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  1. Kandiah N, Ong PA, Yuda T, Ng LL, Mamun K, Merchant RA, et al.
    CNS Neurosci Ther, 2019 02;25(2):288-298.
    PMID: 30648358 DOI: 10.1111/cns.13095
    BACKGROUND: The Ginkgo biloba special extract, EGb 761® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer's disease (AD).

    METHODS: To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence-based consensus recommendations regarding the use of EGb 761® in neurocognitive disorders with/without cerebrovascular disease.

    RESULTS: Key randomized trials and robust meta-analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761® versus placebo in patients with mild-to-moderate dementia. In those with mild cognitive impairment (MCI), EGb 761® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761® with the same strength of evidence as acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761® to have a positive risk-benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta-analyses have not supported this association.

    CONCLUSIONS: The Expert Group foresee an important role for EGb 761® , used alone or as an add-on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761® should be used in alignment with local clinical practice guidelines.

    Matched MeSH terms: Mild Cognitive Impairment/complications
  2. Paudel YN, Angelopoulou E, Jones NC, O'Brien TJ, Kwan P, Piperi C, et al.
    ACS Chem Neurosci, 2019 10 16;10(10):4199-4212.
    PMID: 31532186 DOI: 10.1021/acschemneuro.9b00460
    Emerging findings point toward an important interconnection between epilepsy and Alzheimer's disease (AD) pathogenesis. Patients with epilepsy (PWE) commonly exhibit cognitive impairment similar to AD patients, who in turn are at a higher risk of developing epilepsy compared to age-matched controls. To date, no disease-modifying treatment strategy is available for either epilepsy or AD, reflecting an immediate need for exploring common molecular targets, which can delineate a possible mechanistic link between epilepsy and AD. This review attempts to disentangle the interconnectivity between epilepsy and AD pathogenesis via the crucial contribution of Tau protein. Tau protein is a microtubule-associated protein (MAP) that has been implicated in the pathophysiology of both epilepsy and AD. Hyperphosphorylation of Tau contributes to the different forms of human epilepsy and inhibition of the same exerted seizure inhibitions and altered disease progression in a range of animal models. Moreover, Tau-protein-mediated therapy has demonstrated promising outcomes in experimental models of AD. In this review, we discuss how Tau-related mechanisms might present a link between the cause of seizures in epilepsy and cognitive disruption in AD. Untangling this interconnection might be instrumental in designing novel therapies that can minimize epileptic seizures and cognitive deficits in patients with epilepsy and AD.
    Matched MeSH terms: Mild Cognitive Impairment/complications
  3. Smith TO, Neal SR, Peryer G, Sheehan KJ, Tan MP, Myint PK
    Int Psychogeriatr, 2019 10;31(10):1491-1498.
    PMID: 30522546 DOI: 10.1017/S1041610218002065
    OBJECTIVES: To determine the relationship between falls and deficits in specific cognitive domains in older adults.

    DESIGN: An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

    SETTING: United Kingdom community-based.

    PARTICIPANTS: 5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.

    MEASUREMENTS: Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.

    RESULTS: Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65-0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p = 0.05) remained significant for predicting recurrent falls.

    CONCLUSIONS: The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall.

    Matched MeSH terms: Mild Cognitive Impairment/complications
  4. Srisurapanont M, Mok YM, Yang YK, Chan HN, Della CD, Zainal NZ, et al.
    J Affect Disord, 2018 05;232:237-242.
    PMID: 29499506 DOI: 10.1016/j.jad.2018.02.014
    BACKGROUND: Several studies have described the presence of perceived cognitive dysfunction amongst Asian patients with major depressive disorder (MDD). To date, no study has been conducted investigating the predictors of perceived cognitive dysfunction amongst Asian MDD patients.

    METHODS: This was a post-hoc analysis of the Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Descriptive statistics were used to describe the most common cognitive complaints by patients. Univariate and multivariate analyses were performed to determine variables associated with perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D).

    RESULTS: The CogDAD study population is comprised of MDD patients with mild-to-moderate depression (Patient Health Questionnaire 9-item [PHQ-9]: 11.3 ± 6.9) who reported perceived cognitive dysfunction (PDQ-D = 22.6 ± 16.2). The most common cognitive complaints were: mind drifting (42.3%), trouble making decision (39.6%) and trouble concentrating (38.0%). Predictors of perceived cognitive dysfunction were: being Southeast Asians (vs. Taiwanese) (p 

    Matched MeSH terms: Mild Cognitive Impairment/complications*
  5. Raman P, Khy Ching Y, Sivagurunathan PD, Ramli N, Mohd Khalid KH
    J Glaucoma, 2019 08;28(8):685-690.
    PMID: 31033782 DOI: 10.1097/IJG.0000000000001269
    PRECIS: This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD).

    AIM: Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients.

    METHODS: This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model.

    RESULTS: Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=-0.20, P=0.03; rs=-0.20, P=0.04; rs=-0.28, P=0.003; rs=0.21, P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation.

    CONCLUSION: Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.

    Matched MeSH terms: Mild Cognitive Impairment/complications*
  6. Choo BKM, Kundap UP, Johan Arief MFB, Kumari Y, Yap JL, Wong CP, et al.
    PMID: 30844417 DOI: 10.1016/j.pnpbp.2019.02.014
    Epilepsy is marked by seizures that are a manifestation of excessive brain activity and is symptomatically treatable by anti-epileptic drugs (AEDs). Unfortunately, the older AEDs have many side effects, with cognitive impairment being a major side effect that affects the daily lives of people with epilepsy. Thus, this study aimed to determine if newer AEDs (Zonisamide, Levetiracetam, Perampanel, Lamotrigine and Valproic Acid) also cause cognitive impairment, using a zebrafish model. Acute seizures were induced in zebrafish using pentylenetetrazol (PTZ) and cognitive function was assessed using the T-maze test of learning and memory. Neurotransmitter and gene expression levels related to epilepsy as well as learning and memory were also studied to provide a better understanding of the underlying processes. Ultimately, impaired cognitive function was seen in AED treated zebrafish, regardless of whether seizures were induced. A highly significant decrease in γ-Aminobutyric Acid (GABA) and glutamate levels was also discovered, although acetylcholine levels were more variable. The gene expression levels of Brain-Derived Neurotrophic Factor (BDNF), Neuropeptide Y (NPY) and Cyclic Adenosine Monophosphate (CAMP) Responsive Element Binding Protein 1 (CREB-1) were not found to be significantly different in AED treated zebrafish. Based on the experimental results, a decrease in brain glutamate levels due to AED treatment appears to be at least one of the major factors behind the observed cognitive impairment in the treated zebrafish.
    Matched MeSH terms: Mild Cognitive Impairment/complications
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