Search Results (1,034)

Age-related dementia is commonly associated with several secondary complications such as sarcopenia. To date, the correlation between Dementia and Sarcopenia is not completely understood. This review summarizes the correlation between dementia and sarcopenia using human clinical and observational studies. We also summarize the impact of exercise on these two conditions. We performed a narrative search with systematic elements using PubMed, Embase, Web of Science, and Google Scholar. In this review, we included studies that performed dementia assessments using appropriate methods (e.g., Mini-Mental State Examination, neuropsychological testing, brain MRI, or clinical dementia rating scales) and validated sarcopenia criteria (e.g., European Working Group on Sarcopenia in Older People). We included a total of nine studies consisting of 5217 participants (mean age 63.1–87.6 years). Of these, participants had dementia-only or mixed cognitive cohorts. Depending on diagnostic criteria, the prevalence of sarcopenia among individuals with dementia ranged from 6.8% to 68.8%. Most of the studies showed a positive association between dementia and sarcopenia. Interestingly, the higher the cognitive impairment, the higher the physical decline and signs of sarcopenia. As expected, any kind of physical activity (e.g., aerobic exercise, walking, and Tai Chi) improves cognitive function and brain health. Overall, the current literature supports that dementia is associated with increased risk of sarcopenia, supporting a brain-muscle axis in neurodegeneration. Physical activity appears to be a key modifiable factor with benefits for both cognitive and musculoskeletal health. Further longitudinal and mechanistic studies are needed to clarify causality and underlying pathways. Full article

Older adults with dementia in long-term care facilities often become lost, enter unintended rooms, and develop greater dependence on care staff as a result of visuospatial impairment. However, existing dementia-friendly design studies have rarely distinguished among residents with different cognitive impairment characteristics. This exploratory cross-sectional study investigated 76 older adults with dementia and visuospatial impairment in three long-term care facilities in Xi’an, China. Neuropsychological assessment, behavior mapping, BIM-based modeling, space syntax analysis, and statistical analysis were integrated to examine the associations between environmental factors and the spatial behaviors of older adults with different research-based visuospatial impairment profiles. The results showed that the sample could be classified into three profiles: visual construction impairment, spatial disorientation, and global spatial cognitive impairment. The three groups showed different sensitivities to visual cues, path structure, and environmental stability, and exhibited distinct patterns of getting lost and spatial use. Based on these exploratory findings, this study formulates three hypothesis-generating unit-based design concepts: feature-enhanced units, path-simplified units, and stable low-load units. These concepts provide a provisional framework for examining how dementia care environments might be adapted to cognitive abilities and require validation in larger, longitudinal, and intervention-based studies. Full article

Background: Preventive strategies, including adherence to specific dietary patterns, have received increasing attention as approaches to reduce cognitive decline and dementia risk. However, findings remain inconsistent, partly due to differences in dietary assessment methods, cognitive outcomes, and THE consideration of genetic susceptibility factors such as apolipoprotein E (APOE) genotype. Methods: This study examined associations between dietary patterns and longitudinal cognitive change in 185 older adults without dementia from the Western Australia Memory Study. Participants completed a food frequency questionnaire at baseline and underwent comprehensive neuropsychological assessments at baseline and up to five follow-up visits at 18-month intervals. Composite scores were generated for six cognitive domains and the Preclinical Alzheimer’s Cognitive Composite (PACC). Results: Western and Prudent dietary pattern scores were analysed using linear mixed-effects models stratified by APOE ε4 carrier status. Among APOE ε4 carriers, greater adherence to a Western dietary pattern was associated with a faster decline in attention (p = 0.016), whereas no significant associations were observed for the Prudent dietary pattern or among APOE ε4 non-carriers. This association was attenuated after excluding participants with possible baseline cognitive impairment (MoCA < 23). Conclusion: These findings suggest that adherence to a Western dietary pattern may accelerate cognitive decline in individuals genetically at risk for Alzheimer’s disease, highlighting the importance of considering gene–diet interactions when developing dietary strategies for dementia prevention. Full article

Unilateral spatial neglect (USN) is a neuropsychological syndrome characterized by a reduced awareness of, and attention toward, stimuli located in the contralesional space. The left side of the space is most frequently affected, due to the higher incidence of the disorder following right-hemisphere lesions, particularly within the territory of the right middle cerebral artery and, less commonly, the right anterior cerebral artery. Although USN can also occur following left-hemisphere damage, it is typically less severe and tends to resolve more quickly. USN is a common consequence of acquired brain injury, especially of vascular origin, and significantly impairs a patient’s functional abilities and quality of life. Its high incidence in the acute phase after stroke, together with its potential persistence into the chronic stage, makes early diagnosis and timely rehabilitation essential. In this narrative review, we provide an overview of current assessment tools and rehabilitation approaches for post-stroke USN, with a focus also on recent advances and emerging therapeutic strategies. To illustrate diagnostic and therapeutic decision making, a representative case of a patient admitted to a Stroke Unit is reported, illustrating the application of assessment methods in a real-world setting. The aim of this review is to offer clinicians practical tools and evidence-based strategies to support a more effective and individualized management of patients affected by this complex and disabling condition. Full article

Background and Objectives: Functional decline is a major determinant of disability, caregiver burden, and loss of independence in behavioral variant frontotemporal dementia (bvFTD). Although bvFTD is characterized by early and rapidly progressive deterioration in everyday functioning, the multimodal contributors associated with longitudinal functional change remain insufficiently understood. The present study aimed to identify the strongest cognitive, behavioral, personality, and neuroimaging correlates of longitudinal functional deterioration in bvFTD using an integrated multimodal framework over a 12-month follow-up period. Methods: Twenty-seven patients diagnosed with bvFTD were recruited from the 2nd Neurology Clinic of the “AHEPA” University Hospital in Thessaloniki, Greece, and underwent comprehensive face-to-face neuropsychological assessment for the evaluation of a wide range of cognitive domains, alongside caregiver-based evaluations of behavioral disturbances, personality changes, and functional abilities, at baseline, 6 months, and 12 months. Brain perfusion single-photon emission computed tomography (SPECT) was acquired only at baseline, with regional cerebral blood flow (rCBF) quantified using a Brodmann area (BA)-based approach. Functional status was assessed using the Disability Assessment for Dementia (DAD) as the primary outcome, while the Frontotemporal Dementia Rating Scale (FRS) served as a secondary measure. Repeated-measures analysis of variance (ANOVA) was used to characterize longitudinal changes across cognitive, behavioral, personality, and functional domains, while linear mixed-effects (LME) models were applied to identify longitudinal correlates of functional decline and sources of inter-individual variability in functional outcomes. Results: Significant progressive decline in functional abilities was observed over the 1-year follow-up period, consistent with an aggressive and rapidly deteriorating clinical course in bvFTD. Reductions in functional performance were evident across both basic and instrumental activities of daily living, with deterioration being more pronounced in instrumental activities. Based on the final LME model, greater apathy-related (negative) behavioral symptoms, global cognitive impairment, attentional and processing speed deficits, and impaired inhibitory control were independently associated with poorer longitudinal functional outcomes (p < 0.001). At the neuroimaging level, reduced baseline perfusion in the right BA 24 within the anterior cingulate cortex was also significantly associated with greater loss of functional independence over time (p < 0.001). Conclusions: Longitudinal functional decline in bvFTD reflects the combined disruption of behavioral regulation, global cognition, executive control, and frontal–cingulate network integrity. The findings provide a preliminary foundation for future research investigating factors associated with accelerated functional decline. Further validation in larger, multicenter longitudinal cohorts is needed to determine the prognostic relevance of these factors and their potential applicability to patient stratification and individualized care planning. Full article

Cirrhosis, accounting for 2.4% of global mortality in 2019, represents a leading cause of death in chronic liver disease. Hepatic encephalopathy (HE), a decompensated complication of cirrhosis, is associated with a median survival of only 0.92 years post-diagnosis. Current screening methods relying on neuropsychological tests (e.g., Psychometric Hepatic Encephalopathy Score, PHES) have limitations such as time-consuming procedures and subjective interpretation, potentially delaying diagnosis. To address this, we integrated four cirrhotic transcriptomic cohorts (GSE41919, GSE57193, GSE139602, and GSE15654) and employed an integrated algorithm (LASSO [Least Absolute Shrinkage and Selection Operator]–RFE [Recursive Feature Elimination]–random forest) to identify HE-specific biomarker genes. Ultimately, we developed an HE risk-prediction system centered on eight HE-specific marker genes, namely, PRB2, TUBA1C, NPC2, LRRC32, TLN1, SOX9, SERPINA3 and RNASE4. Based on these genes, an XGBoost (eXtreme Gradient Boosting)-based HE risk stratification model was constructed, and SHAP (SHapley Additive exPlanations) analysis was further introduced to address the “black-box” limitation of conventional machine learning models and to improve the interpretability. The finalized eight-gene system enables accurate, efficient, and interpretable HE risk assessment in patients with cirrhosis. Functional characterization through gene set enrichment analysis and structural equation modeling further revealed that these marker genes converge on four interconnected biological processes, namely, metabolic homeostasis, synaptic and neural transmission, immune inflammatory signaling, and hepatic detoxification, which collectively reflect the gut–liver–brain axis disruption central to HE pathogenesis. This dual-model system, incorporating both cirrhosis progression and survival prognosis, provides a reliable and clinically applicable tool for early HE risk warning and stratification, reducing the limitations of traditional neuropsychological screening and offering a translational foundation for timely intervention and prognostic optimization in high-risk cirrhotic patients. Full article

This study examined visuomotor performance and selected psychometric characteristics of the Bender–Gestalt Test using the Koppitz developmental scoring system in Moroccan children aged 7 to 11 years. A cross-sectional study was conducted with 200 children enrolled in public primary schools in the Rabat region, Morocco. Performance was assessed using the Koppitz developmental scoring system. Statistical analyses included descriptive statistics, factorial analyses of variance, post hoc comparisons, inter-rater reliability, and test–retest reliability. The results revealed significant age-related differences in total error scores, with older age groups obtaining lower mean error scores than younger age groups, F(4, 190) = 29.965, p < 0.001, ηp² = 0.387. Designs 3 and 7 produced the highest mean error scores, which may reflect their greater visuospatial and perceptual-motor complexity. Inter-rater reliability demonstrated good agreement (ICC = 0.805, 95% CI [0.669, 0.887], p < 0.001), while test–retest reliability demonstrated excellent temporal stability (single-measure ICC(A, 1) = 0.913, 95% CI [0.772, 0.960], Pearson’s r = 0.928, p < 0.001). These findings support the reproducibility and temporal stability of the Koppitz developmental scoring system. Overall, the findings support its use for the assessment of visuomotor performance in Moroccan school-aged children from the Rabat region and provide preliminary regional reference data that may contribute to the development of future national normative standards. Full article

Chemotherapy-associated cognitive impairment (CACI) is a common long-term complication of cancer treatment that predominantly affects attention, executive function, information processing, and working memory. Although considerable progress has been made in understanding its molecular basis, the relationship between chemotherapy-induced neurobiological alterations and the functional organization of working memory remains incompletely understood. This narrative review aims to integrate current evidence on the neuroanatomical organization of working memory, the molecular mechanisms underlying CACI, and neuroimaging findings in patients receiving chemotherapy. The review summarizes current knowledge regarding mitochondrial dysfunction, oxidative stress, neuroinflammation, blood–brain barrier disruption, purinergic signaling, and chemotherapy-specific mechanisms of central nervous system injury. Furthermore, the principal mechanisms by which commonly used chemotherapeutic agents reach or indirectly affect the brain are discussed. Clinical neuroimaging findings from selected malignancies are interpreted within the framework of the four-component model of working memory, including the visuospatial sketchpad, phonological loop, central executive, and episodic buffer. Current evidence indicates that chemotherapy induces structural and functional alterations involving the prefrontal cortex, parietal cortex, hippocampus, insula, anterior cingulate cortex, angular gyrus, and associated neural networks. These changes are accompanied by disturbances in executive control, visuospatial processing, verbal working memory, and multimodal information integration. However, considerable heterogeneity among available studies and the difficulty in distinguishing cancer-related from chemotherapy-induced cognitive impairment remain major limitations. By integrating molecular, neuroanatomical, and neuroimaging evidence, this review proposes a conceptual framework linking chemotherapy-induced brain alterations with dysfunction of specific working memory components. Future longitudinal studies combining multimodal neuroimaging, molecular biomarkers, and standardized neuropsychological assessment are needed to identify chemotherapy-specific patterns of cognitive dysfunction and support the development of personalized preventive and therapeutic strategies for cancer survivors. Full article

Background/Objectives: Cognitive impairment can weaken self-management competency in heart failure (HF) patients. This study estimated domain-specific cognitive impairment prevalence using actuarial criteria and identified latent cognitive profiles among Korean HF outpatients. Methods: Using a previously collected cross-sectional dataset of 106 HF outpatients, cognitive function was assessed with the Seoul Neuropsychological Screening Battery-II. Actuarial criteria determined domain-specific impairment, and latent profile analysis (LPA) derived cognitive profiles based on domain composite z-scores. Results: Any cognitive impairment (≥1 impaired domain) was present in 32.1% (95% confidence interval [CI], 24.0–41.5%), most frequently affecting executive function (17.9%) and memory (15.1%). LPA identified three exploratory profiles: relatively preserved (30.2%), memory-vulnerable (45.3%), and globally vulnerable (24.5%). In exploratory models, anxiety symptoms were associated with higher odds of memory-vulnerable profile membership (odds ratio [OR] = 2.81, 95% CI, 1.03–7.64) and overall vulnerability in a Firth penalized analysis (OR = 3.39, 95% CI, 1.46–8.11), whereas depressive symptoms showed no significant association. No associations remained statistically significant after false discovery rate correction. Conclusions: Cognitive vulnerability in HF outpatients is phenotypically heterogeneous and showed a possible, unconfirmed association with anxiety symptoms that did not remain statistically significant after correction for multiple comparisons. Outpatient HF care planning may benefit from considering both domain-specific deficits and latent cognitive profile patterns; however, these exploratory findings require validation in larger cohorts. Full article

Developmental and/or epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS), previously described as continuous spike-wave during slow-wave sleep (CSWS) or electrical status epilepticus in sleep (ESES), is a childhood-onset disorder characterized by cognitive, language, behavioral, and/or motor regression or stagnation associated with marked activation of epileptiform discharges during non-rapid eye movement sleep. Three themes are central to the evolving understanding of D/EE-SWAS. First, it is a network disorder in which thalamocortical dysfunction, impaired sleep-dependent synaptic homeostasis, and potentially neuroinflammatory mechanisms contribute to neurodevelopmental deterioration. Second, increasing recognition of its genetic and structural heterogeneity is reshaping diagnostic evaluation. Monogenic etiologies are identified in up to one-third of cases, with a higher yield in the developmental and epileptic encephalopathy subtype, supporting early genomic testing alongside prolonged sleep EEG, MRI, and serial neuropsychological assessment. Third, treatment remains empiric and constrained by limited comparative evidence. Corticosteroids retain the strongest evidence base for cognitive improvement, although the overall certainty of this evidence remains low to moderate. Benzodiazepines are commonly used alternatives, and epilepsy surgery can provide substantial benefit in appropriately selected patients with focal structural abnormalities. Emerging etiology-directed therapies, including L-serine for selected GRIN loss-of-function variants and primidone for TRPM3-related disease, illustrate a broader transition from syndrome-based to precision management. However, no pharmacological therapy is specifically approved for D/EE-SWAS, long-term neurodevelopmental morbidity remains common, and adequately powered trials using standardized EEG and neurocognitive outcomes are urgently needed. Full article

Background: Specific learning disorder (SLD), termed “specific learning disability” in the Human Phenotype Ontology (HP:0001328), is a heterogeneous neurodevelopmental disorder, and the association between peripheral biological changes and cognitive function remains not well understood. Peripheral hematological and immune-endocrine biomarkers and their relationships with neuropsychological evaluations were evaluated in children with SLD. Methods: In this retrospective case–control study, we evaluated the peripheral biomarkers of a complete blood count and biochemical panel in 103 children with SLD and 102 well-child outpatient controls. Within the SLD group, we examined the association of systemic inflammatory indices with cognitive domains as assessed by the Wechsler Intelligence Scale for Children—Revised. Results: Group comparisons revealed modest peripheral changes, including reduced mean platelet volume (MPV) and increased eosinophil counts, that persisted after false discovery rate correction. Both differences remained significant after adjustment for age and sex. Inflammatory indices from complete blood count showed poor discriminative validity and were not strongly related to the global intelligence quotient. Exploratory analyses revealed only nominal, domain-specific associations between systemic inflammation indices and particular Wechsler subtests for verbal abstraction and visuospatial organization that did not survive multiple-comparison correction. Conclusions: The findings indicate a selective peripheral hematological pattern in SLD rather than evidence of generalized systemic inflammation. The evaluated indices showed limited discriminative utility and were not independently associated with global cognitive performance after multiple-testing correction. They should not be considered screening or diagnostic biomarkers for SLD. The selective pattern of lower MPV and higher eosinophil count observed in children with SLD appears to be novel but should be considered preliminary and requires independent confirmation in larger, prospectively recruited groups. Full article

Objective: This study examined the association between glycemic status, indexed by HbA1c, and cognitive functioning in individuals with bipolar disorder (BD), recurrent major depressive disorder (rMDD), schizophrenia (SZ), and healthy controls (HCs). Methods: In this cross-sectional study, 215 participants (45 HCs, 64 BD, 62 rMDD, 44 SZ) were assessed. Cognitive performance was evaluated using a comprehensive neuropsychological battery measuring attention, processing speed, memory, executive functions, and social cognition. Sociodemographic characteristics, chlorpromazine-equivalent antipsychotic doses (CEDA), and metabolic variables (body mass index, waist circumference, lipid profile, fasting glucose, and HbA1c) were collected. Group differences, correlation analyses, and multiple regression models were performed. Results: All patient groups showed significantly poorer cognitive performance compared with HCs. HbA1c levels were highest in the SZ group; however, associations between HbA1c and cognitive performance were strongest in the BD group and less consistent in rMDD. In regression analyses, HbA1c was associated with cognitive performance in BD and HCs, with weaker effects in rMDD. CEDA was associated with HbA1c levels and partially attenuated the relationship between HbA1c and cognitive outcomes. Conclusions: HbA1c levels were associated with cognitive performance in non-diabetic individuals, particularly in BD and rMDD. These findings suggest that subclinical variation in glycemic regulation may be relevant to cognitive functioning in psychiatric disorders. Further longitudinal studies are needed to clarify the influence of metabolic factors and psychotropic medication on cognitive outcomes. Full article

Background and Clinical Significance: Alien hand syndrome (AHS) is a rare disorder of agency and complex motor control characterized by involuntary, apparently purposeful limb movements experienced as outside voluntary control. Pontine hemorrhage is an uncommon substrate, and its manifestations may overlap with sensory ataxia and other post-stroke movement disorders. Case Presentation: An 86-year-old right-handed man developed right-sided alien hand phenomena after a left pontine hemorrhage. Examination showed dysarthria, limited left gaze, diplopia, preserved muscle strength, marked right-sided proprioceptive impairment, a thalamic-hand-like posture, impaired spatial control, involuntary levitation, intermanual conflict, and purposeful-appearing rubbing movements when distracted. The diagnosis was based on loss of agency and autonomous limb behavior that could not be explained by sensory ataxia alone. Serial CT demonstrated an interval reduction in the size of the pontine hemorrhage; a representative thalamic level CT showed no evident thalamic hemorrhage or gross structural lesion, although a small CT occult ischemic lesion could not be excluded. Repeat MRI was not completed because of severe claustrophobia and anesthesia risk. EEG, formal neuropsychological testing, and standardized functional scales were unavailable. The NIHSS, assessed 15 days after admission to our hospital, was 6 points. No specific pharmacological treatment was initiated. Cognitive-behavioral rehabilitation was recommended, but transportation difficulties prevented regular attendance. Approximately three months after discharge, physician relatives reported resolution of abnormal movements and improved independent gait; no formal post-discharge examination was performed. Conclusions: Pontine hemorrhage may rarely be associated with mixed AHS phenomenology. Disruption of ascending proprioceptive and sensorimotor pathways is plausible, but the absence of advanced imaging and neurophysiological assessment precludes definitive anatomical or causal conclusions. Full article

Background: Cognitive impairment and fatigue are common in patients with advanced chronic kidney disease (CKD). However, whether these symptoms reflect kidney failure itself or factors associated with hemodialysis (HD) remains unclear. This study compared cognitive performance and fatigue between patients with CKD G5 not requiring kidney replacement therapy, referred to as CKD G5 not on dialysis (CKD G5 ND), and those receiving maintenance HD. Methods: In this cross-sectional, single-center study, 68 clinically stable patients with kidney failure were enrolled, including 27 patients with CKD G5 ND and 41 patients receiving HD. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) and fatigue via the Fatigue Assessment Scale (FAS). Results: Global cognitive performance did not differ significantly between patients receiving HD and those with CKD G5 ND, with median MoCA scores of 24.00 and 23.00, respectively. Cognitive impairment was frequent, affecting 61.0% of HD patients and 74.1% of those with CKD G5 ND. Fatigue severity was also comparably high, with significant fatigue in 51.2% and 44.4% of individuals, respectively. No association was observed between global cognitive performance and fatigue. Exploratory analyses showed that language performance was inversely associated with total and mental fatigue after false discovery rate correction. In the adjusted logistic regression, HD status was associated with lower odds of cognitive impairment; however, this finding should be interpreted cautiously, given the cross-sectional design, small sample size, and baseline clinical differences between groups. Conclusions: Cognitive impairment and fatigue were highly prevalent both in patients with CKD G5 ND and those receiving maintenance HD, with no significant between-group differences in global cognitive performance or fatigue severity scores. These findings suggest that neuropsychological vulnerability may be present in patients with kidney failure before dialysis initiation. Full article

Background/Objectives: Psychosocial, neuropsychological, social, and academic difficulties may persist after pediatric cancer treatment. We described parent/caregiver-reported functioning and support needs and explored their associations with clinical, family-related, socio-economic, premorbid, and place-based characteristics in an Italian survivorship setting. Methods: This single-center cross-sectional exploratory study included 93 of 130 families approached between November 2022 and January 2023 (response rate, 71.5%). One parent or caregiver completed a purpose-built questionnaire for each survivor. The cohort included 38 survivors with central nervous system (CNS) tumors and 55 with non-CNS tumors. Outcomes were evaluated relative to retrospectively reported pre-diagnosis functioning. Exact confidence intervals, effect estimates, multivariable Firth logistic regression, and Benjamini–Hochberg false discovery rate correction were used. Results: Worsening internalizing difficulties were reported for 48/90 survivors (53.3%), neuropsychological difficulties for 42/90 (46.7%), academic worsening for 30/85 (35.3%), and social integration difficulties for 27/90 (30.0%). CNS survivors more frequently had social integration difficulties than non-CNS survivors (47.4% versus 17.3%; odds ratio, 4.22; 95% confidence interval, 1.50–12.73; q = 0.015) and underwent cognitive assessment after cancer (50.0% versus 17.0%; odds ratio, 4.80; 95% confidence interval, 1.71–14.44; q = 0.013). Municipality size and geographic area showed no nominal associations with parent-reported outcomes. No candidate-variable association in the exploratory screen remained significant after false discovery rate correction. Conclusions: Parent-reported difficulties and support needs were common, with differences by CNS versus non-CNS tumor site. Family-related, premorbid, and place-based patterns are hypothesis-generating and require prospective evaluation using validated multi-informant measures. Full article