====== Cognitive impairment ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1R3QZIpFgea1QJttX9v1R9BUXYeHWkVf9vqxAEydzxQLXjUc5Y/?limit=15&utm_campaign=pubmed-2&fc=20250318173554}} [[Cognitive]] [[impairment]] refers to difficulties in one or more areas of [[cognitive function]]ing, such as [[memory impairment]], [[attention]], [[language]], [[perception]], or problem-solving. ---- Cognitive impairment and [[dementia]] are related concepts, but they refer to different conditions with distinct characteristics. Cognitive Impairment: Definition: Cognitive impairment is a broad term that encompasses a range of cognitive function deficits, including memory, attention, language, and problem-solving skills. Scope: Cognitive impairment can be a temporary or permanent condition, and it may result from various factors such as medication side effects, nutritional deficiencies, sleep disorders, or other medical conditions. Severity: Cognitive impairment can vary in severity, from mild to moderate to severe. Reversibility: In some cases, cognitive impairment is reversible if the underlying cause is identified and treated. Dementia: Definition: Dementia is a syndrome characterized by a decline in cognitive function that is severe enough to interfere with a person's daily life and activities. Scope: Dementia is generally a progressive condition and is often caused by neurodegenerative diseases such as Alzheimer's disease, vascular dementia, Lewy body dementia, or frontotemporal dementia. Symptoms: Common symptoms of dementia include memory loss, impaired judgment, difficulty with problem-solving, and changes in mood and behavior. Irreversibility: Unlike some forms of cognitive impairment, dementia is usually irreversible and tends to worsen over time. In summary, cognitive impairment is a broader term that can encompass various degrees and causes of cognitive decline, while dementia is a specific syndrome characterized by a significant and usually irreversible decline in cognitive function. Dementia is one of the potential outcomes of cognitive impairment, but not all individuals with cognitive impairment develop dementia. If someone is experiencing cognitive difficulties, it is essential to consult with a healthcare professional for a comprehensive evaluation and appropriate diagnosis. ---- Functional [[cognitive]] [[disorder]]s are a group of overlapping conditions in which [[cognitive symptoms]] are present, which are genuine, distressing, and often disabling, but experienced inconsistently and not related to systemic or brain disease ---- [[Cognitive fatigability]] [[Cognitive]] decline is a deterioration in [[cognitive function]]. Several studies claimed that surgery in [[eloquent area]]s is possible without causing severe [[cognitive decline]]. However, this conclusion was relatively ungrounded due to the lack of extensive [[neuropsychological test]]ing in homogenous patient groups. ---- Liu et al. retrospectively enrolled 92 consecutive patients with a confirmed diagnosis of [[Cushing's disease]]. A voxel-based analysis was performed to investigate the association between cerebral (18)F-fluorodeoxyglucose uptake and serum [[cortisol]] level. Relatively impaired metabolism of specific brain regions correlated with serum cortisol level was found. Specifically, notable correlations were found in the [[hippocampus]], amygdala, and cerebellum, regions considered to be involved in the regulation and central action of [[glucocorticoid]]s. Moreover, some hormone-associated regions were found in the frontal and occipital cortex, possibly mediating the [[cognitive decline]] seen in Cushing's disease. The findings link patterns of perturbed [[brain metabolism]] relates to individual hormone level, thus presenting a substrate for cognitive disturbances seen in Cushing's disease patients, as well as in other conditions with abnormal cortisol levels ((Liu S, Wang Y, Xu K, Ping F, Wang R, Li F, Cheng X. Brain glucose metabolism is associated with hormone level in Cushing's disease: A voxel-based study using FDG-PET. Neuroimage Clin. 2016 Aug 24;12:415-9. doi: 10.1016/j.nicl.2016.08.018. eCollection 2016. PubMed PMID: 27622138; PubMed Central PMCID: PMC5008049. )). ---- In the mid-1970s, the psychiatrist Edward Hare published two accounts of Michael Faraday's memory symptoms. He suggested the diagnostic possibilities of an amnesic syndrome related to a transient ischemic attack in the vertebrobasilar cerebrovascular system. This article revisits the contemporary evidence of Faraday's letters and the notes of his physician, Peter Mere Latham, and considers subsequent responses to and shortcomings of Hare's analysis. In light of more recent conceptualizations of memory disorders, a new formulation for Faraday's memory symptoms is suggested: namely, that he manifested a functional cognitive disorder ((Larner AJ. Michael Faraday's "loss of memory" revisited [published online ahead of print, 2020 Sep 16]. J Hist Neurosci. 2020;1-8. doi:10.1080/0964704X.2020.1814978)). ---- ===== Classification ===== [[Cognitive impairment classification]]. ===== Etiology ===== As [[Normal pressure hydrocephalus]] (NPH) progresses, cognitive impairment may become more generalized and less responsive to treatment. [[Phenobarbital]]: Cognitive impairment (may be subtle and may outlast administration of the drug by at least several months), thus avoid in peds; sedation; paradoxical hyperactivity (especially in peds); may cause hemorrhage in newborns if the mother is on phenobarbital. ---- [[Vascular cognitive impairment]] (VCI) represents the second most common cause of [[dementia]] after [[Alzheimer's disease]], and pathological changes in cerebral vascular [[structure]] and [[function]] are pivotal causes of VCI. [[Cognitive impairment]] caused by arterial [[ischemia]] has been extensively studied the whole time; the influence of cerebral venous [[congestion]] on cognitive impairment draws doctors' attention in recent [[clinical practice]], but the underlying neuropathophysiological alterations are not entirely understood. A study by Wei et al. elucidated the specific pathogenetic role of cerebral [[venous congestion]] in cognitive-behavioral deterioration and possible electrophysiological mechanisms. Using cerebral venous congestion [[rat model]]s, they found these [[rat]]s exhibited decreased long-term potentiation (LTP) in the hippocampal [[dentate gyrus]] and impaired spatial [[learning]] and [[memory]]. Based on untargeted [[metabolomics]], N-acetyl-L-[[cysteine]] (NAC) deficiency was detected in cerebral venous congestion rats; supplementation with NAC appeared to ameliorate synaptic deficits, rescue impaired LTP, and mitigate cognitive impairment. In a cohort of cerebral venous congestion patients, NAC levels were decreased; NAC concentration was negatively correlated with subjective cognitive decline (SCD) score but positively correlated with mini-mental state examination (MMSE) score. These findings provide a new perspective on cognitive impairment and support further exploration of NAC as a therapeutic target for the prevention and treatment of VCI ((Wei H, Jiang H, Zhou Y, Xiao X, Zhou C, Ji X. Cerebral venous congestion alters brain metabolite profiles, impairing cognitive function. J Cereb Blood Flow Metab. 2023 Jun 13:271678X231182244. doi: 10.1177/0271678X231182244. Epub ahead of print. PMID: 37309740.)) ===== Diagnosis ===== [[Cognitive impairment diagnosis]].