Cognitive Impairment in Patients With Dual Pathology

Background: Breast cancer treatment, particularly chemotherapy, is known to cause cognitive impairment, often referred to as "chemo fog" or "chemo brain," which can persist for months to years after treatment has been completed. Currently, there are no proven options to attenuate the development of cognitive impairment in chemotherapy patients. Some non-pharmacological interventions that may help alleviate chemotherapy-induced cognitive impairment include music therapy, guided meditation (or mindfulness), and acupuncture. Music therapy has been shown to activate cortical areas in the brain that help with emotional processing and stress while acupuncture is hypothesized to promote neuroplasticity, reduce inflammation and improve cerebral blood flow. Guided meditation has been shown to improve memory and executive function potentially by preventing neuronal loss during chemotherapy. Acupuncture, guided meditation and music therapy have all shown promise in alleviating cognitive and emotional symptoms in those with mild cognitive impairment and dementia. Their efficacy in addressing chemotherapy-induced cognitive impairment (CICI) in breast cancer patients remains underexplored. Objective: This study aims to evaluate the effectiveness of music therapy, guided meditation and acupuncture in mitigating cognitive impairment in breast cancer patients undergoing chemotherapy. We hypothesize that these complementary interventions will blunt any cognitive impairment in patients receiving neoadjuvant and adjuvant chemotherapy. Methods: Participants will be randomly assigned to one of four groups: (1) guided meditation and music therapy; (2) guided meditation and acupuncture; (3) music therapy and acupuncture; and (4) no intervention. Cognitive function will be assessed using a PROMIS NIH questionnaire across domains related to anxiety, depression, cognition, fatigue, sleep, companionship, and emotional support. Data will be analyzed to compare the efficacy of the intervention groups against each other as well as against the control group. Results: We anticipate that the combined intervention of acupuncture and music therapy will result in significant improvements in cognitive function compared to other interventions and the control group. We believe that the domains most likely to be affected include anxiety, depression, cognition, and emotional support. We anticipate that the (1) guided meditation and music therapy and (2) guided meditation and acupuncture intervention groups will also show improvements in cognitive function compared to the control group. Conclusions: The study aims to provide evidence that the combination of acupuncture and music therapy offers a novel, non-pharmacological approach to alleviating chemotherapy-induced cognitive impairment in breast cancer patients. If successful, these interventions could be incorporated into standard supportive care practices, improving the overall quality of life for patients suffering from cognitive deficits post-chemotherapy. Further research will be needed to fully understand the underlying mechanisms and optimize treatment protocols to attenuate chemotherapy-induced cognitive dysfunction. Citation Format: Jules Cohen, Gaurav Sharma. The role of music therapy, guided meditation and acupuncture in attenuating chemotherapy-induced cognitive impairment in breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-05-06.

Objective To investigate the correlation between cognitive impairment and cerebral atherosclerosis in patients with acute ischemic stroke. Methods Acute ischemic stroke patients without cognitive impairment were recruited before symptom onset. The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function. Magnetic resonance imaging (MRI) was used to identify the infarct locations and sides. Magnetic resonance angiography, CT angiography and digital subtraction angiography were used to identify atherosclerotic arteries. Results A total of 101 patients with acute ischemic stroke were enrolled, including 75 (74.3%) with cognitive impairment. The proportions of age (54.54±12.59 years vs. 64.43±10.37 years; t= -3.960, P<0.001), years of education ≤6 years (50.7% vs. 11.5%; χ2 =12.257, P<0.001), and cerebral atherosclerosis (89.3% vs. 50.0%; χ2 =18.137, P<0.001) of the cognitive impairment group were significantly higher than those of the normal cognitive function group. Multivariate logistic regression analysis showed that cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke (odds ratio 1.720, 95% confidence interval 1.005-2.942; P=0.048). MoCA score was negatively correlated with the offending vessels (r= -0.365, P<0.001) and the most severe vessels of atherosclerotic degree (r= -0.243, P=0.014). Conclusions Most patients with acute ischemic stroke had cognitive impairment in the early stage after onset, and the MoCA scores was negatively correlated with the degree of cerebral atherosclerosis. Cerebral atherosclerosis was an independent risk factor for cognitive impairment in patients with acute ischemic stroke. Key words: Stroke; Brain Ischemia; Cognition Disorders; Atherosclerosis; Risk Factors

Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder (MDD). Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients. We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments. We also hypothesize that anxiety symptoms, especially psychic anxiety, is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors. To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode. A comprehensive neurocognitive test battery assessed executive function, attention, processing speed, and memory in 162 medication-free MDD patients and 142 matched healthy controls. The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms, and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms. Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms, as well as their interactions, on cognitive impairments. Among the depressive symptoms, sleep disturbances were associated with poorer executive function (P = 0.004), lower processing speed (P = 0.047), and memory impairments (P < 0.001), and psychomotor retardation (PR) was associated with lower processing speed in patients with MDD (P = 0.019). Notably, PR was found to mediate the impact of sleep disturbances on the processing speed. Regarding anxiety symptoms, psychic anxiety, rather than somatic anxiety, was associated with cognitive impairments in all aspects. Sleep disturbances mediated the effect of psychic anxiety on executive function [β = -0.013, BC CI (-0.027, -0.001)] and memory [β = -0.149, BC CI (-0.237, -0.063)], while PR mediated its effect on processing speed (β = -0.023, BC CI (-0.045, -0.004)]. Sleep disturbances may be a key predictor of poorer executive function, lower processing speed, and memory loss, while PR is crucial for lower processing speed during a depressive episode. Psychic anxiety contributes to all aspects of cognitive impairments, mediated by sleep disturbances and PR.

Background and Aims. The most common psychiatric conditions in epilepsy are depression, anxiety, behavioral, psychotic disorders, and cognitive disorders as well as those which can be caused by convulsive seizures. The research aimed to define cognitive and affective impairments in patients with epilepsy and methods of its non-pharmacological correction since cognitive impairments and affective disorders have a considerable impact on the functioning of patients, their socialization, and the level of their disability. Methods. We studied the features of clinical and psychopathological manifestations in patients suffering from epilepsy. The study covered 100 patients (47 men and 53 women) who were in inpatient care. The following psychodiagnostic techniques were used: the Toronto Cognitive Assessment TorCA, the test of 10 words of Luria, the MOCA test, the Munsterberg test, the Mini-Mult test, the quality of life scale, the Hamilton scale of depression and anxiety. We used non-pharmacological methods of rehabilitation for correction cognitive impairments in patients with mild and moderate dementia. During the COVID-19 pandemic, patients got access to the online version of cognitive training which was very important during quarantine restrictions. Currently, a group of patients is training remotely. Results. The following data of the study were observed: 88 % of patients had decreased memory, 38% had symptoms of depression, 28% had mild situational or neurotic depression, 8% had moderate depression, 2% had severe depression, 20% had a state of severe anxiety, 16% had symptoms of anxiety. The average rate of quality of life among all examined people was 67.5 out of 100. Conclusions. The results of the conducted research indicate the need for further study of the features of the comorbid pathology in epilepsy and the development and implementation of nonpharmacological methods for treatments of epilepsy. There is a need for further study of the effectiveness of cognitive training in patients with epilepsy.

Mitochondrial dysfunction is associated with cognitive impairment in adults with OSA without dementia

Currently, the features of the pathogenesis of cognitive impairment in patients with diabetes mellitus are being actively studied. The study of the mutual influence of these pathologies is of particular relevant not only in connection with a decrease in cognitive functions in patients with diabetes mellitus, but also due to the fact that the management of diabetes mellitus requires a thorough approach to the implementation of doctor’s recommendations and self-control on the part of the patient himself. The degree of cognitive impairment has a direct impact on patient compliance and, consequently, on the management and control of the disease. A comprehensive strategy is necessary for the prevention and progression of cognitive impairments in patients with diabetes mellitus. This strategy should include minimizing modifiable risk factors, controlling comorbidities, maintaining a healthy lifestyle, following a diet, engaging in regular physical activity, and medication therapy. Also, one of the key aspects is the control of blood glucose levels. Regular monitoring and maintaining a stable level of sugar can significantly reduce the risk of developing cognitive impairments in diabetic patients. This review also analyzes the effects of oral hypoglycemic drugs, incretin-based therapy and insulin on the risk of developing cognitive impairments. This review examines important aspects of the role of pathogenetic links and clinical manifestations of type 2 diabetes mellitus in the development of cognitive impairment and the possibility of influencing their development and rate of progression. Understanding these relationships will help develop effective strategies for the prevention and treatment of cognitive impairments in patients with diabetes mellitus.

The presence of cognitive impairment in patients who are receiving hospice care can affect numerous practical, ethical and legal aspects of their healthcare. A number of factors can contribute to cognitive impairment in these patients. Prevalence rates of cognitive impairment vary widely, but it remains under-recognised and under-treated. The aims of this pilot study were to evaluate the presence and nature of cognitive deficits in patients receiving inpatient hospice care who did not have a known current or past diagnosis of a cognitive disorder or any obvious cognitive impairments. A convenience sample of 30 patients receiving inpatient hospice care underwent bedside cognitive testing. A comprehensive battery of tests was used, including the Mini-Mental State Examination (MMSE) and standardised neuropsychological tests of pre-morbid intellectual functioning, immediate and delayed recall, digit span forward and backward, verbal reasoning and letter and category fluency. On average, subjects were impaired on the MMSE and on tests of learning, verbal reasoning and letter and category fluency. Furthermore, 12 of the 30 subjects met DSM-IV cognitive impairment criteria for dementia based on impaired performance in memory and at least one other cognitive domain on testing. The results of this pilot study suggest that a sizable proportion of patients receiving inpatient hospice care have undetected but clinically significant cognitive impairments. Assessing for and helping patients, families and caregivers deal with cognitive impairment might benefit patients’ quality of life, relationships and overall care at the end of life. Future research in this population is needed to evaluate the causes and time course of cognitive impairment over time, as well as any relationship between cognitive impairment and decision-making capacity.

Cerebral small vessel disease (CSVD) is the most common vascular cause of cognitive impairment. This study aimed to explore the association between MTHFR C677T polymorphism and cognitive impairment in CSVD patients. Demographic, medical, laboratory, cognitive evaluation, and MTHFR C677T polymorphism data were collected from CSVD patients admitted to our hospital between January 2019 and July 2023. Inclusion criteria for CSVD were based on the Standards for Reporting Vascular changes on Neuroimaging (STRIVE) criteria, with age ≥ 45 years. Binary logistic regression models were used to analyze risk factors associated with WMH and cognitive impairment. A total of 330 CSVD participants were recruited in this study, including 179 male and 151 female, with a median age of 64 years (interquartile range: 58-73 years). There were 185 patients (56.1%) with cognitive impairment, 236 patients (71.5%) with WMH, 89 patients (27.0%) with CMB, 87 patients (26.4%) with lacunes. All participants completed MTHFR polymorphism analysis, 149 cases (45.2%) of the CC genotype, 112 cases (33.9%) of the CT genotype and 69 cases (20.9%) of the TT genotype. Patients with TT genotype exhibited higher plasma homocysteine levels and more severe WMH and cognitive impairment (p < 0.001). Multivariable binary logistic regression model showed that WMH was significantly associated with age (p = 0.019), history of hypertension (p = 0.011), HHcy (p = 0.019) and MTHFR genotype (p = 0.041); while cognitive impairment was significantly associated with age (p = 0.033), history of hypertension (p = 0.019), HHcy (p = 0.040), MTHFR genotype (p = 0.039), WMH (p = 0.041), and lacunes (p = 0.001). In this cross-sectional study, we investigated the association between MTHFR C677T polymorphism and cognitive function in CSVD patients. We found that MTHFR 677 TT genotype was an independent risk factor for the progression of WMH and cognitive impairment in CSVD patients.

Introduction: Coronavirus Disease-2019 (COVID-19) affects mental health, causing various psychiatric symptoms, including cognitive impairment, which may persist for a long time. To develop effective strategies for combating this global health burden, it is necessary to ascertain whether COVID-19 itself causes cognitive decline or whether other factors also play any role. Aim: To determine the prevalence of cognitive impairment in long COVID patients who present with post-COVID-19 psychiatric sequelae, and to investigate its association with socio-demographic factors, depression, anxiety, and stress. Materials and Methods: A cross-sectional study was conducted from July 2022 to June 2023 at a ‘Post-COVID Mental Health Clinic’ in a tertiary care medical college in Kolkata, India. A total of 204 subjects were selected through simple random sampling, aged between 18 and 65 years, of both sexes, who had recovered from COVID-19 more than three months but less than six months prior, and who presented with post-COVID-19 psychiatric sequelae, excluding those with a history of psychiatric disease before contracting COVID-19. The dependent variable, cognition, was measured using the Montreal Cognitive Assessment (MoCA) score, while independent variables included socio-demographic factors, depression, anxiety, and stress, measured by the Depression Anxiety Stress Scale -21 (DASS-21) scores. The Chisquare test was used to find the association between cognition and socio-demographic variables and Pearson’s correlation test was applied to measure the association of cognition with depression, anxiety, and stress scores. Results: The prevalence of cognitive impairment was found to be 86.8%. Chi-square tests of association showed no significant association with socio-demographic factors. However, there was a significant correlation between the severity of depression (r-value=-0.337, p-value&lt;0.001), anxiety (r-value=-0.275, p-value&lt;0.001), and stress (r-value=-0.277, p-value&lt;0.001) with cognitive impairment. When controlling for anxiety and stress, only depression showed a significant correlation (r-value=- 0.221, p-value=0.002). Simple linear regression indicated that the severity of depression significantly predicted the severity of cognitive impairment {R2 =0.114, F(1, 202)=25.88, p-value&lt;0.001}. Conclusion: Cognitive impairment was found to be unrelated to socio-demographic factors, post-COVID-19 anxiety, or stress, except for post-COVID-19 depression, which was identified as a significant predictor of cognitive dysfunction in some patients. This suggests that COVID-19 infection itself may be the most important factor contributing to post-COVID-19 cognitive impairment in patients with post-COVID-19 psychiatric sequelae.

IntroductionCerebral small vessel disease (cSVD), including Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and Cerebral Amyloid Angiopathy (CAA), is a major cause of non-sporadic stroke and cognitive impairment. Despite the recognized benefits of the Mediterranean Diet (MD) on cardiovascular and neurodegenerative diseases, its role in cSVD has not been yet investigated.MethodsThe DIETETICA study (“Effect of Mediterranean Diet on stroke incidence and cognitive impairment in patients with CADASIL and CAA”) aims to explore the association between MD adherence, stroke incidence and cognitive impairment in patients affected by CADASIL and CAA. During observational phase, 22 participants were recruited: 9 with CADASIL and 13 with CAA. 68.18% were male and 31.82% were female.ResultsAccording to the response obtained through a validated 14-item questionnaire, 63.63% of the total cohort had moderate adherence to MD, 27.27% had low adherence, and 9.09% had high adherence. Differences in body composition, in terms of fat mass (FM) and fat-free mass (FFM), were observed between the two patient cohorts. Overall, the preliminary observations regarding dietary daily intake were characterized by inadequate of nutrients which are known to have neurovascular benefits, such as polyunsaturated fatty acids (PUFAs), calcium, potassium and vitamin D, for both CADASIL and CAA patients.ConclusionThe present study will pave the way to the evaluation of the effects of MD pattern on cSVD, in order to provide evidence-based dietary recommendations aimed at reducing stroke incidence and cognitive impairment.

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation in the elderly. Airflow limitation is partially reversible and progressive. COPD not only causes a gradual decline in lung function but also affects the function of other systems throughout the body; it also has adverse effects on the central nervous system that can lead to cognitive impairment, especially in elderly patients. Therefore, understanding the influencing factors of cognitive impairment in elderly patients with COPD and applying early intervention are crucial in improving the quality of life of patients and reducing the burden on their families and society. This article mainly discusses the related factors of cognitive impairment in elderly patients with COPD and expands the possible mechanism of exercise in improving cognitive impairment in patients with COPD to provide a reference for the clinical prevention and treatment of cognitive impairment in elderly patients with COPD.

Background: Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions, which cause abnormal and often repetitive movements and postures. Despite the definition exclusively related to motor aspects, recent studies show non-motor manifestations in patients diagnosed with dystonia. There has been great emphasis on aspects related to psychiatric disorders, cognitive impairment, pain, sleep and abnormalities in sensory perception and their importance as predictors of quality of life. Objective: Investigation of psychiatric symptoms and cognitive impairment in patients with idiopathic cervical dystonia in a tertiary center. Methods: Cross-sectional, descriptive and analytical study including 31 patients diagnosed with isolated idiopathic cervical dystonia and 31 healthy control subjects matched by sex, age and education. The sample was evaluated by standardized scales and interviews to obtain data on psychiatric symptoms and cognitive disorders. The instruments used were Mental State Mini Exam, Brief Cognitive Test Battery, Digit symbol substitution test, Hayling Test, Facial Emotion Identification Test, Frontal Evaluation Test Battery, Mini International Neuropsychiatric Interview, Yale Brown Obsessive Compulsive Scale and Toronto Western Spasmodic Torticollis Rating Scale. Results: The psychiatric symptoms assessed in this study showed statistically significant differences in the prevalence of current depressive episode (38.7% and p=0.020) and depressive episode with melancholic symptoms (32.3% and p=0.003) among idiopathic cervical dystonia patients compared to the prevalence of 12.7% and 3.2% respectively among control group participants. Regarding cognitive aspects, no statistically significant difference was found in this study for results of tests applied to assess cognitive domains. A statistically significant difference was observed between patients with cervical and idiopathic dystonia and healthy control subjects to identify anger and neutral emotions (p&lt;0.05) on the emotion recognition test. Conclusion: Our study showed no difference between cervical dystonia and control subjects in tests of visual and verbal episodic memory, attention, visuo-constructive skills and executive function. However, both the higher prevalence of depression and the facial emotion recognition test were capable of distinguishing patients with cervical dystonia in this study.

Low carotid artery wall shear stress is independently associated with brain white-matter hyperintensities and cognitive impairment in older patients

Cognitive impairment and neurovascular function in patients with severe steno-occlusive disease of a main cerebral artery

Study objectivesPrimary insomnia (PI) triggers a decline in cognitive function, and the thalamus plays an integral role in this process; however, the mechanisms are unclear. The purpose of this study was to investigate the altered functional connectivity (FC) of the thalamus in PI patients with mild cognitive impairment (MCI) and to explore the potential neural mechanisms of thalamic involvement in these patients.MethodsThis case–control study was conducted in older adults from various communities in Fuzhou, China with a PI diagnosis. These participants underwent neuropsychological assessment and were matched in a 1:2 ratio to the healthy control (HC) group and the PI group according to sex, age, and education level. Resting‐state functional magnetic resonance imaging was used to explore changes in thalamic FC in PI patients. To further compare changes in thalamic and whole‐brain FC, we further divided the PI group into cognitively normal patients and patients with MCI according to the diagnostic criteria for MCI. The relationship between abnormal FC and cognitive function was investigated.ResultsThe 28 HCs and 58 participants with PI showed significant differences in Montreal Cognitive Assessment (MoCA) scores (p = .044). In comparison to the HC group, the PI group showed enhanced FC of the occipital thalamus with the left inferior occipital gyrus, right lingual gyrus, left middle temporal gyrus, left superior marginal gyrus, left dorsolateral superior frontal gyrus, and right anterior central gyrus. The MoCA total score and the executive function, attention, and abstraction scores of PI patients with MCI (PI–MCI) were worse than those of PI patients without MCI. In comparison to the simple PI group, FC was enhanced in the PI–MCI group between the left occipital thalamus and the middle occipital gyrus, and between the right occipital thalamus and the right superior frontal gyrus, left middle frontal gyrus, right superior occipital gyrus, and orbital inferior frontal gyrus. There was a significant negative correlation between the MoCA total score and the enhanced FC between the right occipital thalamus and right superior occipital gyrus (r = −.419, p = .042).ConclusionThe early onset of cognitive impairment in patients with PI is associated with altered FC between the thalamus and the cortex. Enhanced FC between the thalamus and the visual cortex, that is, the superior occipital gyrus, which is involved in attentional processing, may play a role in the early onset of cognitive impairment in insomnia patients. Moreover, due to the fact that PI patients “overdraw” the compensatory capacity of these brain regions earlier, the PI–MCI may fall into the abyss of “decompensation” faster and face more severe cognitive impairments.