Active lifestyle as a reflection of cognitive reserve : The Modified Cognitive Reserve Scale

Cognitive reserve (CR) refers to individual differences in cognitive processing that can protect from and compensate for functional decline related to ageing or brain pathology. The CR theory postulates that attaining an active and cognitively stimulating lifestyle can accumulate CR. The Cognitive Reserve Scale (CRS) is a questionnaire that measures lifelong attainment in leisure activities. This cross-sectional study aimed to examine the usefulness, validity and reliability of a modified Finnish translation of the CRS, the Modified Cognitive Reserve Scale (mCRS). The mCRS consists of 20 questions concerning studying and information seeking, hobbies and social relationships during three age phases: young adulthood (18-35 years), adulthood (36-64 years) and late adulthood (>= 65 years). A group of 69 neurologically healthy adults aged 26-78 filled the mCRS and completed a neuropsychological test battery. We examined the internal consistency of the mCRS and associations between the mCRS, demographical variables and cognitive performance. The mCRS was normally distributed and showed satisfactory internal consistency (Cronbach's alpha 0.81). It was significantly associated with occupation (ԑ(2) = 0.14) and education (rho = 0.51) but not with age or gender. There were significant associations between the mCRS and verbal reasoning (rho = .306), visual reasoning (r = .319), learning (r = .293) and inhibition (rho = -.368). Our study suggests that the mCRS is a reliable and valid method to assess lifelong leisure activity. The mCRS is related to other factors that enhance CR, occupation and education, and associated with cognitive performance of healthy adults. It provides an easily administrable means to assess lifelong attainment in stimulating leisure activities.Peer reviewe

Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome

Objectives Postoperative cognitive dysfunction (POCD) is a common consequence of coronary artery bypass grafting. However, domain-specific associations between postoperative changes and long-term performance are poorly known. The aim of this study was to investigate whether domain-specific cognitive changes after cardiac surgery predict long-term cognitive outcome. Materials and Methods We assessed 100 patients (86 men, mean age 60) before coronary artery bypass grafting, with re-examinations after one week, three months, and a mean of 6.7 years. The extensive neuropsychological test battery was organized into seven functional cognitive domains. Cognitive decline and improvement were defined with the reliable change index derived from 17 matching healthy controls. Analyses were adjusted for baseline cognitive performance, age, gender, education and cardiovascular risks factors. Results On group level, one week after surgery 71% patients showed cognitive decline and 9% improvement in any functional domain, as compared to preoperative results. Three months postsurgery, decline was observed in 47% and improvement in 25% of patients. Executive functioning was the most sensitive domain to both decline and improvement. Postoperative dysfunction predicted long-term cognitive deterioration six years after operation, particularly in the domain of executive functioning. Conclusions POCD after coronary artery bypass grafting is an essential risk factor for long-term deterioration and an indication for neuropsychological follow-up. Assessment of change in executive functioning after coronary artery bypass grafting may help to identify patients at risk for unfavorable long-term outcome.Peer reviewe

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

BackgroundStenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease. MethodsA total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3-8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls. ResultsBefore surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase. ConclusionOur findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.Peer reviewe

Subfoveal choroidal thickness in ipsi- and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy : a prospective study

Purpose To compare subfoveal choroidal thickness (SFCT) and associated clinical variables in patients with carotid stenosis (CS) before and 6 months after carotid endarterectomy (CEA). Methods The prospective non-randomized Helsinki Carotid Endarterectomy Study - Brain and Eye Sub-sTudy included seventy patients (81% male, mean age 69 years) and 40 control subjects (77% male, 68 years), from March 2015 to December 2018. Ophthalmological examination included SFCT measured with enhanced-depth imaging-optical coherence tomography. Carotid stenosis (CS) was more severe (>= 70% stenosis in 92%) ipsilateral to the CEA than contralaterally ( Results At baseline, patients had thinner mean SFCT than control subjects in both eyes (ipsilateral, 222 versus 257 mu m and contralateral, 217 versus 258 mu m, p Conclusions Subfoveal choroidal thickness (SFCT) is thinner in patients with CS without association between SFCT and the grade of CS. Unchanged SFCT after CEA suggests, that choroidal vessels in severe CS are unable to react to increased blood flow. Bilaterally thin SFCT could be considered as yet another sign of CS.Peer reviewe

Ocular signs of carotid stenosis in ipsi- and contralateral eyes before and after carotid endarterectomy : a prospective study

Purpose We describe hypoperfusion-related and embolic ocular signs of carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) in a CS population. Methods We enrolled prospectively 70 CEA patients (81% male, mean age 69) and 41 non-medicated control subjects (76%, 68), from March 2015 to December 2018, assessing intraocular pressure (IOP), best-corrected visual acuity (BCVA) in logMAR units and performing a bio-microscopy examination. Results Main index symptoms included amaurosis fugax (Afx) (29, 41%) and hemispheric TIA (17, 24%), and 17 (24%) were asymptomatic. Of the 70, 17 patients (24%, 95% CI 16-36) showed ocular signs of CS. Of four embolic (Hollenhorst plaques) findings, one small macular plaque disappeared postoperatively. Four had hypoperfusion, that is ocular ischaemic syndrome (OIS), requiring panretinal photocoagulation: one for multiple mid-peripheral haemorrhages, two for iris neovascularization and one for neovascular glaucoma (NVG); only the NVG proved irreversible. Nine (de novo in three) showed mild OIS, that is only few mid-peripheral haemorrhages, ranging pre- /postoperatively in ipsilateral eyes from one to eleven (median two)/ one to two (median one), and in contralateral eyes from three to nine (median five)/ one to six (median three). Pre- and postoperative median BCVA was 0 or better, and mean IOP was normal, except in the NVG patient. Temporary visual impairment from 0 to 0.3 occurred in one eye soon after CEA due to ocular hyperperfusion causing macular oedema. Conclusions Ocular signs of CS are common in CEA patients, ranging from few mid-peripheral haemorrhages to irreversible NVG. Clinicians should be aware of these signs in detecting CS.Peer reviewe

Flicker-induced retinal vascular dilation in ipsi- and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy : a prospective study

Purpose Retinal vascular function was assessed in patients with carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) and in controls at a six-month interval. Methods We studied 68 patients (81% male, mean age 69) and 41 healthy non-medicated controls (77%, 68) from March 2015 to December 2018. Our ophthalmological examination included flicker-induced arteriolar and venular measurements with a Dynamic Vessel Analyser in both eyes. Results At baseline, flicker-induced arteriolar and venular dilation was reduced in the ipsilateral eyes of the patients compared with dilation in the controls (arteriolar 1.0% versus 2.6%, p = 0.001 and venular 2.2% versus 2.8%, p = 0.049). These differences subsided after CEA. In patients' ipsilateral eyes, flicker-induced arteriolar dilation was borderline postoperatively (preoperative 1.0% versus postoperative 1.6%, p = 0.06), whereas venular dilation increased (2.2% versus 2.8%, p = 0.025). We found various tentative associations with the change in flicker-induced dilations after CEA, but not with the preoperative dilations. Conclusions Postoperative recovery of the reduced flicker-induced arteriolar and venular dilatation in the ipsilateral eye shows that, after CEA, the activity-dependent vascular reactivity of haemodynamically compromised retinal tissue can improve.Peer reviewe

Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome

Objectives: Postoperative cognitive dysfunction (POCD) is a common consequence of coronary artery bypass grafting. However, domain-specific associations between postoperative changes and long-term performance are poorly known. The aim of this study was to investigate whether domain-specific cognitive changes after cardiac surgery predict long-term cognitive outcome. Materials and Methods: We assessed 100 patients (86 men, mean age 60) before coronary artery bypass grafting, with re-examinations after one week, three months, and a mean of 6.7 years. The extensive neuropsychological test battery was organized into seven functional cognitive domains. Cognitive decline and improvement were defined with the reliable change index derived from 17 matching healthy controls. Analyses were adjusted for baseline cognitive performance, age, gender, education and cardiovascular risks factors. Results: On group level, one week after surgery 71% patients showed cognitive decline and 9% improvement in any functional domain, as compared to preoperative results. Three months postsurgery, decline was observed in 47% and improvement in 25% of patients. Executive functioning was the most sensitive domain to both decline and improvement. Postoperative dysfunction predicted long-term cognitive deterioration six years after operation, particularly in the domain of executive functioning. Conclusions: POCD after coronary artery bypass grafting is an essential risk factor for long-term deterioration and an indication for neuropsychological follow-up. Assessment of change in executive functioning after coronary artery bypass grafting may help to identify patients at risk for unfavorable long-term outcome.</div

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

BackgroundStenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease. MethodsA total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3-8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls. ResultsBefore surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase. ConclusionOur findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.</p

Effects of attention on semantic processing of speech : An event-related potential study

Semantic processing can be studied with semantic priming. Target words that are preceded by semantically related prime words are recognized faster and more accurately than targets preceded by unrelated prime words. Semantic priming also affects the magnitude of the N400 event-related potential. The response is smaller to a target word when it is preceded by a related than an unrelated prime word. The effect is called the N400 effect. It is not yet clear, however, how attention modulates semantic priming and the N400 effect. This study investigated how the direction of attention affects the semantic processing of speech. The N400 effect was studied in experimental conditions in which the subjects attention was directed 1) away from the speech stimuli, 2) to phonological features of the speech stimuli, and 3) to semantic features of the speech stimuli. The first aim of the study was to investigate whether the N400 effect for spoken words is dependent on attention to the auditory information. The second aim was to study the differences in the N400 effect when attention is directed to the semantic or other features of speech stimuli. The results showed an N400 effect even when attention was directed away from the speech stimuli. The N400 effect was, however, stronger in conditions during which the speech stimuli were attended. The magnitude of the behavioral semantic priming and the N400 effect did not differ between the conditions during which attention was directed to the semantic or phonological features of the words. The findings indicate that the semantic processing of spoken words is not dependent on attention to auditory information. Furthermore, the results suggest that whether or not semantic processing is relevant for the task performance does not affect the semantic processing of attended spoken words.Kielen merkityssisällön käsittelyä voidaan tutkia semanttisen virittämisen avulla. Kun pareittain esitetyt sanat ovat toisiinsa merkitysyhteydessä, jälkimmäisen sanan tunnistaminen nopeutuu ja tunnistusvirheiden määrä vähenee. Semanttinen virittäminen vaikuttaa myös sanaärsykettä seuraavan N400-herätevastekomponentin voimakkuuteen. Komponentin amplitudi pienenee, jos sanaa edeltää siihen merkityssisällöltään sopiva sana. Tätä ilmiötä kutsutaan N400-vaikutukseksi. Vielä ei kuitenkaan ole selvää, minkälainen vaikutus tarkkaavaisuudella on semanttiseen virittämiseen ja N400-vaikutukseen. Tässä tutkimuksessa selvitettiin, miten tarkkaavaisuuden suuntaaminen vaikuttaa kuullun puheen merkityssisällön käsittelyyn aivoissa. N400-vaikutusta tarkasteltiin koetilanteissa, joissa koehenkilöiden tarkkaavaisuus oli suunnattu 1) pois puheärsykkeistä, 2) puheärsykkeiden äännepiirteisiin ja 3) puheärsykkeiden merkityssisältöön. Tutkimuksen ensimmäinen tavoite oli selvittää, edellyttääkö N400-vaikutuksen syntyminen puheärsykkeille tahdonalaisen tarkkaavaisuuden suuntaamista kuuloinformaatioon. Toinen tavoite oli selvittää, minkälaisia eroja N400-vaikutuksen ilmentämässä semanttisessa virittämisessä on sen mukaan, onko tarkkaavaisuus suunnattu puheärsykkeiden merkityssisältöön vai muihin ärsykepiirteisiin. N400-vaikutus syntyi puhutuille sanoille jopa silloin, kun tarkkaavaisuus oli suunnattu pois puheärsykkeistä. N400-vaikutus oli kuitenkin voimakkaampi koetilanteissa, joissa puheärsykkeitä tarkkailtiin. Kun tarkkaavaisuus oli suunnattu puheärsykkeisiin, N400-vaikutuksen ja tehtäväsuoriutumisen ilmentämän semanttisen virittämisen voimakkuus ei eronnut sen mukaan, oliko tarkkaavaisuus suunnattu sanojen merkityssisältöön vai äännepiirteisiin. Tulokset osoittavat, että N400-vaikutuksen heijastamaa puheen merkityksen käsittelyä tapahtuu aivoissa myös silloin, kun kuuloinformaatiota ei tarkkailla. Kun puhetta tarkkaillaan, tarkkaavaisuuden kohdistaminen puheen merkityssisällön kannalta epäolennaisiin piirteisiin ei heikennä merkityssisällön käsittelyn voimakkuutta tai nopeutta aivoissa

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Background: Carotid endarterectomy (CEA) has been associated with both postoperative cognitive dysfunction (POCD) and improvement (POCI). However, the prognostic significance of postoperative cognitive changes related to CEA is largely unknown. The aim of this study was to examine the associations between postoperative cognitive changes after CEA and long-term survival. Methods: We studied 43 patients 1 day before CEA as well as 4 days and 3 months after surgery with an extensive neuropsychological test array, and followed them for up to 14 years. POCD and POCI relative to baseline were determined with the reliable change index derived from 17 healthy controls. Associations between POCD/POCI and mortality within the patient group were studied with Cox regression analyses adjusted for confounders. Results: POCD in any functional domain was evident in 28% of patients 4 days after surgery and in 33% of patients 3 months after surgery. POCI was shown in 23% of patients at 4 days and in 44% of patients at 3 months. POCD at 3 months was associated with higher long-term mortality (hazard ratio 5.0, 95% CI 1.8-13.9, p = 0.002) compared with patients with no cognitive decline. Conclusions: Our findings suggest that POCD in a stable phase, 3 months after CEA predicts premature death. Evaluation of postoperative cognitive changes is essential, and POCD in a stable phase after CEA should prompt scrutiny of underlying factors and better adherence to therapies to prevent recurrences and to promote early intervention in imminent deterioration.Peer reviewe