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To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation. Analysis of historical clinical and demographic data obtained from inpatient stay. Inpatient rehabilitation unit in a large, metropolitan university hospital. Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation. Not applicable. FIM Motor and Cognitive subscales, discharge destination, and care plan. Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent. The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Ketamine, an N-methyl D-aspartic acid receptor antagonist drug, is reported to produce memory disruptions. The aim of this study was to investigate the protective effects of ethyl pyruvate (EP), a pyruvic acid derivative, and risperidone, an atypical antipsychotic drug, against ketamine-induced cognitive disturbances. MATERIALS AND METHODS: A passive-avoidance test, a novel object recognition test, and a modified elevated plus maze test were used to assess memory functions. Hippocampal malondialdehyde (MDA) levels were measured to determine the oxidation levels. RESULTS: Ketamine applications produced memory deficits in all tests and insignificantly increased MDA levels, which were alleviated by risperidone, EP, and combination treatments. CONCLUSIONS: Increased oxidative stress and neurotransmission imbalance can be responsible for ketamine-induced memory disruptions. With its antioxidant effects, EP may be helpful to reduce cognitive impairments related to schizophrenia either alone or in combination with antipsychotics. [ABSTRACT FROM AUTHOR]

Trainee lady health visitors in Pakistan have extensive problems in their daily fieldwork: sexual harassment, character calling, rude behavior of people, irregular wages and life-threatening situations (Diwan, 2013). TLHVs experience vulnerability and harassment by religious fundamentalists (Naqvi & Khan, 2005). Their gender, age, socioeconomic background and unhealthy patterns of Pakistan's patriarchal society add more stress (Tabassum, 2016). Stress may cause depression therefore this study is conducted to explore the prevalence of depression in TLHVs of Karachi, Pakistan and to find the correlation of depression with somatic/affective factor and cognitive factor of depression by using Beck Depression Inventory-II based on descriptive and correlational design. The results indicate the prevalence of moderate depression among TLHVs, further it indicates stronger positive correlation between depression and somatic/affective factors of depression than cognitive factors of depression. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between subjective cognitive symptoms and objective cognitive test scores in patients after concussion. We additionally examined factors associated with subjective and objective cognitive dysfunction, as well as their discrepancy. Participants: Eighty-six individuals (65.1% female; 74.4% adult) from an interdisciplinary concussion clinic. Methods: Subjective and objective cognitive functioning was measured via the SCAT--Symptom Evaluation and the CNS Vital Signs Neurocognition Index (NCI), respectively. Cognitive discrepancy scores were derived by calculating standardized residuals (via linear regression) using subjective symptoms as the outcome and NCI score as the predictor. Hierarchical regression assessed predictors (age, education, time postinjury, attention-deficit/hyperactivity disorder, affective distress, and sleep disturbance) of cognitive discrepancy scores. Nonparametric analyses evaluated relationships between predictor variables, subjective symptoms, and NCI. Results: More severe affective and sleep symptoms (large and medium effects), less time postinjury (small effect), and older age (small effect) were associated with higher subjective cognitive symptoms. Higher levels of affective distress and less time since injury were associated with higher cognitive discrepancy scores (β = .723, P < .001; β = -.204, P < .05, respectively). Conclusion: Clinical interpretation of subjective cognitive dysfunction should consider these additional variables. Evaluation of affective distress is warranted in the context of higher subjective cognitive complaints than objective test performance. [ABSTRACT FROM AUTHOR]

Background: Since the year 2000, over 342 000 military service members have experienced a concussion, often associated with chronic neuropsychiatric and neurocognitive symptoms. Repetitive transcranial magnetic stimulation (rTMS) protocols have been developed for many of these symptoms in the general population. Objective: To conduct a scoping review of the literature on rTMS for neuropsychological and neurocognitive symptoms following concussion.Methods: PubMed and Google Scholar search engines identified 9 articles, written in English, corresponding to the search terms TBI or concussion; and TMS or rTMS; and depression, PTSD, or cognition. Studies that were not therapeutic trials or case reports, did not have neuropsychiatric or neurocognitive primary outcome measures, or described samples where 80% or more of the cohort did not have a TBI were excluded. Results: There were no reports of seizures nor difference in the frequency or quality of other adverse events as compared with the broader rTMS literature, supporting the safety of rTMS in this population. Support for the efficacy of rTMS for the treatment of neuropsychiatric and neurocognitive symptoms, in this population, is limited. Conclusions: Largescale, innovative, neuroscience-informed protocols are recommended to elucidate the potential utility of rTMS for the complex neuropsychiatric and neurocognitive symptoms associated with military concussions. [ABSTRACT FROM AUTHOR]

Objective: Previous transcranial magnetic stimulation (TMS) studies have demonstrated cortical inhibition (CI) abnormalities in patients with schizophrenia. However, the relationship between changes in CI and changes in psychopathology and cognition resulting from antipsychotic treatment is not known. This is an 8 week follow up study which aims to evaluate the relation of the CI with the symptoms and cognitive functions of the patients who are switched to new atypical antipsychotic treatment, and to compare the TMS measurements of patients with those of controls. Method: Thirteen patients and 13 control subjects matched according to age, sex, and educational level were included in the study. Patients were assessed with TMS, Positive and Negative Syndrome Scale (PANSS), and a neurocognitive battery at baseline and at 8 weeks post-treatment, while the control group was evaluated with the neurocognitive battery and TMS at baseline only. CI parameters evaluated by TMS include resting motor threshold, cortical silent period, ipsilateral silent period (ISP), short interval intracortical inhibition (SICI) and intracortical facilitation. Results: Intracortical facilitation (ICF) was weaker and ISP was longer in patients relative to control subjects both at baseline and at the end of the eight weeks. Intracortical facilitation decreased following 8 weeks of antipsychotic treatment, indicating an increase in CI. The decrease in PANSS general psychopathology score was directly correlated with the decrease in ICF. SICI positively correlated with cognitive test performance in both cross-sectional and longitudinal analyses. Conclusion: Our findings suggest that increase in CI is associated with the improvement in the symptoms and the action of the atypical antipsychotics. [ABSTRACT FROM AUTHOR]

Objective: Previous transcranial magnetic stimulation (TMS) studies have demonstrated cortical inhibition (CI) abnormalities in patients with schizophrenia. However, the relationship between changes in CI and changes in psychopathology and cognition resulting from antipsychotic treatment is not known. This is an 8 week follow up study which aims to evaluate the relation of the CI with the symptoms and cognitive functions of the patients who are switched to new atypical antipsychotic treatment, and to compare the TMS measurements of patients with those of controls. Method: Thirteen patients and 13 control subjects matched according to age, sex, and educational level were included in the study. Patients were assessed with TMS, Positive and Negative Syndrome Scale (PANSS), and a neurocognitive battery at baseline and at 8 weeks post-treatment, while the control group was evaluated with the neurocognitive battery and TMS at baseline only. CI parameters evaluated by TMS include resting motor threshold, cortical silent period, ipsilateral silent period (ISP), short interval intracortical inhibition (SICI) and intracortical facilitation. Results: Intracortical facilitation (ICF) was weaker and ISP was longer in patients relative to control subjects both at baseline and at the end of the eight weeks. Intracortical facilitation decreased following 8 weeks of antipsychotic treatment, indicating an increase in CI. The decrease in PANSS general psychopathology score was directly correlated with the decrease in ICF. SICI positively correlated with cognitive test performance in both cross-sectional and longitudinal analyses. Conclusion: Our findings suggest that increase in CI is associated with the improvement in the symptoms and the action of the atypical antipsychotics. [ABSTRACT FROM AUTHOR]

Introduction. AD and VD are preceded by a preclinical stage. Small but tangible cognitive impairments sometimes occur many years before the onset and diagnosis of dementia. The ongoing degenerative process can be conductive to behavioural and psychological symptoms. Aim. The aim of the study was to investigate the rates of neurobehavioral symptoms in the preclinical stages of AD and VD. Methods: Two hundred and ninety one residents of nursery homes were included in the study. Participants of the study did not display symptoms of dementia in accordance with DSMIV criteria and obtained at least 24 points on the MMSE scale and were on the first or second level of the Global Deterioration Scale. Participants were screened for behavioural and psychological symptoms with the NPI - NH scale, while their cognitive functioning was evaluated by means of the ADAS-cog. Participants of the study were evaluated with the MMSE scale annually. Participants who obtained less than 24 points on the MMSE scale were evaluated by a senior psychiatrist. Diagnosis of dementia was done on the basis of DSM criteria. Alzheimer's Disease was diagnosed on the basis of NINCDS-ADRDA criteria and vascular dementia on the NINDS-AIREN criteria. The study was carried out over a period of seven consecutive years. Results. A hundred and fifty people were included in the final analysis - in 111 of them were found not to be afflicted with dementia, 25 were found to have AD and in 14 VD was diagnosed. The control group differed from the AD and VD group with respect to the initial level of cognitive impairment (ADAS-cog) and the intensity of behavioural and psychological symptoms (NPI--NH scale). Particular items of the NPI -NH scale differentiated the two groups to a different degree. In people with AD the greatest differences were observed with respect to agitation/aggression, mood swings, irritability/emotional liability and the rates of anxiety. People with VD, similarly to people with AD, significantly differed from the control group with respect to mood disorders and irritability/emotional liability, as well as disinhibition and anxiety. People with VD were found not have high rates of agitation/aggression. In the AD group, the shorter the period between the evaluation with the NPI-NH scale and the diagnosis of AD was the greater the rates of agitation/aggression, anxiety, and elevated mood/euphoria were. Conclusion. Inpreclinical stages of both AD and VD behavioural and psychological symptoms occur very frequently. The closer the diagnosis of dementia is the greater the possibility of behavioural and psychological symptoms occurring, especially in AD. [ABSTRACT FROM AUTHOR]

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Background and aims: The aim of this study was to assess the prescription practices and judgment of efficacy of physicians of drugs used for the cognitive and non-cognitive symptoms of dementia. Methods: Physicians from 88 Italian Alzheimer Evaluation Units were surveyed by means of a structured questionnaire assessing the proportion of patients with four different types of dementia prescribed with drugs for cognitive and non-cognitive symptoms, and physicians' perceived efficacy of cholinesterase inhibitors. The Units prescribed cholinesterase inhibitors for 73 patients per year on average. Results: Cholinesterase inhibitors are prescribed to 90% of patients with Alzheimer's disease (AD), 80% with with Lewy body dementia (LBD), and 35-45% with vascular dementia (VD) and frontotemporal lobar degeneration (FTLD). Selective serotonin uptake inhibitors (SSRIs) are prescribed for 28-45% of patients with all dementias except LBD (16%). Atypical neuroleptics were prescribed for 23-31% of patients, with no difference across types of dementia. Other drugs, such as ginkgo and nootropics, were prescribed less frequently, except in VD (20%). The perceived efficacy on cognitive and non-cognitive symptoms, assessed on a 0 to- 10 ordinal scale, was highest in AD (4.3-6.1), intermediate in LBD (3.5-5.3) and VD (3.3-4.7), and lowest in FTLD (2.0-2. 7). Conclusions: The data indicate that, in specialized Italian centers, cholinesterase inhibitors and atypical neuroleptics are largely used in patients with AD and LBD, but the former are prescribed off-label to a remarkable proportion of patients with VD and FTLD. The efficacy of cholinesterase inhibitors is perceived to be highest in AD and poorest in FTLD. Perceived efficacy is affected more by whom is treated than by what is used. [ABSTRACT FROM AUTHOR]

The article discusses a study on cognitive symptoms that influence rehabilitation of patients with dementia who have had a hip fracture. It found that the main symptoms that interfere with the ability of healthcare professionals (HCPs) to rehabilitate patients are patients' memory impairment, lack of insight and lack of ability to carry out purposeful movement. About 50% of nurses and HCPs listed approaches they used to address such symptoms. The strategies include offering consistent routines.