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At least 19 recordsLinked to original sources
PubMed2025

Contribution of the Brain-Gut-Microbiome Axis to Intergenerational Abnormalities in a Rat Model of Perioperative Neurocognitive Disorder.

BACKGROUND: The brain-gut-microbiome (BGM) axis is a communication network through which the brain and gastrointestinal microbiota interact via neural, hormonal, immune, and gene expression mechanisms. Gut microbiota dysbiosis is thought to contribute to neurocognitive disorders, including perioperative neurocognitive disorder, and to various metabolic abnormalities. Recently, the authors reported that sevoflurane induces neurocognitive deficits in exposed rats as well as their future offspring, with male offspring being particularly affected (intergenerational perioperative neurocognitive disorder). In this study, the authors examined in the same animals whether the intergenerational effects of sevoflurane involve abnormalities in the BGM axis, and whether they are mitigated by paternal pretreatment with either the Na + -K + -Cl - (NKCC1) Cl - transporter inhibitor bumetanide or the glucocorticoid receptor inhibitor RU486, as previously demonstrated for neurocognitive deficits. METHODS: Male Sprague-Dawley rats (F0 generation) were exposed to 2.1% sevoflurane for 3 h on postnatal days 56, 58, and 60 (F0M_S group). Before each sevoflurane exposure, distinct experimental groups of F0 males received bumetanide (F0M_BS group) or RU486 (F0M_RS group). These males were mated on postnatal day 90 to produce offspring (F1 generation). Gut microbiota were profiled using 16S rRNA gene sequencing, and brain changes analyzed via RNA sequencing of hippocampal samples. RESULTS: F1 male offspring of F0M_S sires exhibited heightened corticosterone responses to stress, increased inflammatory markers, altered hippocampal transcriptomes, gut microbiota dysbiosis, elevated serum low-density lipoprotein cholesterol levels, and increased body weight. The only abnormality observed in F1 females was a shift in microbial diversity. F0M_S displayed profound alterations in hippocampal transcriptome, while microbial diversity was the only parameter affected in their gut microbiota. Bumetanide or RU486 mitigated most abnormalities, except increased body weight in F1 males. CONCLUSIONS: Paternal sevoflurane exposure in rats induces BGM axis abnormalities, particularly in male offspring, despite the absence of direct anesthetic exposure. Pretreatment with bumetanide or RU486 showed therapeutic efficacy.

Animals↗
PubMed2006

Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study.

CONTEXT: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions. OBJECTIVE: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. METHODS: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison. RESULTS: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups. CONCLUSION: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.

Aged↗
PubMed2003

Base rate of Hiscock Digit Memory Test failure in HIV-associated neurocognitive disorders.

There is an emergent need for base rate data on symptom validity tests (SVTs) in clinical populations that are likely to seek disability benefits. The inclusion of HIV under the Americans with Disabilities Act has prompted many persons with HIV-1 infection to apply for disability, which raises the concern that a subset of these individuals might feign cognitive deficits to obtain benefits. This brief report provides base rate data on one SVT, the Hiscock Digit Memory Test (HDMT), in a sample of 82 non-compensation-seeking, neuropsychologically impaired participants who met diagnostic criteria for an HIV-associated neurocognitive disorder. Approximately 98% of individuals with HIV-associated neurocognitive disorders performed above an established HDMT cutoff for suboptimal effort (i.e., HDMT> or =90% accuracy), whilst 95% of the sample obtained perfect scores. Clinicians can therefore be confident that, in the absence of severe dementia or amnesia, HDMT scores below standard cutoffs are unlikely to be solely attributable to HIV-associated cognitive impairment.

Adult↗
PubMed1991

Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas.

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.

Adult↗
PubMed2000

Diagnosis and treatment of HIV-associated neurocognitive disorders.

Although significant strides have been made in recent years in treating HIV disease with new antiretroviral medications, the management of neurocognitive disorders continues to remain a challenge. This chapter provides an overview of the current epidemiology, neuropathogenesis, clinical features, diagnosis, and treatment of the central nervous system complications of HIV infection.

AIDS Dementia Complex↗
PubMed2004

Psychiatric and neurocognitive disorders among HIV-positive and negative veterans in care: Veterans Aging Cohort Five-Site Study.

BACKGROUND: The risk for psychiatric and neurocognitive disorders among middle-aged and older individuals with HIV infection has not been well characterized. METHODS: The Veterans Aging Cohort 5-Site Study enrolled 1803 patients (1047 HIV-positive) from VA infectious disease and general medicine clinics from September 2001 to June 2002. A convenience subset of 10 patients from each site (n = 50) was consented for formal neurocognitive and psychiatric (NCP) testing. Data from this subset were linked to the larger sample. RESULTS: Kappa scores for agreement beyond chance were fair for available measures when compared with formal NCP testing. Using available measures, depressive symptoms (PHQ-9 and provider reported), alcohol abuse or dependence (ICD-9 codes), and drug abuse or dependence (DAST-10) decreased with age in HIV-negative subjects (P trend <0.05) but did not among HIV-positive subjects (P > 0.05). HIV-positive subjects demonstrated higher prevalence of these conditions with increasing age when compared to HIV-negative subjects. Patient report of memory problems increased with age among both groups after excluding those reporting symptoms of depression (PHQ-9e > or = 10). CONCLUSION: Available measures were no substitute for formal NCP testing. Older HIV-positive veterans demonstrate greater prevalence of depressive symptoms, alcohol abuse or dependence, and drug abuse or dependence than age-matched, HIV-negative veterans. Both groups reported increased memory problems with advancing age. This preliminary work suggests a substantial prevalence of psychiatric and neurocognitive problems among middle-aged and older HIV-infected individuals.

Adult↗
PubMed1999

Should schizophrenia be treated as a neurocognitive disorder?

The search is on for meaningful psychopharmacological and cognitive/behavioral interventions for neurocognitive deficits in schizophrenia. Findings in this area are emerging rapidly, and in the absence of integrating frameworks, they are destined to emerge chaotically. Clear guidelines for testing neurocognitive interventions and interpreting results are critical at this early stage. In this article, we present three models of increasing complexity that attempt to elucidate the role of neurocognitive deficits in schizophrenia in relation to treatment and outcome. Through discussion of the models, we will consider methodological issues and interpretive challenges facing this line of investigation, including direct versus indirect neurocognitive effects of antipsychotic medications, selection of particular neurocognitive constructs for intervention, the importance of construct validity in interpreting cognitive/behavioral studies, and the expected durability of treatment effects. With a growing confidence that some neurocognitive deficits in schizophrenia can be modified, questions that seemed irrelevant only a few years ago are now fundamental. The field will need to reconsider what constitutes a successful intervention, what the relevant outcomes are, and how to define treatment efficacy.

Activities of Daily Living↗
PubMed2007

Dementia and neurocognitive disorders due to HIV-1 infection.

Human immunodeficiency virus-type 1 (HIV-l) infection is the most common preventable and treatable cause of neurocognitive impairment in individuals under age 50 years. Although the incidence of HIV-associated dementia has decreased over the past few years due to combination antiretroviral therapy (cART), the prevalence of less severe HIV-associated neurocognitive impairment continues to increase. HIV-associated neurocognitive impairment is a significant burden to persons living with HIV infection, caregivers, and the health care system. Neurocognitive changes associated with HIV are typically subcortical, consisting of the triad of cognitive, behavior, and motor dysfunction. HIV-associated dementia and HIV-associated neurocognitive impairment are clinical diagnostic syndromes with neuropsychological performance testing, neuroimaging, and cerebral spinal fluid studies providing additional information. With the advent of more effective cART, the incidence of fatal opportunistic complications has dramatically diminished. Accordingly, the present review focuses on primary HIV-induced disease of the central nervous system, rather than its opportunistic complications.

AIDS Dementia Complex↗
PubMedDate not supplied

Neurocognitive disorders seen in HIV disease.

Despite dramatic improvements in the therapeutic management of clients with human immunodeficiency virus (HIV) disease, cognitive disorders still appear as clinical manifestations of the illness trajectory. The development of neuro-cognitive impairment is associated with high levels of HIV activity and the resultant severe degree of immunosuppression. Although many clinicians almost exclusively associate HIV-related cognitive dysfunction with HIV encephalopathy and dementia, the etiologic conditions are numerous and include not only HIV infection affecting the brain, but also infections and neoplasms, as well as adverse effects of prescribed therapies. Treatment strategies include pharmacologic interventions, alternative and complementary therapies, and milieu management.

AIDS Dementia Complex↗
PubMed1999

Cortical synaptic density is reduced in mild to moderate human immunodeficiency virus neurocognitive disorder. HNRC Group. HIV Neurobehavioral Research Center.

Dendritic and synaptic damage (without frank neuronal loss) may be seen in milder human immunodeficiency virus (HIV)-related cognitive disorders. Synapse volume estimates, performed by stereological methods, could enhance the ability to detect subtle neuronal changes that may accompany cognitive impairment in HIV infection. For the present study, synaptic density and neuronal number were assessed by combined stereology/confocal microscopy and these measures were then correlated with ante-mortem levels of cognitive performance in AIDS patients. Three-dimensional stereological measures showed a significant correlation between reduced synaptic density and poor neuropsychological performance. To evaluate the specificity of any observed associations, additional variables including viral burden, astrogliosis and number of calbindin-immunoreactive neurons were measured. Factor analysis of a set of neuropathological variables revealed two factors; one defined by synaptic density and volume fraction, calbindin pyramidal neuronal densities and viral burden; the second by astrocytosis and calbindin interneuron density. Only the first factor correlated significantly with neuropsychological functioning during life. It is concluded that a combination of factors including synaptic damage, specific neuronal loss and increasing viral load underlies HIV-associated cognitive impairment. As synaptic damage is potentially reversible, early diagnosis and treatment of mild cogntive disorders may improve functioning and prevent the progression of brain disease.

AIDS Dementia Complex↗
PubMed2003

[Medical students' understanding of geriatric medicine].

With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. At Ehime University School of Medicine, the Department of Geriatric Medicine was established on April 1,1997. To assess the status of geriatric medicine in undergraduate education, we surveyed the opinions of medical students on geriatric medicine. A questionnaire was sent to both fourth-year medical students before their classes on internal medicine and geriatric medicine had ended and to sixth-year medical students after their classes had already ended. Medical students of Ehime University School of Medicine had significantly more interest in geriatric medicine than students at other medical schools. From a clinical viewpoint of problems in old age, they considered that cerebrovascular disease, cardiovascular disorders, neurocognitive disorders and pulmonary disease were important. A total of 60% agreed that all medical schools should have classes in geriatric medicine, which is a higher rate than that of previous reports. To study the opinions of medical students on textbooks on geriatrics, we also conducted a questionnaire among medical students. Although 90% of students had their own textbooks of internal medicine and almost half (42%) had textbooks on physical examination, none had their own textbook of geriatric medicine. The most frequent reason was "hard to choose the best textbook". The present study indicates that to develop education in geriatric medicine, it is important to make a recommendable text book for medical students, which is easily understood with high quality and originality.

Attitude to Health↗
PubMed2005

Subfrontal transbasal approach and technique for resection of craniopharyngioma.

A multimodality approach to craniopharyngioma, including minimally invasive stereotactic techniques, microsurgery, conventional radiotherapy, and radiosurgery has been recommended to tackle craniopharyngioma aggressively while minimizing harm to the patient. With all approaches, there are varying levels of risk for endocrinological morbidity, vascular complications, neuropsychological and behavioral disorders, neurocognitive disorders, and learning disabilities. Although many treatment options are available, total tumor resection remains the most commonly performed procedure for treatment of craniopharyngioma, and it is still believed to give the patient the greatest chance of having an independent and productive life with low risk of recurrences. The authors prefer the subfrontal transbasal approach for resection of these tumors, and they describe this approach and illustrate it with the accompanying figures.

Brain Neoplasms↗