Objective To investigate the characteristics of cognitive function and its correlation to neuroendocrine status in patients with refractory depression. Methods A total of 41 patients diagnosed by ICD-10 as depression onset who have been treated with more than two antidepressants drugs, fulfilled the criteria of refractory depression. Another 40 patients diagnosed by ICD-10 as depression onset but who have not been treated, or have been treated with only one antidepressant drug were selected as controls. Patients in both groups were evaluated by WAIS-RC, STROOP, VF, TRAILS A, B, TOH and M-WCST, and the concentrations of CORT, ACTH, T3, FT3, T4, FT4, TSH were also determined. Results A significant difference was found in VF between the refractory depression group and the control group. This showed that the damage to short-term memory, attention and interference rejection capability was much more serious in the refractory depression group. The ACTH concentration in the refractory depression group was significantly different from that of the control group, which indicated that the damage to the Hypothalamic-pituitary-adrenal axis was more serious in the refractory depression group. In particular in relation to memory and attention defect. Conclusion Changes in the levels of CORT, ACTH, TSH, FT3 and T4 may be correlated to cognitive function damage in patients with refractory depression.
ObjectiveTo investigate the effects of hippocampal long-term potentiation (LTP) on cognitive dysfunction in immature epileptic rats. MethodsImmature epileptic rats were established by intraperitoneal injection of lithium chloride-pilocarpine (li-pilo). Racine classification standard modified by Becker was used to evaluate behavior of epileptic seizure, and the survival rats within RacineⅣmagnitude were selected in the experiment. The function of learning and memory of epileptic rats when they were adult was assessed using Morris water maze experiment, and their independent exploratory behavior was evaluated by the open-field test. Field potential was recorded by electrophysiological technology to detecte whether hippocampal LTP was essential of cognitive dysfunction. ResultsThe function of learning and memory was significantly impaired when compared with controls(n=8, t=10.86, P < 0.05;n=8, t=9.98, P < 0.05). In addition, independent exploratory behavior was significantly reduced when compared with controls(n=8, t=12.89, P < 0.05). Besides, CA1 hippocampal LTP induced by high-frequency stimulation presented the significant inhibition in epileptic rats with cognitive dysfunction when compared with controls(Slope:n=8, t=13.32, P < 0.05;Amplitude:n=8, t=20.02, P < 0.05). ConclusionInhibition of CA1 hippocampal LTP may be implicated in cognitive dysfunction of epileptic rats.
ObjectiveTo investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). MethodsBetween January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). ResultsMean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). ConclusionsDHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. MethodsThe randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). ConclusionDexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.
Objective To explore the characteristics of cognitive impairment in patients with alcohol dependence, and analyze the related influencing factors. Methods The Montreal Cognitive Assessment Scale (MoCA) was used to evaluate the cognitive function of 65 alcohol dependent patients hospitalized between January 1st and December 31st, 2014. The features of cognitive impairment and related influencing factors were analyzed. Results The differences of MoCA attention and delayed recall between different drinking year groups had statistical significance (P<0.05). The correlations of drinking year with MoCA attention (r=–0.250,P=0.044), and with delayed recall (r=–0.326,P=0.008) were both negative. MoCA scores, naming, attention and delayed recall were different statistically among different age groups (P<0.05). The correlations of ages with MoCA scores (r=–0.429,P<0.001), naming (r=–0.261,P=0.035), attention (r=–0.391,P=0.001) and delayed recall (r=–0.461,P<0.001) were all negative. MoCA scores, the visuoconstructional skills, language, abstraction and delayed recall were significantly different among different education level groups (P<0.05). The correlations of education level with MoCA scores (rs=0.650,P<0.001), the visuoconstructional skills (rs=0.540,P<0.001), language (rs=0.486,P<0.001), abstraction (r=0.602,P<0.001) and delayed recall (rs=0.593,P<0.001) were all positive. Ages had an effect on MoCA scores by multiple linear regression analysis (P<0.01). Conclusions For alcohol dependent patients with cognitive impairment, cognitive function is correlated with drinking year, age and education level. The cognitive function is much serious in patients with older age and longer drinking years. This kind of patients should be focused on and intervened early.
ObjectiveTo investigate the status of newly diagnosed adult epilepsy in the General Hospital of Jilin Province, in order to improve the prevention and treatment of epilepsy. MethodsTo collect the clinical data of newly diagnosed adult epilepsy from October 2016 to February 2017, and to follow up 6 months. ResultsA total of 81 patients were included. At the last clinic visit, 73 cases origined from focal, 74 cases were positive in EEG examination, 56 cases were unknown etiology, 12 cases had hippocampal sclerosis, 48 cases were mildly declined cognitive function, and 30 cases were poor compliance. ConclusionThe newly diagnosed epilepsy were focal origin, delayed treatment, mildly declined cognitive function and poor compliance.
ObjectiveAnalyzing the seizure and cognitive outcome after different treatment by observation of a large group of intractable child epilepsy patients under 15 years old. MethodsCollecting data of children with Intractable epilepsy from Apirl 2008 to December 2013 in Sanbo Brain Hospital, Capital Medical University. Three historical cohorts of intractable child epilepsy defined by the final treatment including medication, curative operation and palliative operation depending on the surgical assessment and the families intension was retrospectively observed. 1 year and 3 years follow-up postoperatively were conducted including seizure outcome and cognitive outcome. ResultsThe curative operation group had significant better seizure free rate, and cognitive statement than medication group. And, the seizure free and cognitive outcome were better in palliative operation group than the medication group. ConclusionsEarly surgical intervention is highly recommended for intractable epilepsy chilelren in order to improve both the seizure and cognitive prognosis.
Objective This study aimed to observe the protective effects of 17β-estradiol (17β-E2) to the damage of phenobarbital (PB) upon the cognition of the newly-born rats. Methods Thirty healthy 3-day-old Sprague Dawley (SD) rats were randomly divided into 3 groups: control group (10 rats), PB group (10 rats) and PB+17β-E2 group (10 rats). The control group were injected saline water with a dose of 10 mL/(kg·d); the PB group were injected with PB of 10 mg/(kg·d); the PB+17β-E2 group were injected with PB 10 mg/(kg·d) and 17β-E2 300 ug/(kg·d). All the rats were intraperitoneal injected once a day after weighing, for three continuous days. They were normally raised to one month old and then 8 rats were selected out of each group respectively for water maze test. Results The PB group was reported to have increasing latent periods in finding the underwater stage compared with control group (P<0.05). In comparison with the PB group, the PB+17β-E2 group has a shorter latent period in finding the underwater stage, and furthermore statistically significantly fewer times in finding validation areas (P<0.05). During the 120s test, the stage quadrant journey to total journey ratio of PB+17β-E2 group was lower than the ratio of PB groups, but no statistics significance had been detected. The PB+17β-E2 group exhibits no significance difference from the control group in the above-mentioned indexes. Conclusions Even a short-term injection of PB with an usual clinical dose will bring a long-term damage to an immature brain in terms of the learning ability and memory, whereas the 17β-E2 may play a protective role in this course.
Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs (AEDs) therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine (LTG), Oxcarbazepine (OXC), and Sodium valproate (VPA). Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for 1 year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05) and image free recall (P<0.01) of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05), portrait characteristics contact memory (P<0.05) were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment (P<0.05), and directed memory after VPA treatment (P<0.05). Conclusions Epileptic patients accompanied with cognitive deficits before drug intervention. Through standard AEDs treatment, seizures could be better controlled. The cognitive function of epileptic patients was not declined after short-term（within 1 year） intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.
ObjectiveTo investigate the correlation and clinical significance of 8-hydroxydeoxyguanosine (8-OHdG) and endothelin-1 (ET-1) levels with cognitive dysfunction in patients with chronic obstructive pulmonary disease (COPD), and provide new idea for the prevention and treatment for cognitive dysfunction in COPD patients.MethodsA total of 103 COPD patients, according to the Montreal cognitive assessment scale standard for evaluation, were divided into a cognitive dysfunction group and a cognitive normal group. Serum 8-OHdG and ET-1 levels were compared between the two groups and their correlations with cognitive function were analyzed with the receiver operating characteristic (ROC) curve.ResultsThe levels of serum 8-OHdG and ET-1 in the COPD patients with cognitive impairment were significantly higher than those in the cognitive normal group ［8-OHdG: (13.91±9.04) ng/ml vs. (7.28±3.00) ng/ml; ET-1: (95.64±57.66)pg/ml vs. (69.20±7.89)pg/ml］ (both P<0.05). The levels of 8-OHdG (OR=22.94, 95%CI 7.06-74.53) and ET-1 (OR=19.76, 95%CI 6.59-59.31) were associated with cognitive impairment in the COPD patients. The areas under ROC curve of serum 8-OHdG and ET-1 levels to predict cognitive dysfunction in the COPD patients were 0.786 (95%CI 0.691-0.881) and 0.790(95%CI 0.695-0.885).ConclusionsThe serum levels of 8-OHdG and ET-1 are associated with cognitive impairment in COPD patients. The levels of 8-OHdG and ET-1 in serum can predict cognitive impairment with high specificity.