ObjectiveTo analyze the risk factors of cognitive dysfunction in patients with epilepsy, and provide evidence for clinical prevention and treatment.MethodsDuring the period from January 1, 2018 to January 31, 2019, 101 patients with epilepsy who were admitted to the epilepsy specialist clinic of the General Hospital of Ningxia Medical University were included in this study. The cognitive function of the patients was evaluated by the Mini-mental State Examination (MMSE) scale and patients were divided into cognitive impairment group and normal cognitive function group according to the MMSE. Single factor and logistic regression analysis were used to find the differences of influencing factors between the two groups.Results① There were 27 cases of cognitive dysfunction in 101 patients with epilepsy, the incidence of cognitive impairment was 26.7%; ② Univariate analysis showed that the course of disease, frequency of seizures, seizure forms, anti-epileptic drugs (AEDs) and abnormal rate of electroencephalogram (EEG) existed significant differences between the two groups (P<0.05). ③ Logistic regression showed that course of disease, frequency of seizures and AEDs multidrug therapy were independent risk factors for cognitive dysfunction in patients with epilepsy (P<0.05).ConclusionCourse of disease, frequency of seizures and AEDs multidrug therapy are independent risk factors for cognitive dysfunction in patients with epilepsy.
The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO2 of S group were significantly higher before CPB time of rewarming than that before SGB (P＜0.05), much higher than corresponding non-blocked side rSO2 before CPB (P＜0.05), and much higher than rSO2 level in group C before CPB and after CPB(P＜0.05). The non-blocked side rSO2 in group S before anesthesia were much lower than basic levels and those in group C (P＜0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO2 compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.
ObjectiveTo systematically review the prevalence of cognitive impairment in patients with sarcopenia. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect studies related to the objectives from inception to December 10, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 14.0 software. ResultsA total of 27 studies were included. The overall prevalence rate of cognitive impairment in sarcopenia was 36.1% (95%CI 29.4% to 42.8%). Subgroup analysis showed that the prevalence in Europe was higher than that in other areas. The prevalence of nursing home residents was highest. ConclusionCurrent evidence shows that the prevalence of cognitive impairment in patients with sarcopenia is high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo study the correlation of postoperative cognitive dysfunction (POCD) with type-2 diabetes and glycosylated hemoglobin (HbA1c) levels in elderly patients. MethodsA total of 140 elderly patients who were going to undergo non-cardiothoracic surgery in our hospital between January 2011 and February 2013 were included in this study.ASA classification was between I and Ⅲ.There were 78 males and 62 females,aged between 65 and 86 years old.Group A had 70 patients with diabetes,while group B had another 70 corresponding patients without diabetes.One day before surgery and a week after surgery,Mini-mental State Examination (MMSE) and Montreal Cognitive Functioning Scale (MoCA) were used to test patients'cognitive function,and the incidence of POCD was compared between the two groups.Group A patients,according to HbA1c levels,were divided into group AH (HbA1c>7.5%) and group AL (HbA1c<7.5%).And we compared the relationship between group AL and group B,and the relationship between group AH and group B. ResultsThe incidence of POCD in group A was significantly higher than that in group B (P<0.05).Group AH had a significantly higher incidence of POCD than group AL (P<0.05).No significant difference was found in fasting plasma glucose among the groups. ConclusionElderly diabetic patients with poor glycemic control is a risk factor for POCD occurrence,but fasting glucose as a predictor of POCD is not as good as HbA1C.
Objective To evaluate diagnostic accuracy of several relevant cut-off points of Montreal cognitive assessment (MoCA) for mild cognitive impairment (MCI) in Chinese middle-aged adults. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), OVID, CBM, CNKI, VIP, WanFang Data were searched for diagnostic tests about MoCA for MCI from April 9th 2005 to December 31st 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality by QUADAS-2 tool. Then, meta-analysis was performed by Stata 14.0 software. Results A total of 27 studies involving 5 755 participants were included with mean ages from 60 to 80 years old. Among them, 1 997 were diagnosed as MCI patients by Petersen criteria. Based on maximal area under the ROC curve as well as optimal pooled sensitivity and specificity, the optimal cutoff value of MoCA was 25/26, the pooled sensitivity was 0.96 with 95%CI 0.93 to 0.97, specificity was 0.83 with 95%CI 0.75 to 0.89, and DOR was 107 with 95%CI 61 to 188. The subgroup analysis with different research designs, different sources of study participants and different MoCA versions all indicated 25/26 as an optimal cut-off value. Conclusion The optimal cutoff value of MoCA in Chinese middle-aged adults for screening MCI by Petersen criteria was 25/26.
【摘要】 目的 了解心脏瓣膜置换术后认知功能障碍（POCD）的危险因素，明确围手术期脑糖代谢异常是否为术后POCD的可能发病机制之一。 方法 选取2004年3月-2009年7月心脏瓣膜置换术患者70例，根据术后第7天患者认知功能测定结果分为POCD组（n =31）和非POCD组（n =39），比较两组患者年龄、性别、体外循环（CPB）时间、主动脉阻断时间、主动脉阻断后平均动脉压和平均灌注流量，并且分别于麻醉后手术前（T1）、CPB稳定的低温期（T2）、复温至33℃（T3）、CPB结束后30 min（T4）4个时点采动脉及颈内静脉血，测定血气、血糖浓度，计算出脑摄氧率（CEO2）、脑糖摄取Glu（a-v）。 结果 发生POCD的患者年龄较非POCD组大，并且CPB时间和主动脉阻断时间也更长，两组之间比较有统计学差异（Plt;0.05），但是两组在性别、主动脉阻断后平均动脉压和平均灌注流量比较无统计学差异。两组的CEO2变化趋势一致，各时点的值无明显变化，两组间比较无差异；非POCD组的Glu（a-v）各时点间比较无统计学差异，POCD组的Glu（a-v）T1、T2时点也无明显变化，但POCD组的Glu（a-v）在T3、T4明显降低，并且与非POCD组比较有统计学意义（Plt;0.05）。 结论 年龄、CPB时间和主动脉阻断时间是POCD发生的危险因素。脑糖代谢异常是POCD发生的可能机制之一。【Abstract】 Objective To understand the risk factor of postoperative cognitive dysfunction (POCD), and identify whether perioperative brain glucose metabolism disorder was or not pathogenesis of POCD after heart valve replacement operation. Methods From March 2004 to July 2009, 70 patients with heart valve replacement were divided into POCD group (n=31) and non-POCD group (n=39) according to cognitive function status tested on the seventh day after operation. The age, sex, cardiopulmonary bypass (CPB) duration, aortic crossclamp duration, mean arterial blood pressure and mean priming volume after aortic crossclamp of two groups were compared. Blood samples were drawn from the radial artery and jugular bulb catheters for determination of blood gas and glucose after induction of anaesthesia (baseline), at the time of the lowest CPB temperature, rewarming to 33℃, and 30 minutes after termination of CPB, CEO2 and Glu (a-v) were calculated: CEO2= (CaO2－CvO2) /CaO2. Results In POCD group, the average age was larger and CPB duration and aortic crossclamp duration was longer than in non-POCD group (Plt;0.05) , but there were no statistical differences in sex, mean arterial blood pressure and mean priming volume after aortic crossclamp. The change tendency of CEO2 of two groups were similar and without significant difference. Glu (a-v) of non-POCD group had no difference in every point, and Glu (a-v) of POCD group had no difference in T1 and T2 points, but value of Glu (a-v) of POCD group decreased obviously and had distinct difference with that of non-POCD group in T3 and T4 points (Plt;0.05). Conclusion Age, CPB duration, and aortic crossclamp duration were risk factors of POCD. Brain glucose metabolism disorder was possibly one of pathogenesis of POCD.
Postoperative cognitive dysfunction (POCD) is a common and important complication after cardiac surgery. The pathological reactions caused by cardiac surgery, such as traumatic stress reaction, inflammation, hemodynamics disorders, and blood coagulation dysfunction, by triggering central inflammation, ischemia, hypoxia and ischemia-reperfusion injury and other mechanisms, leading to brain function-impairment, causing the development of POCD. According to the above mechanisms, taking corresponding protective measures, reducing the development of POCD, and improving the quality of life after cardiac surgery are of great importance.
Objective To investigate the prevalence of cognitive impairment and identify its influencing factors among lung cancer patients undergoing chemotherapy, providing a scientific basis for targeted interventions. Methods A convenience sample of lung cancer patients receiving chemotherapy at West China Hospital, Sichuan University between April and October 2024 was enrolled. Data were collected using a general information questionnaire, the Mini-Mental State Examination, Nutritional Risk Screening 2002, Hospital Anxiety and Depression Scale, Barthel index, and FRAIL scale. Univariate analyses and multivariate logistic regression were performed to determine factors associated with cognitive impairment. Results A total of 380 patients undergoing chemotherapy for lung cancer were enrolled, and 205 (53.9%) of them had cognitive impairment. Univariate analyses revealed that there were statistically significant differences between the cognitively normal group and the cognitive impairment group in age, educational level, work status, nutritional status, Barthel index, and FRAIL scale score (P<0.05). Multivariate logistic regression showed that advanced age [odds ratio (OR)=1.045, 95% confidence interval (CI) (1.015, 1.075), P=0.002] and FRAIL scale score [OR=1.369, 95%CI (1.165, 1.609), P<0.001] were identified as independent risk factors for cognitive impairment, whereas higher educational attainment served as a protective factor, compared with patients with primary school education or below, patients with junior high school, high school/secondary vocational school, college, or undergraduate education and above had a lower risk of cognitive impairment [OR=0.437, 0.258, 0.243, 0.120, P<0.05]. Conclusions Cognitive impairment is highly prevalent among lung cancer patients undergoing chemotherapy and is significantly influenced by age, educational level, and frailty. Healthcare providers should develop targeted interventions based on these factors to reduce the prevalence of cognitive impairment.