To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairmen...To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.展开更多
Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation （AF） receiving oral anticoagulations （OACs） therapy. Many patients with AF are elderly and may suf...Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation （AF） receiving oral anticoagulations （OACs） therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Me- thods The study involved 111 AF patients （mean age, 73.5±8.3 years） treated with OACs. Cognitive function was assessed using the Mini Mental State Examination （MMSE）. The level of adherence was assessed by the 8-item Mot^sky Medication Adherence Scale （MMAS-8）. Scores on the MMAS-8 range from 0 to 8, with scores 〈 6 reflecting low adherence, 6 to 〈 8 medium adherence, and 8 high adherence. Re- sults 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OACs. Patients with lower adherence were older than those with moderate or high adherence （76.6 ±8.7 vs. 71.3 ~ 6.4 vs. 71.1 ± 6.7 years） and obtained low MMSE scores, indicating cognitive disorders or dementia （MMSE = 22.3 ± 4.2）. Patients with moderate or high adherence obtained high MMSE test results （27.5 ±1.7 and 27,5 ± 3.6）. According to Spearman＇s rank correlation, worse adherence to treatment with OACs was determined by older age （rs = -0.372） and lower MMSE scores （rs = 0.717）. According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence （b = 1.139）. Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.展开更多
Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment ...Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.展开更多
A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient cl...A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.展开更多
Mild cognitive impairment （MCI） is common in patients with Parkinson＇s disease （PD）, yet the underlying neural mechanisms of this disease state remain unclear. We investigated alterations in the spontaneous brain...Mild cognitive impairment （MCI） is common in patients with Parkinson＇s disease （PD）, yet the underlying neural mechanisms of this disease state remain unclear. We investigated alterations in the spontaneous brain activity of PD patients with MCI （PD-MCI） relative to cognitively normal PD patients （PD-CN） and healthy control （HC） subjects. In this work, 13 PD-MCI patients, 16 PD-CN patients, and 16 HC subjects completed resting state functional MRI. Spontaneous brain activity was measured by calculating amplitude of low frequency fluctuation （ALFF） values across the whole brain. Between-group differences and correlations between ALFF values and cognitive test scores were analyzed. ALFF values decreased in the right superior temporal gyrus and increased in the left middle temporal gyrus and left superior frontal gyms of PD-MCI patients compared with PD-CN patients. In the PD-MCI group, ALFF values in the left middle temporal gyrus were negatively correlated with Montreal Cognitive Assessment and vocabulary test scores, and the ALFF values in the left superior frontal gyms were negatively correlated with vocabulary test scores. Our study demonstrates that PD-MCI is associated with abnormal spontaneous brain activity in the temporal and frontal lobes. These findings inform the underlying neural mechanism of cognitive impairment in PD.展开更多
文摘To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.
文摘Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation （AF） receiving oral anticoagulations （OACs） therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Me- thods The study involved 111 AF patients （mean age, 73.5±8.3 years） treated with OACs. Cognitive function was assessed using the Mini Mental State Examination （MMSE）. The level of adherence was assessed by the 8-item Mot^sky Medication Adherence Scale （MMAS-8）. Scores on the MMAS-8 range from 0 to 8, with scores 〈 6 reflecting low adherence, 6 to 〈 8 medium adherence, and 8 high adherence. Re- sults 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OACs. Patients with lower adherence were older than those with moderate or high adherence （76.6 ±8.7 vs. 71.3 ~ 6.4 vs. 71.1 ± 6.7 years） and obtained low MMSE scores, indicating cognitive disorders or dementia （MMSE = 22.3 ± 4.2）. Patients with moderate or high adherence obtained high MMSE test results （27.5 ±1.7 and 27,5 ± 3.6）. According to Spearman＇s rank correlation, worse adherence to treatment with OACs was determined by older age （rs = -0.372） and lower MMSE scores （rs = 0.717）. According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence （b = 1.139）. Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.
基金This work was supported by grants from the National Natural Science FoundationQ6 of China （81273968 and 81471027）, the ministerial projects of the National Working Commission on Aging （QLB2014W002）, and the four htmdred project of 301 （YS201408）.
文摘Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.
文摘A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.
基金supported by the National Natural Science Foundation of China(81271429 and 81571228)
文摘Mild cognitive impairment （MCI） is common in patients with Parkinson＇s disease （PD）, yet the underlying neural mechanisms of this disease state remain unclear. We investigated alterations in the spontaneous brain activity of PD patients with MCI （PD-MCI） relative to cognitively normal PD patients （PD-CN） and healthy control （HC） subjects. In this work, 13 PD-MCI patients, 16 PD-CN patients, and 16 HC subjects completed resting state functional MRI. Spontaneous brain activity was measured by calculating amplitude of low frequency fluctuation （ALFF） values across the whole brain. Between-group differences and correlations between ALFF values and cognitive test scores were analyzed. ALFF values decreased in the right superior temporal gyrus and increased in the left middle temporal gyrus and left superior frontal gyms of PD-MCI patients compared with PD-CN patients. In the PD-MCI group, ALFF values in the left middle temporal gyrus were negatively correlated with Montreal Cognitive Assessment and vocabulary test scores, and the ALFF values in the left superior frontal gyms were negatively correlated with vocabulary test scores. Our study demonstrates that PD-MCI is associated with abnormal spontaneous brain activity in the temporal and frontal lobes. These findings inform the underlying neural mechanism of cognitive impairment in PD.
