schizophrenia. Factors in addition to the acute episode of asphyxia likely contribute to these specific outcomes, making prediction difficult. Future studies that better document long-term cognitive-behavioural outcome, quantitatively identify patterns of brain injury over development and consider additional variables that may modulate the impact of asphyxia on cognitive and behavioural function will forward the goals of predicting long-term outcome and understanding the mechanisms by which it unfolds.     

中年Ⅱ型糖尿病人记忆损伤特点

本研究主要探讨中年Ⅱ型糖尿病人的记忆损伤特征。研究选取病人和对照各30人,控制年龄(65岁以下。病人组平均53岁,正常组52岁)、教育水平和相关疾病等因素。测试数字符号、数字工作记忆广度、动作记忆和无意义图形再认4项认知任务。结果发现：(1)病人组数字符号测试显著低于正常组;(2)在支持性条件记忆自由回忆中,病人组在有动作演练的高语义关联和无动作演练的低语义关联项目上显著低于对照组。出现分离现象;(3)在线索回忆中,病人组与对照组差异不显著;(4)两组数字工作记忆广度、无意义图形再认的成绩无差异。根据SPT(subject—performed task)研究理论对结果进行了分析,得出结论：中年Ⅱ型糖尿病人记忆的一般性信息加工能力未表现出受损,但特异信息加工受到损伤,并可能预测随年龄及病程进行而表现出一般性信息加工能力受损。     

Impact pattern of dialectical thinking on perceived leadership training outcomes

This research examined the impact of dialectical thinking (DT) on perceived training outcomes in commercial leadership training using a quasi‐experimental design. Study 1 found that high‐DT individuals had better perceived on‐site training outcomes when compared with individuals with low DTs, regardless of training methods. But there was no significant difference between low and high DTs on subsequent behavioral improvements. It was also found that self‐reported training outcomes were consistent with others' observation. To further validate the on‐site effect of DT, we introduced a cognitive style manipulation prior to training to increase DT levels among trainees in Study 2. Individuals following the cognitive style manipulation reported significantly better perceived training outcomes. The implications of this research for field training are discussed.     

Neuropsychology of mildly disabled patients with relapsing-remitting multiple sclerosis

Previous papers have mainly demonstrated the presence of cognitive impairment in patients with multiple sclerosis (MS), these changes have been traditionally associated with the later stages of the disease. In the current study, a comprehensive neuropsychological battery was administered to 216 relapsing-remitting MS patients with mild clinical disability (EDSS相似文献   

Investigating medical decision‐making capacity in patients with cognitive impairment using a protocol based on linguistic features

A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision‐making capacity by use of a Swedish linguistic instrument for medical decision‐making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision‐making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision‐making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one‐dimensional instrument of medical decision‐making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.     

Working memory and attention are still impaired after three years in patients with stress‐related exhaustion

Cognitive impairment is one of the most pronounced symptoms reported by patients with stress‐related mental health problems. Impairments related to executive function and to some extent speed and attention are therefore common in patients with stress‐related burnout/exhaustion. In this paper we present a follow‐up of cognitive performance in patients with stress‐related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow‐up time was three years. Half of the patients still reported mental health problems at follow‐up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long‐lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress‐related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow‐up periods longer than three years are needed to explore the persistence of the cognitive impairment.     

Neurocognitive and functional outcomes in persons recovering from West Nile virus illness

Long‐term neurocognitive and functional impairments following West Nile virus (WNV) disease are poorly understood. We assessed quality‐of‐life indices and neurocognitive performance in a cohort of 54 persons recovering from one of three WNV disease syndromes (fever [WNF], meningitis [WNM], or encephalitis [WNE]) approximately 1.5 years following acute illness. We compared findings between the three syndromic groups; the study cohort and a demographically similar group of 55 controls from a study of chronic fatigue syndrome (CFS); and the study cohort and a ‘normative’ control population based on cognitive test data. Persistent symptoms, diminished quality of life, and functional impairment were reported by 50% of WNF patients, and 75% each of WNM and WNE patients. Overall, objective neurocognitive performance did not differ significantly between the three syndromic groups, or between the study cohort and the CFS controls or the normative controls. In some neurocognitive subtests, the study cohort scored below the 15th percentile when compared with normative control data. Most persons who returned to independent living following hospitalization for WNV illness had persistent subjective complaints, but had normal cognitive function. However, a minority displayed subtle neurocognitive deficits more than 18 months following acute disease.     

Neurocognitive outcomes in pediatric HIV

Cognitive impairment has long been associated with the natural history of HIV among vertically infected children. In children, HIV may have a direct or indirect impact on the developing brain, may lead to global or highly specific consequences, and may be responsible for minor cognitive consequences or, conversely, long-term and severe disability. This differential impact is related to multiple factors that influence the individual expression of the virus in any given child. This review provides an overview of the relevant literature on neurocognitive outcomes for infants, children, and youth vertically infected with HIV, with attention to those factors impacting neurocognitive outcome within a developmental framework. Research findings in both the era preceding and following the introduction of combined therapies are reviewed, since many of the issues identified prior to state-of-the-art treatment currently available in the United States and other developed countries still apply in much of the developing world. Intervention issues and directions for future research are also discussed.     

Increasing the number of contacts generated during contact tracing interviews

ABSTRACT

To stem the spread of infectious diseases (e.g., Ebola), epidemiologists conduct contact tracing interviews (CTIs) with infected individuals regarding their contacts who may also be infected. These contact tracing interviews, however, may be vulnerable to deadly errors of omission. A promising technique to maximise recall is the Cognitive Interview (CI), which is grounded in psychological theory. In the present study, participants imagined they were infected with meningococcal meningitis and reported their contacts over the previous three days during either a control interview or a CI. To model the cognitive impairment associated with being sick, half of the participants were interviewed while simultaneously completing a cognitive impairment task. The CI generated more contacts than the control interview. However, when the cognitive impairment task was completed, the CI and the control interview performed similarly. We recommend the CI be considered as an alternative to the control interview, particularly if the interviewee is not temporarily impaired due to distraction or illness.     

Assessment of 'subcortical dementia' in patients with Huntington's disease, Parkinson's disease, multiple sclerosis and AIDS by a neuropsychological screening battery

Four diagnostic groups categorized as 'subcortical dementia' were studied using a neuropsychological screening battery. The specificity of the battery in disclosing characteristic patterns of impairment in subgroups within the category, and the correspondence between natural subgroups generated by an unsupervised statistical classification technique and the diagnostic labels were investigated. All cognitive affected subgroups demonstrated impairment on tests of sensomotor function, congnitive efficiency and/or memory, and were characterized in terms of severity of impairment as well as a progressive involvement of functional areas. The diagnostic groups were not evenly represented in all natural subgroups. Affected AIDS-patients seemed to resemble patients with Huntington's disease more than the other diagnostic groups. The screening battery could give a general characterization of the pattern of 'subcortical dementia' and different levels of impairment, but more specific process-oriented tasks are needed to contrast diagnostic groups within the concept of 'subcortical dementia'.     

Just lying there, remembering: improving recall of prose in amnesic patients with mild cognitive impairment by minimising interference

The hallmark of amnesia is poor explicit long-term memory along with normal short-term memory. It is often stated that information encountered by amnesic patients is forgotten within 1 minute of presentation. However, previous work has not distinguished between forgetting as a function of time versus the interfering material occupying that time. We show that there is a marked benefit of reduced interference in amnesic patients with mild cognitive impairment (MCI), a condition that is characterised by anterograde amnesia in the absence of other neuropsychological deficits and carries an increased risk for Alzheimer's disease. The result suggests that long-term memory is encoded in these patients to a greater extent than had been realised but that their memory is highly vulnerable to interference.