Patients with autoimmune encephalitis are mainly characterized by behavioral, mental and motor abnormalities, neurological dysfunction, memory deficits and seizures. Different antibody types of autoimmune encephalitis its pathogenesis, clinical characteristics are different, in recent years found immune related epilepsy is closely related to autoimmune encephalitis, based on autoimmune encephalitis type is more, we choose more common autoimmune encephalitis, expounds its characteristics, to help clinical diagnosis.
ObjectiveTo analyze of the extent of neuropsychological damage in post-traumatic epilepsy patients. MethodsOne hundred and thirty-five patients treated at the Department of Neurosurgery, the 904th Hospital of PLA from January 2016 to December 2018 were analyzed retrospectively, including 94 males and 41 females, with an average age of (32.94 ± 9.51) years. They were divided into 3 groups: 40 patients with post-traumatic epilepsy (epilepsy group): 53 trauma patients without post-traumatic epilepsy (trauma group) and 42 patients with health examination (control group). Neuropsychological assessment using the following scales: Mini-mental State Examination (MMSE): Montreal Cognitive Assessment-Basic (MoCA-B): Audio Verbal Memory Test (AVMT): Rey-Osterrieth Complex Figure Test (CFT): Trail Making Test (TMT): Hamilton Depression Scale (HAMD): Activity of Daily Living (ADL). ResultsThe results of one-way ANOVA showed that there was significant difference between all scales of epilepsy group, trauma group and control group (P<0.01). MMSE and MoCA-B scores: Compared with trauma group, epilepsy group decreased significantly, but there was no significant difference between groups (P>0.05); Memory and spatial structure ability: AVMT short/long delayed memory, CFT recall and copy test results showed that epilepsy group decreased more significantly than trauma group, and there was statistical significance between groups (P<0.05); Executive ability: TMT-A and TMT-B showed that epilepsy group spent longer time than trauma group, and there was significant difference between groups (P<0.01); Depressive symptoms: HAMD scale showed significant difference between epilepsy group and trauma group (P<0.01): while there was no statistical difference between trauma group and control group (P>0.05); Activity of daily living: ADL scale results showed that there was no significant difference between epilepsy group and trauma group (P>0.05). ConclusionPost-traumatic epilepsy can aggravate the cognitive impairment of patients, mainly in the decline of memory, spatial structure and executive ability, and prone to depressive symptoms. At the same time of treating epilepsy seizures, patients with post-traumatic epilepsy should be screened and assessed early in neuropsychology to improve their quality of life and return to society as soon as possible.
ObjectivesTo systematically review the current status of cognitive impairment of the elderly in China.MethodsCNKI, VIP, CBM, WanFang Data, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect studies on the current status of cognitive impairment of the elderly in China from January 1st, 2000 to March 12th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using Stata 14.1 software.ResultsA total of 126 studies involving 187 115 elderly were included. The results of meta-analysis showed that the cognitive impairment rate of the elderly in China was 22.0% (95%CI 20.4% to 23.6%). Subgroup analysis showed that the cognitive impairment rate was higher in females, seniors, low education level, residing in rural area, engaging in manual labor, no spouse, living alone, monthly income less than 1 000 yuan, and suffering from chronic diseases.ConclusionsCurrent evidence shows that the cognitive impairment rate of the elderly in China is 22%, which is relatively high in females, seniors, low education level, residing in rural area, engaging in manual labor, no spouse, living alone, low-income, and suffering from chronic diseases.
Based on literatures on Meta-analysis and randomized controlled trial, drug use and some geriatrics syndromes such as cognitive impairment and depression, in elderly diabetic patients were reviewed. Insulin plus oral hypoglycemic drugs was more rational therapy for insulin resistance and islet dysfunction in type 2 diabetes mellitus. We should pay more attention to cognitive impairment and depression in elderly type 2 diabetic patients.
Event-related potentials (ERPs) are potential activities extracted from electroencephalogram (EEG) that are associated with specific stimuli. They possess the advantages of objectivity, ease of operation, and real-time reflection of cognitive processing in the brain. ERPs have been extensively utilized in studying pathophysiological mechanisms related to Alzheimer’s Disease (AD), Parkinson’s Disease (PD), stroke, schizophrenia, and other conditions. Epilepsy is a common neurological disorder wherein ERPs can be employed to explore the neuroelectrophysiological causes underlying cognitive impairment, anxiety, and depression in patients with epilepsy while providing an objective assessment. This article reviews the application of ERPs in patients with epilepsy.
ObjectiveTo systematically review the accuracy of the mini-mental state examination scale (MMSE) in the screening of poststroke cognitive impairment (PSCI), and the diagnostic value of different cut-off values of the scale, so as to provide references for the selection of the threshold of the MMSE scale. MethodsDatabases including PubMed, EMbase, Cochrane Library, Web of Science, CINAHL, CBM, VIP, CNKI, and WanFang data were searched for diagnostic tests about MMSE for PSCI from inception to November 2022. Two researchers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. Then, meta-analysis was performed by Stata 16.0 software. ResultsA total of 23 studies involving 1 525 patients were included. The results of meta-analysis showed that after the analysis of bivariate mixed effect model, the optimal cutoff value of MMSE scale was 23/24 (the pooled sensitivity=0.75, 95%CI 0.52 to 0.89; the pooled Specificity=0.90, 95%CI 0.81 to 0.95; DOR=28, 95%CI 12 to 65; AUC=0.92, 95%CI 0.89 to 0.94). The results of hierarchical summary receiver-operating characteristic (HSROC) curve model showed that the pooled sensitivity=0.77, 95%CI 0.70 to 0.83; the pooled specificity=0.76, 95%CI 0.69 to 0.83, Beta=0.1, 95%CI −0.13 to 0.33, Z=0.82, P=0.41, Lambda=2.38, 95%CI 2.12 to 2.64, and the area under the SROC curve was 0.84. Fagan pre-test probability was 38%, positive likelihood ratio was 3.3, positive post-test probability was 67%, negative likelihood ratio was 0.3,negative post-test probability was 16%. ConclusionThe current evidence shows that MMSE has a certain diagnostic value as a screening tool for PSCI, the overall diagnostic efficacy is moderate, and the diagnostic value is highest when the cut-off value is 23/24. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectivesTo compare the clinical features and the effects on cognition, emotion, and prognosis of antiepileptic drugs (AEDs) between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE).MethodsWe collected the clinical data of the patients with OLE and TLE from the Department of Neurology, the First Hospital of Jilin University from January 2016 to May 2018. We measured the patients with Mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital span, Auditory verbal memory test (AVMT), Generalized anxiety disorder (GAD-7), Patient health questionnaire-9 (PHQ-9) and Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (c-NDDI-E) and followed up for 1 year.Results① After 1 year’s follow-up, the frequency of the two groups decreased compared with the first visit (Z=3.734, P=0.000) and the extent was similar (Z=−0.290, P=0.772). In group OLE, occipital aura was 45.9% (17 cases) and temporal aura was 37.8% (14 cases). In TLE group, temporal aura was 49.3% (33 cases) and occipital aura 7.5% (5 cases). In OLE group, post-seizure headache was found in 17 cases (45.9%), which was more than the 15 cases (22.4%) in TLE group (χ2=6.210, P=0.013). ② 30 cases (81.1%) in OLE group interictal discharge involved lobes outside occipitotemporal lobe, 4 of which had a wide-lead-involved discharge, and 19 cases (28.4%) in TLE group involved lobes outside temporal lobe, and there was a significant difference between the two groups (χ2=26.592, P=0.000). ③ There was no significant difference in the score of MOCA and AVMT in the group of OLE-A and OLE-B, either the group of TLE-A and TLE-B. The score of AVMT in group OLE-A was higher than that in group TLE-A (t=3.193, P=0.002), and that in group OLE-B was higher than that in group TLE-B (t=2.264, P=0.029). There was no significant difference in GAD-7, PHQ-9, and c-NDDI-E (P>0.05). After follow-up for 1 year, the scores were compared with its initial scales. The score of GAD-7 (Z=−2.561, P=0.010), PHQ-9 (Z=−2.053, P=0.040) and c-NDDI-E (Z=−2.493, P=0.013) all decreased. The score of GAD-7 (r=0.281, P=0.021) and c-NDDI-E (r=0.456, P=0.000) have a positive correlation with the frequency of seizure. Therapeutic effect: In OLE group, the efficiency of carbamazepine or oxcarbazepine group was 58.82% and of levetiracetam group was 83.33%. in TLE group, the efficiency of carbamazepine or oxcarbazepine was 72.50% and of levetiracetam group was 70.00%. There was no significant difference between group OLE and group TLE in the curative effect of carbamazepine or oxcarbazepine group (χ2=1.033, P=0.310) or levetiracetam group (χ2=0.356, P=0.551). After 1 year’s follow-up, the frequency of OLE group was 0.00 (0.000, 2.750) times per month, and the TLE group was 0.00 (0.000, 1.500) times per month. There was no significant difference between the two groups (Z=−0.226, P=0.822). At the follow-up, the frequency of seizure in the two groups was lower than that at the first visit (P=0.000). The frequency of seizure in TLE group was similar to that in OLE group (=−0.648, P=0.517). After 1 year, 5 patients (13.51%) in OLE group were newly diagnosed as refractory epilepsy and 6 patients (9.00%) in TLE group There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups (2=0.524, P=0.469).ConclusionOccipital aura and post-seizure headache are specific to OLE, which can be used as one of the basis for diagnosis of OLE. Epileptiform discharge in OLE is more likely to spread out in multiple cerebral lobes, while epileptiform discharge in TLE is confined to temporal lobe and the area near it. The cognitive impairment in OLE or TLE is not related to the duration of the disease. The degree of depression is positively correlated with the frequency of seizure. The responses to AEDs of OLE and TLE are similar.
White matter lesion (WML) of presumed vascular origin is one of the common imaging manifestations of cerebral small vessel diseases, which is the main reason of cognitive impairment and even vascular dementia in the elderly. However, there is a lack of early and effective diagnostic methods currently. In recent years, studies of diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI) have shown that cognitive impairment in patients with WMLs is associated with disrupted white matter microstructural and brain network connectivity. Therefore, it’s speculated that DTI and rs-fMRI can be effective in early imaging diagnosis of WMLs-related cognitive impairment. This article reviews the role and significance of DTI and rs-fMRI in WMLs-related cognitive impairment.
ObjectiveTo systematically review the prevalence of cognitive impairment in patients with sarcopenia. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect studies related to the objectives from inception to December 10, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 14.0 software. ResultsA total of 27 studies were included. The overall prevalence rate of cognitive impairment in sarcopenia was 36.1% (95%CI 29.4% to 42.8%). Subgroup analysis showed that the prevalence in Europe was higher than that in other areas. The prevalence of nursing home residents was highest. ConclusionCurrent evidence shows that the prevalence of cognitive impairment in patients with sarcopenia is high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objectives This study aims to examine the possible association between C-reactive protein (CRP) concentration and cognitive impairment in patients with post-stroke epilepsy. Methods Patients with post-stroke epilepsy admitted to Western China Hospital from January 2010 to June 2016 were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset, and then correlated with cognitive status assessed two years after stroke using the Six-Item Screener. Results Among the 96 patients with post-stroke epilepsy who included in our study, 24 patients were found to have cognitive impairment during the two years follow-up period. Our data showed a significant association between CRP levels and cognitive performance in these patients (31.5±36.2 vs. 11.9±19.4, P=0.029). In addition, this association persisted even after adjusting for potential confounders［OR=1.021, 95%CI (0.997, 1.206), P=0.037］. Conclusions Following ischemic stroke, higher CRP levels is associated with subsequent cognitive decline in patients with epilepsy. Association and prospective studies in larger sample size are needed in order to validate our findings, especially studies in which baseline CRP level and CRP level during follow-up are closely monitored.