rome and Cognition-Disorders

The aim of this study was to assess the relationship between serum levels of S100β and neuron-specific enolase (NSE), postoperative diffusion-weighted magnetic resonance imaging (DW-MRI) and Mini-Mental State Examination (MMSE) score in asymptomatic patients affected by ≥ 70% carotid stenosis submitted to carotid endarterectomy (CEA) or carotid artery stenting (CAS), and to compare MMSE scores and DW-MRI findings at follow-up evaluations. Between April 2008 and April 2009, 60 patients were submitted to carotid intervention. All patients underwent DW-MRI and MMSE preoperatively, at 24 hours postoperatively, at 6 months and at 12 months. Neurobiomarkers were assessed for each patient at six time-points. Thirty-two patients were submitted to CEA and 28 to CAS. No mortality was observed. One CAS patient presented with an ischemic stroke. In six CAS patients and one CEA patient, new subclinical ischemic lesions were detected at postoperative DW-MRI (21.4% versus 3%, P = 0.03). In CAS patients, new DW-MRI lesions were significantly associated with MMSE score decline (P = 0.001). At 12 months, patients presenting with new postoperative ischemic lesions showed lower MMSE scores (P = 0.08). CAS patients showed increasing neurobiomarker levels compared with CEA patients (P = 0.02). In conclusion, microembolization effects may persist over time, so it should be avoided whenever possible. Carotid revascularization procedures should be evaluated and compared not only with respect to death/stroke but also to microembolism rates.

Topics: Aged; Angioplasty; Asymptomatic Diseases; Biomarkers; Carotid Stenosis; Chi-Square Distribution; Cognition; Cognition Disorders; Diffusion Magnetic Resonance Imaging; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Nerve Growth Factors; Neuropsychological Tests; Phosphopyruvate Hydratase; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Rome; S100 Calcium Binding Protein beta Subunit; S100 Proteins; Severity of Illness Index; Stents; Stroke; Thromboembolism; Time Factors; Treatment Outcome

We describe the prevalence of cognitive impairment in a population aged 65 and older requiring urgent medical services and to propose global evaluation, involving cognitive, functional and social aspects, during the emergency department (ED) visit to define an individualized care protocol. A total of 150 patients aged 65 and older attended at the ED were screened for cognitive impairment using the Mini-Mental State Examination (MMSE). Patients with an MMSE score lower or equal to 23 were included in the second step of the study, namely evaluation involving neuropsychological instruments to assess cognitive and functional status and a questionnaire exploring socioeconomic conditions and type of support need. Cognitive impairment was detected in 24 patients (16%). In no case of mild impairment had a cognitive deficit already been diagnosed. The functional and socioeconomic profile enabled proposing a strategy for better management of the patients discharged by the ED.

Topics: Aged; Aged, 80 and over; Cognition Disorders; Emergency Service, Hospital; Female; Geriatric Assessment; Humans; Male; Neuropsychological Tests; Patient Discharge; Prevalence; Prospective Studies; Rome

Topics: Cognition Disorders; Consciousness Disorders; France; Germany; Greece; History, 17th Century; History, 19th Century; History, 20th Century; History, Ancient; Humans; Psychiatry; Rome; Terminology as Topic; United Kingdom