Relationship between cognition and functional magnetic resonance in elderly patients with metabolic syndrome: a cohort study with one year follow up

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BV UNIFESP: Teses e dissertaçõe

Functional magnetic resonance imaging response as an early biomarker of cognitive decline in elderly patients with metabolic syndrome

Objectives: We assessed whether potential changes in brain activation patterns of elderly individuals with metabolic syndrome (MetS) who were cognitively healthy (without mild cognitive impairment or dementia) were associated with cognitive decline in executive function in the short-term. Method: We analyzed 43 individuals (23 MetS, 20 controls) using a global geriatric evaluation, a neuropsychological battery, and task-related (attention) fMRI exam. Correlation analysis between the fMRI signal at baseline and cognitive impairment after 1 year was based on the voxel-based Pearson coefficient, corrected for multiple comparisons. Results: At baseline, MetS patients showed reduced brain response in frontal and parietal regions compared to controls. After one year, the MetS group also showed a decline in verbal fluency performance. fMRI response in the right dorsolateral prefrontal cortex and bilateral parietal lobes was negatively correlated with verbal fluency decline in the MetS group. Discussion: Our results provide an early biomarker of the possible development of cognitive impairment, particularly in the executive function, of elderly individuals suffering from MetS. These findings also point to an up or down regulation which could be interpreted as compensatory mechanism for possible brain tissue burden caused by MetS.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Ministry of Health which, via Technical Area of Health of Aged (PROADI)Hospital Israelita Albert Einstein under Support Program for Institutional Development of Brazilian Unified National Health System (SUS)Univ Fed Sao Paulo, Escola Paulista Med, Dept Psychiat, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Ave Albert Einstein, Sao Paulo, BrazilHosp Israelita Albert Einstein, Rua Madre Cabrini 462, BR-04020001 Sao Paulo, SP, BrazilUniv Estadual Sao Paulo Julio de Mesquita Filho, Fac Med Botucatu, Dept Internal Med, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Internal Med, Div Geriatr, Rua Francisco de Castro 105, BR-04020050 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Psychiat, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Internal Med, Div Geriatr, Rua Francisco de Castro 105, BR-04020050 Sao Paulo, SP, BrazilCAPES: 2009/12271-3Web of Scienc

Cognitive assessment in an elderly population with metabolic syndrome in Brazil

ABSTRACT Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. Objective: To compare the cognitive status of Brazilian elderly outpatients with and without MetS. Methods: A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. Results: Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. Conclusion: The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders

An interdisciplinary approach aiding the diagnosis of primary progressive aphasia: A case report

ABSTRACT Frontotemporal dementia (FTD) is one of the most common causes of early-onset dementia with primary progressive aphasia (PPA) being the second-most-frequent form of this degenerative disease. Despite the similarity with progressive dementia (especially in early stages of Alzheimer´s disease), three types of PPA can be differentiated: semantic, agrammatic and logopenic (subtype discussed in this study). To date, no medications have been shown to improve or stabilize cognitive deficits in patients with PPA. We report the case of a 62-year-old woman with difficulty naming objects and planning. An interdisciplinary evaluation, including imaging and lab exams, together with neuropsychological and personality assessments, confirmed that the patient had logopenic PPA on the basis of repetition difficulty, phonemic and semantic paraphasias and absence of agrammatism. The timing of the assessment in this case, along with the resources available and commitment of an integrated interdisciplinary team, allowed a differential diagnosis (from other classical dementias) to be reached