DOCSLIB.ORG

Chapter 10. Delirium, Dementia, and Amnestic and Other Cognitive Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chapter 10. Delirium, Dementia, and Amnestic and Other Cognitive Disorders CHAPTER 10. DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS Kaplan & Sadock’s Comprehensive Textbook of Psychiatry CHAPTER 10. DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS ERIC D. CAINE, M.D. AND JEFFREY M. LYNESS, M.D. Definition History Comparative Nosology Diagnosis Pathology and Laboratory Examination Etiology and Differential Diagnosis Cognitive Disorders Diagnosis and Clinical Features Diagnosis and Clinical Features Psychiatry is in the midst of a profound transformation, at once struggling to incorporate a dynamic understanding of neuroscience and molecular biology while maintaining a view of unique persons or individuals as the central focus of therapeutic intervention. To date it has been beyond the scope of knowledge to effectively integrate research data regarding individual differences with more abstract findings regarding fundamental aspects of brain development or aging-related neurodegeneration. Discovering the bases for the major neuropsychiatric diseases can be expected to provide powerful clues for defining the nature of how neurobiological processes are expressed as emotions, thoughts, or actions, or how life events and daily experiences alter and shape brain growth and development. Since the late 1980s, a major conceptual transition has occurred in the way clinicians and researchers view the relation between mental disorders and brain function. For much of the past century psychiatry was trapped in an either-or dilemma—either a condition was viewed as a symptomatic manifestation of structural cerebral or systemic pathology (organic), or it was considered psychological or emotional in nature (functional). However, clinicians recognized that there are no behaviors that do not involve the brain, and that the transmission of culturally derived processes from individual to individual is influenced by each person's central nervous system (CNS). Behaviors defined by some cultures as abnormal may be mediated by normal neurophysiology; in contrast, patients with damaged brains may develop compensatory strategies reflective of CNS plasticity to ameliorate the effects of disordered neural systems. The same behavior (e.g., suicide) may reflect normal or abnormal physiology. For many diseases the CNS develops normally but acquires its dysfunction later in life whereas other diseases may reflect aberrant wiring patterns or connections that function in a neurochemically or neurophysiologically normal fashion. Despite such complexity, clinicians often depended on a single criterion for defining organic disorders—either the detection of a structural lesion or, less often, the diagnosis of a known disease process; however, such an approach is no longer satisfactory. Diagnostic decisions have depended largely on available technology. For more than a century gross postmortem examination and microscopic histopathological examination were the primary tools. Working in a tradition of clinical-pathological correlation, psychiatrists, neurologists, and others used a dichotomous approach to both diagnosis and classification—that is, a lesion was either present or absent. This approach proved heuristically limiting and became increasingly unrewarding. Indeed, histopathology is now no longer the gold standard for defining brain-based diseases. It was only marginally useful for psychiatry, and in the near future molecular biological methods will replace it for neurology. The advent of new technologies already has undermined the pseudocertainty of earlier years. Many patients with functional syndromes are found to have CNS abnormalities when studied with magnetic resonance imaging (MRI), positron emission tomography (PET), or single photon emission computed tomography (SPECT). Should these syndromes be reclassified as organic? Most would argue that such changes would be premature because the pathophysiological significance of newer findings remains obscure. Such arguments also are pertinent to the entire question of organic versus functional. The fourth edition of Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) establishes a new approach to those questions. The categories of organic and functional have been abandoned. When a psychopathological syndrome is known to be a symptomatic manifestation of a systemic medical or cerebral disorder, it is designated as “due to . .” (secondary), with a designation of the specific disease process. When it is considered to be an idiopathic psychiatric disturbance, it is designated primary. A clinician should follow a careful process of case reasoning before settling on the primary or secondary status of a disorder. To appropriately diagnose a patient as having an idiopathic (i.e., primary) condition, the clinician must necessarily exclude all definable, potentially etiological disease processes. The clinician must exercise equal caution before diagnosing a disorder as secondary or symptomatic. To date there are no widely accepted guidelines for establishing probable causal relations between psychopathological conditions and detected cerebral abnormalities. Traditionally, such assignment of probable causality has been left to clinical judgment. DSM-IV outlines such guidelines; they have the effect of encouraging the clinician to undertake a thorough evaluation and to postulate causal connections conservatively. DEFINITION The primary-secondary classification, like similar classifications, reflects the thinking of its time. The change in terminology in DSM-IV from organic to due to . is more than cosmetic in that it captures the conceptual shift away from structure and lesion and toward active disease process and etiology. The broad group of cognitive disorders includes dementia, delirium, amnestic disorder, and other syndromes in which disordered cognition caused by known (or presumed) disease entities is the central characteristic featuret (Table 10-1). Specific secondary syndromes are scattered through the nosology, classified along with other phenomenologically similar clinical conditions (e.g., mood disorders due to general medical conditions are grouped among the mood disturbances). Such groupings are intended to foster differential diagnostic consideration; the changes in DSM-IV are intended to enhance rigorous clinical reasoning. Use of more specific designations (e.g., mood disorder due to thyroid deficiency, with major depressive-like episode) strengthens diagnostic specificity when contrasted to the previously used organic mood disorder and lays the foundation for more meaningful comparative research. Table 10-1 DSM-IV Cognitive Disorders Throughout this chapter the term “neuropsychiatry” is used in reference to the field of medicine that considers the brain bases of mental disorders. In the United Kingdom this field is sometimes called organic psychiatry. At one time nearly all of psychiatry was neuropsychiatry; at another time, few would have chosen that label. Considering the brain substrates of behavior necessarily forces clinicians and researchers also to recognize the experiential, psychological, social, and cultural aspects of the patients and the problems they encounter. HISTORY The development of neuropsychiatry and the growth of general psychiatry coincided with competition and ultimately cooperation between public psychiatric asylums (now called hospitals or centers) and clinical practice in universities and private offices. Different ideologies or dogmas developed, depending on whether the clinician was seeing principally institutionalized psychotic patients, for whom there was little hope for improvement or recovery, or ambulatory patients, whose apparent psychological accessibility gave rise to therapeutic optimism. Additionally, psychiatrists in the asylums (often called alienists) had different needs than the nerve doctors or neurointernists who saw the walking wounded in their offices. Table 10-2 presents a brief categorization of historical periods in neuropsychiatry. It is probably not presumptuous to state that Wilhelm Griesinger (1817–1868) created neuropsychiatry with the publication of his book in 1845, crafted after practicing 2 years in Winenthal, one of the leading German asylums. An advocate of physiological medicine, Griesinger attempted to steer German medical practice away from both the romantic and somatic schools of that time. He asserted that psychiatry was part of medicine and that “psychological diseases are diseases of the brain.” He also advocated knowing one's patients well, understanding their life course, and appreciating how their mental disease affected their overall functioning. He advanced a specific notion of the ego that attempted to explain all disease under a single conceptual view based on a gradual pathological erosion of ego integrity. He supported the idea of careful neuropathological observation, although he never pursued such work in the later fashion of Theodor H. Meynert, Karl Wernicke, or Alois Alzheimer. Table 10-2 Historical Periods in Neuropsychiatry Despite Griesinger's attempted integration, many of his notions now seem simplistic or misleading, especially the idea that all mental illnesses reflected one basic pathological process that could be divided into stages. The first of Griesinger's disease stages involved an assault on the ego by the basic disease, although no frank pathological disruption was apparent. In the second and third stages, ego disintegration was completed and permanent brain changes took place. Griesinger believed that therapeutic intervention would be successful
Load more

Recommended publications
  • Clinical Neuropsychology What Is Clinical Neuropsychology?
    Clinical Neuropsychology What is Clinical Neuropsychology? A Neuropsychologist is a licensed psychologist trained to examine the link between a patient’s brain and behavior. A Neuropsychologist will assess neurological, medical, and genetic disorders, psychiatric illness and behavior problems, developmental disabilities, and complex learning issues. UNC PM&R’s Neuropsychologists work with children, adolescents, and adults. The primary goal of this service is to utilize results of the evaluation to collaborate with the patient and develop a treatment plan and recommendations that best fit the patient’s needs. Patients who may benefit from a Neuropsychological Evaluation include those with: • A neurological disorder such as epilepsy, hydrocephalus, Parkinson’s disease, Alzheimer’s disease and other dementias, multiple sclerosis, or hydrocephalus • An acquired brain injury from concussion or more severe head trauma, stroke, hydrocephalus, lack of oxygen, brain infection, brain tumor, or other cancers • Other medical conditions that may affect brain functioning, such as chronic heart, lung, kidney, or liver problems, diabetes, breathing issues, lupus, or other autoimmune diseases • A neurodevelopmental disorder such as cerebral palsy, spina bifida, intellectual disabilities, learning difficulties, ADHD disorder, or autism spectrum disorder • Problems with or changes in thinking, memory, or behavior with no clear known cause What is the evaluation like? The evaluation will be tailored to The evaluation may last between 3-6 address the patient’s specific concerns hours and typically includes: about functioning, and can address 1. Interview with the patient and the following: possibly family members/caretakers • General intellectual ability and/or problems in 2. Assessment and testing (typically a reading, writing, or math combination of one-on-one tests of • Problems with/changes in attention, memory, thinking involving paper/pencil or a thinking abilities, or language tablet, along with questionnaires) • Changes in emotional or behavioral 3.
    [Show full text]
  • NEGLECT and ANOSOGNOSIA a CHALLENGE for PSYCHOANALYSIS Psychoanalytic Treatment of Neurological Patients with Hemi-Neglect
    Psychoanalytische Perspectieven, 2002, 20, 4: 611-631 NEGLECT AND ANOSOGNOSIA A CHALLENGE FOR PSYCHOANALYSIS Psychoanalytic treatment of neurological patients with hemi-neglect Klaus Röckerath1 Introduction This paper deals with two phenomena often observed in patients with a lesion to the right hemisphere of the brain: neglect and anosognosia. Fol- lowing an overview of the neglect syndrome from a neuroscientific per- spective I will present preliminary results and hypotheses formulated by our group based on the psychoanalytic treatment of seven such patients. It may be somewhat unusual for neurologically impaired patients to undergo psychoanalytic treatment. But in recent years, a combined effort to under- stand the underlying mechanisms of psychic phenomena has evolved in psychoanalysis and the neurosciences. Hence, the field of neuro-psycho- analysis established itself, studying the psychic implications of neurologi- cal damage in order to understand and gain insight into the "psychic appa- ratus", as constructed by Freud, from a different point of view. It is well known that Freud, a trained neurologist, hoped that one day the mecha- nism of psychic functions would be understood from a neurologist's point of view. He was convinced that the answer to the psychic problems he encountered with his patients must be rooted in the matter of the mind: the brain. That is why groups of psychoanalysts and neuroscientists all over the world have begun to exchange news and views about their common interest: the human mind. Both sciences basically deal with the same object. One way psychoanalysts can contribute is by looking at neurologically impaired patients in a psychoanalytic framework to establish what is dif- 1.The Neurops ychoanalytic Study Group Frankfurt/Cologne, Germany.
    [Show full text]
  • Psychogenic and Organic Amnesia. a Multidimensional Assessment of Clinical, Neuroradiological, Neuropsychological and Psychopathological Features
    Behavioural Neurology 18 (2007) 53–64 53 IOS Press Psychogenic and organic amnesia. A multidimensional assessment of clinical, neuroradiological, neuropsychological and psychopathological features Laura Serraa,∗, Lucia Faddaa,b, Ivana Buccionea, Carlo Caltagironea,b and Giovanni A. Carlesimoa,b aFondazione IRCCS Santa Lucia, Roma, Italy bClinica Neurologica, Universita` Tor Vergata, Roma, Italy Abstract. Psychogenic amnesia is a complex disorder characterised by a wide variety of symptoms. Consequently, in a number of cases it is difficult distinguish it from organic memory impairment. The present study reports a new case of global psychogenic amnesia compared with two patients with amnesia underlain by organic brain damage. Our aim was to identify features useful for distinguishing between psychogenic and organic forms of memory impairment. The findings show the usefulness of a multidimensional evaluation of clinical, neuroradiological, neuropsychological and psychopathological aspects, to provide convergent findings useful for differentiating the two forms of memory disorder. Keywords: Amnesia, psychogenic origin, organic origin 1. Introduction ness of the self – and a period of wandering. According to Kopelman [33], there are three main predisposing Psychogenic or dissociative amnesia (DSM-IV- factors for global psychogenic amnesia: i) a history of TR) [1] is a clinical syndrome characterised by a mem- transient, organic amnesia due to epilepsy [52], head ory disorder of nonorganic origin. Following Kopel- injury [4] or alcoholic blackouts [20]; ii) a history of man [31,33], psychogenic amnesia can either be sit- psychiatric disorders such as depressed mood, and iii) uation specific or global. Situation specific amnesia a severe precipitating stress, such as marital or emo- refers to memory loss for a particular incident or part tional discord [23], bereavement [49], financial prob- of an incident and can arise in a variety of circum- lems [23] or war [21,48].
    [Show full text]
  • 22 Psychiatric Medications for Monitoring in Primary Care
    22 Psychiatric Medications for Monitoring in Primary Care Medication Warnings, Precautions, and Adverse Events Comments Class: SSRI Fluvoxamine Boxed Warnings: Suicidality Used much less than SSRIs in the group of eight Indications: Warnings and Precautions: Similar to other SSRIs medications for prescribing, probably because it has no Adult: OCD Adverse Events: Similar to other SSRIs FDA indication for MDD or any anxiety disorder. Still Child/Adolescent: OCD (10-17 years) somewhat popular as a medication for OCD. Uses: Anxiety, OCD Monitoring: Same as other SSRIs Citalopram Boxed Warning: Suicidality. Escitalopram, one of the SSRIs in the group of Indications: Warnings and Precautions: Similar to other SSRIs medications for prescribing, is an active metabolite of Adult: MDD Adverse Events: Similar to other SSRIs citalopram. Escitalopram reportedly has fewer AEs and Child/Adolescent: None less interaction with hepatic metabolic enzymes than Uses: Anxiety, MDD, OCD citalopram but is otherwise essentially identical. Citalopram offers no advantage other than price, as Monitoring: Same as other SSRIs escitalopram is branded until 2012. Paroxetine Boxed Warnings: Suicidality. Paroxetine used much less than the SSRIs for Indications: Warnings and Precautions: Similar to other SSRIs prescribing, probably because of its nonlinear kinetics. Adult: MDD, OCD, Panic Disorder, Generalized Anxiety Adverse Events: Similar to other SSRIs A study of children and adolescents showed doubling Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder the dose of paroxetine from 10 mg/day to 20 mg/day Child/Adolescent: None resulted in a 7-fold increase in blood levels (Findling et Uses: Anxiety, MDD, OCD al, 1999). Thus, once metabolic enzymes are saturated, paroxetine levels can increase dramatically with dose Monitoring: Same as other SSRIs increases and decrease dramatically with dose decreases, sometimes leading to adverse events.
    [Show full text]
  • Benzodiazepine Anti-Anxiety Agents: Prevalence and Correlates of Use in a Southern Community
    Benzodiazepine Anti-anxiety Agents: Prevalence and Correlates of Use in a Southern Community rn- rn Marvin Swartz, MD, Richard Landerman, PhD, Linda K George, PhD, Mary Lou Melville, MD, Dan Blazer, MD, PhD, and Karen Smith, PhD Introduction alence and patterns of benzodiazepine antianxiolytic drug use in the Piedmont re- Benzodiazepine anti-anxiety agents gion of North Carolina during 1982-83, uti- are the most widely prescribed psycho- lizing logistic regression analysis, which al- therapeutic drugs in the United States to- lows prediction of benzodiazepine use day.' First introduced in 1960, these drugs while introducing controls for potential rapidly achieved a lead position in the pre- confounding and mediating variables. scription drug market,2 stimulating public and professional debate over appropriate Method psychotropic drug use.3 Recent evidence, however, suggests that the prevalence and The present paper reports results patterns of psychotropic use, especially from Wave 1 of the Piedmont Health Sur- those of benzodiazepine anxiolytics, may vey, one site of the five-site National In- be changing and resulting in decreased stitute of Mental Health Epidemiologic use.4,5 The first detailed population survey Catchment Area program (NIMH- of psychotropic drug use, the National ECA).'1 The sampling frame for the Pied- Household Sample in 1970-71,6-9 found mont Health Survey (PHS) was a five- that 22 percent of American adults had county area in north central North used prescription psychotropic medica- Carolina, consisting of one urban county tion during the year 1969-70, with higher and four contiguous rural counties. The use among women and the elderly.
    [Show full text]
  • Criteria for Unconscious Cognition: Three Types of Dissociation
    Perception & Psychophysics 2006, 68 (3), 489-504 Criteria for unconscious cognition: Three types of dissociation THOMAS SCHMIDT Universität Gießen, Gießen, Germany and DIRK VORBERG Technische Universität Braunschweig, Braunschweig, Germany To demonstrate unconscious cognition, researchers commonly compare a direct measure (D) of awareness for a critical stimulus with an indirect measure (I) showing that the stimulus was cognitively processed at all. We discuss and empirically demonstrate three types of dissociation with distinct ap- pearances in D–I plots, in which direct and indirect effects are plotted against each other in a shared effect size metric. Simple dissociations between D and I occur when I has some nonzero value and D is at chance level; the traditional requirement of zero awareness is necessary for this criterion only. Sensitivity dissociations only require that I be larger than D; double dissociations occur when some experimental manipulation has opposite effects on I and D. We show that double dissociations require much weaker measurement assumptions than do other criteria. Several alternative approaches can be considered special cases of our framework. [what do you see?/ level and that the indirect measure has some nonzero nothing, absolutely nothing] value. This so-called zero-awareness criterion may seem —Paul Auster, “Hide and Seek” (in Auster, 1997) like a straightforward research strategy, but historically it The traditional way of establishing unconscious percep- has encountered severe difficulties. From the beginning, tion has been to demonstrate that awareness of some criti- the field was plagued with methodological criticism con- cal stimulus is absent, even though the same stimulus af- cerning how to make sure that a stimulus was completely fects behavior (Reingold & Merikle, 1988).
    [Show full text]
  • Depression and Delirium of the Older Adult Interprofessional Geriatrics
    3/1/2018 Interprofessional Geriatrics Training Program Depression and Delirium of the Older Adult HRSA GERIATRIC WORKFORCE ENHANCEMENT FUNDED PROGRAM Grant #U1QHP2870 EngageIL.com Acknowledgements Authors: Curie Lee, DNP, AGPCNP-BC, RN L. Amanda Perry, MD Editors: Valerie Gruss, PhD, APN, CNP-BC Memoona Hasnain, MD, MHPE, PhD Learning Objectives Upon completion of this module, learners will be able to: 1. Summarize the difference between delirium and depression in older adults 2. Discuss the use of standardized tools for measuring cognitive, behavioral, and/or mood changes to confirm diagnoses 3. Discuss the structured assessment method to make a differential diagnosis based on the clinical features of delirium and depression 4. Apply management principles according to pharmacologic/ nonpharmacologic strategies 5. Identify materials to educate patients and family/caregivers 1 3/1/2018 Delirium vs. Depression • Delirium and depression can coexist but are not the same diagnosis • Both have Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for diagnosis: • Delirium is the acute onset of behavioral changes and/or confusion and often has an organic cause; resolution is often as abrupt as onset • Depression can be acute or insidious in onset and can last for years; though pathology can exacerbate the depression, it is not the cause of the depression Note: Depression in the geriatric population can be confused with delirium or dementia Delirium Delirium: Definition DSM-5: Five Key Features of Delirium 1) Disturbance in attention and awareness 2) Disturbance develops over a short period of time, represents a change from baseline, and tends to fluctuate during the course of the day 3) An additional disturbance in cognition Continued on next slide..
    [Show full text]
  • Behavorial Health Department – Primary Care Center and Fireweed Treatment Guidelines for Cognitive Disorders
    BEHAVORIAL HEALTH DEPARTMENT – PRIMARY CARE CENTER AND FIREWEED TREATMENT GUIDELINES FOR COGNITIVE DISORDERS EXECUTIVE SUMMARY .................................................................................................... 2 INTRODUCTION AND STATEMENT OF INTENT .................................................................................2 DEFINITION OF DISORDER......................................................................................................2 GENERAL GOALS OF TREATMENT ..............................................................................................3 SUMMARY OF 1ST, 2ND AND 3RD LINE TREATMENT ............................................................................3 CLINICAL AND DEMOGRAPHIC ISSUES THAT INFLUENCE TREATMENT PLANNING..........................................3 FLOW DIAGRAM ............................................................................................................. 4 ASSESSMENT.................................................................................................................. 5 PSYCHIATRIC ASSESSMENT ....................................................................................................5 PSYCHOLOGICAL TESTING ......................................................................................................5 SCREENING/SCALES ............................................................................................................5 MODALITIES & TREATMENT MODELS.............................................................................
    [Show full text]
  • Overview of Stroke: Etiologies, Demographics, Syndromes, And
    Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company Consulting Fees/Honoraria The Medicines Co. Silk Road Medical Definitions Stroke - abrupt development of a focal neurological deficit due to a vascular cause associated with permanent neuronal injury Transient ischemic attack (TIA)- same clinical syndrome as a stroke but resolves completely < 24 hours i.e. without permanent brain injury (old definition) With modern imaging most events >several hours duration are associated with infarction. Epidemiology- USA ~795,000 new or recurrent stroke per year 610,000 first attacks 185,000 recurrent attacks 2001 to 2011 relative rate of stroke death fell 35.1% Actual number of stroke deaths declined 23.0% In 2011 stroke caused ~1 of every 20 deaths in USA On average,1 stroke every 40 seconds in USA 1 Stroke death every 4 minutes There are ~ 4.5-5 million Stroke survivors Stroke is the leading cause of adult disability in USA 15-30% of all stroke leads to permanent disability Mozaffarian D, et al. Heart Disease and Stroke Statistics- 2015 Update. Circulation 2015;131:e29-322. Prevalence of Stroke by Age and Sex (National Health and Nutrition Examination Survey: 2009–2012). Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322 Copyright © American Heart Association, Inc. All rights reserved. Annual Age-adjusted Incidence of First-ever Stroke by Race.
    [Show full text]
  • Treatment of Unawareness of Deficits in Patients with Acquired Brain Injury
    J Head Trauma Rehabil Vol. 29, No. 5, pp. E9–E30 Copyright c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury: A Systematic Review Anne-Claire Schrijnemaekers, MSc; Sanne M. J. Smeets, MSc; Rudolf W. H. M. Ponds, PhD; Caroline M. van Heugten, PhD; Sascha Rasquin, PhD Objective: To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI). Methods: Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated. Results: A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large. Conclusion: Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness.
    [Show full text]
  • Neuroinflammation and Functional Connectivity in Alzheimer's Disease: Interactive Influences on Cognitive Performance
    Research Articles: Neurobiology of Disease Neuroinflammation and functional connectivity in Alzheimer's disease: interactive influences on cognitive performance https://doi.org/10.1523/JNEUROSCI.2574-18.2019 Cite as: J. Neurosci 2019; 10.1523/JNEUROSCI.2574-18.2019 Received: 5 October 2018 Revised: 25 March 2019 Accepted: 11 April 2019 This Early Release article has been peer-reviewed and accepted, but has not been through the composition and copyediting processes. The final version may differ slightly in style or formatting and will contain links to any extended data. Alerts: Sign up at www.jneurosci.org/alerts to receive customized email alerts when the fully formatted version of this article is published. Copyright © 2019 Passamonti et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license, which permits unrestricted use, distribution and reproduction in any medium provided that the original work is properly attributed. 1 Neuroinflammation and functional connectivity in Alzheimer’s disease: 2 interactive influences on cognitive performance 3 4 L. Passamonti1*, K.A. Tsvetanov1*, P.S. Jones1, W.R. Bevan-Jones2, R. Arnold2, R.J. Borchert1, 5 E. Mak2, L. Su2, J.T. O’Brien2#, J.B. Rowe1,3# 6 7 Joint *first and #last authorship 8 9 10 Authors’ addresses 11 1Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK 12 2Department of Psychiatry, University of Cambridge, Cambridge, UK 13 3Cognition and Brain Sciences Unit, Medical Research Council, Cambridge,
    [Show full text]
  • Relationship Between the Postoperative Delirium And
    Theory iMedPub Journals Journal of Neurology and Neuroscience 2020 www.imedpub.com Vol.11 No.5:332 ISSN 2171-6625 DOI: 10.36648/2171-6625.11.1.332 Relationship Between the Postoperative Delirium and Dementia in Elderly Surgical Patients: Alzheimer’s Disease or Vascular Dementia Relevant Study Jong Yoon Lee1*, Hae Chan Ha2, Noh June Mo2, Hong Kyung Ho2 1Department of Neurology, Seoul Chuk Hospital, Seoul, Korea. 2Department of Orthopedic Surgery, Seoul Chuk Hospital, Seoul, Korea. *Corresponding author: Jong Yoon Lee, M.D. Department of Neurology, Seoul Chuk Hospital, 8, Dongsomun-ro 47-gil Seongbuk-gu Seoul, Republic of Korea, Tel: + 82-1599-0033; E-mail: [email protected] Received date: June 13, 2020; Accepted date: August 21, 2020; Published date: August 28, 2020 Citation: Lee JY, Ha HC, Mo NJ, Ho HK (2020) Relationship Between the Postoperative Delirium and Dementia in Elderly Surgical Patients: Alzheimer’s Disease or Vascular Dementia Relevant Study. J Neurol Neurosci Vol.11 No.5: 332. gender and CRP value {HTN, 42.90% vs. 43.60%: DM, 45.50% vs. 33.30%: female, 27.2% of 63.0 vs. male 13.8% Abstract of 32.0}. Background: Delirium is common in elderly surgical Conclusion: Dementia play a key role in the predisposing patients and the etiologies of delirium are multifactorial. factor of POD in elderly patients, but found no clinical Dementia is an important risk factor for delirium. This difference between two subgroups. It is estimated that study was conducted to investigate the clinical relevance AD and VaD would share the pathophysiology, two of surgery to the dementia in Alzheimer’s disease (AD) or subtype dementia consequently makes a similar Vascular dementia (VaD).
    [Show full text]