Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review

Anxiety, aggression/agitation, apathy and disinhibition are common neuropsychiatric consequences of acquired brain injury (ABI); these consequences can cause functional impairment and lead to reduced social integration. This systematic review aims to provide an examination of the current evidence on psychological interventions for treating these consequences. Two reviewers selected potential relevant articles, retrieved from five literature databases; methodological quality was assessed and appraised. A total of 5207 studies were found, of which 43 were included: 21 studies for anxiety, 18 for aggression, two studies for apathy, and six for disinhibition. Three studies addressed multiple consequences. Four high-quality (i.e., Class I and II) studies showed significant decreases in anxiety after cognitive behavioural therapy (CBT). In total, 14 studies consistently showed significant decreases in aggression/agitation after behavioural management techniques or anger management sessions. Substantial variability existed in the examined interventions and in their effects on apathy and disinhibition. Unfortunately, firm conclusions and recommendations for clinical practice are considered premature, due to concerns about the methodology used. However, this review yielded new evidence on the effectiveness of CBT for anxiety symptoms post-ABI and there has been some response to the ongoing call for studies with high methodological quality

Effects of Type 2 Diabetes on 12-Year Cognitive Change

OBJECTIVE: To examine the effects of baseline and incident diabetes on change in cognitive function over 12 years. RESEARCH DESIGN AND METHODS: A sample of 1,290 individuals aged ≥40 years at baseline, participating in the Maastricht Aging Study, were cognitively tested at baseline, after 6 years, and after 12 years. Of these, 68 participants had type 2 diabetes at baseline, and 54 and 57 had incident diabetes at the 6- and 12-year follow-up, respectively. Changes in performance on tests of information-processing speed, executive function, and verbal memory from baseline to 6- and 12-year follow-up were compared between groups using linear mixed models. Effects of diabetes on cognitive decline were adjusted for demographic variables, history of smoking, alcohol intake, and comorbid conditions, including hypertension, cardiovascular disease, BMI, and depression. RESULTS: Participants with baseline diabetes showed larger decline in information-processing speed (estimate −7.64; P < 0.01), executive function (21.82; P < 0.01), and delayed word recall (−1.35; P < 0.05) over the 12-year follow-up compared with control subjects. No significant difference in decline was observed for immediate word recall. Compared with control subjects, participants with incident diabetes showed subtle early decline in information-processing speed only. Interestingly, they did not show larger decline in any other cognitive domain. CONCLUSIONS: Individuals with baseline type 2 diabetes show accelerated cognitive decline, particularly in information-processing speed and executive function, compared with individuals without diabetes. In incident diabetes, decline in speed becomes detectable first, and cognitive decline seems to increase with increasing exposure time

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study.

To access publisher's full text version of this article click on the hyperlink belowstudies on the association of dementia with specific body composition (BC) components are scarce. Our aim was to investigate associations of BC measures with different levels of cognitive function in late-life.we studied 5,169 participants (mean age 76 years, 42.9% men) in the AGES-Reykjavik Study of whom 485 (9.4%) were diagnosed with mild cognitive impairment (MCI) and 307 (5.9%) with dementia. Visceral fat, abdominal and thigh subcutaneous fat, and thigh muscle were assessed by computed tomography. MCI and dementia were based on clinical assessment and a consensus meeting; those without MCI or dementia were categorised as normal. Multinomial regression models assessed the associations stratified by sex and in additional analyses by midlife body mass index (BMI).among women, there was a decreased likelihood of dementia per SD increase in abdominal subcutaneous fat (OR 0.72; 95% CI: 0.59-0.88), thigh subcutaneous fat (0.81; 0.67-0.98) and thigh muscle (0.63; 0.52-0.76), but not visceral fat, adjusting for demographics, vascular risk factors, stroke and depression. Inverse associations of fat with dementia were attenuated by weight change from midlife and were strongest in women with midlife BMI <25. In men, one SD increase in thigh muscle was associated with a decreased likelihood of dementia (0.75; 0.61-0.92). BC was not associated with MCI in men or women.a higher amount of abdominal and thigh subcutaneous fat were associated with a lower likelihood of dementia in women only, while more thigh muscle was associated with a lower likelihood of dementia in men and women.National Institutes of Health National Institute on Aging Intramural Research Program 'Hjartavernd' (the Icelandic Heart Association) 'Althingi' (the Icelandic Parliament) Internationale Stichting Alzheimer Onderzoe

Both Low and High 24-Hour Diastolic Blood Pressure Are Associated With Worse Cognitive Performance in Type 2 Diabetes: The Maastricht Study

OBJECTIVE Hypertension and diabetes are both risk factors for cognitive decline, and individuals with both might have an especially high risk. We therefore examined linear and nonlinear (quadratic) associations of 24-h blood pressure (BP) with cognitive performance in participants with and without type 2 diabetes. We also tested the association of nocturnal dipping status with cognitive performance. RESEARCH DESIGN AND METHODS This study was performed as part of the Maastricht Study, an ongoing population-based cohort study. Cross-sectional associations of 24-h BP (n = 713, of whom 201 had type 2 diabetes) and nocturnal dipping status (n = 686, of whom 196 had type 2 diabetes) with performance on tests for global cognitive functioning, information processing speed, verbal memory (immediate and delayed word recall), and response inhibition were tested using linear regression analysis and adjusted for demographics, vascular risk factors, cardiovascular disease, depression, and lipid-modifying and antihypertensive medication use. RESULTS After full adjustment, we found quadratic (inverted U-shaped) associations of 24-h diastolic blood pressure (DBP) with information processing speed (b for quadratic term = -0.0267, P &lt;0.01) and memory (immediate word recall: b = -0.0180, P &lt;0.05; delayed word recall: b = -0.0076, P &lt;0.01) in participants with diabetes, but not in those without. No clear pattern was found for dipping status. CONCLUSIONS This study shows that both low and high 24-h DBP are associated with poorer performance on tests of information processing speed and memory in individuals with type 2 diabetes