Neurocognitive

神经认知
  • 文章类型: Journal Article
    小细胞肺癌(SCLC)是恶性程度最高、病死率最高的肺癌病理类型,脑转移(BM)的发生率很高。到目前为止,预防性颅脑照射(PCI)已被认为是预防SCLC脑转移的有效治疗方法.PCI作为标准治疗方法长期应用于放疗和化疗后完全缓解的局限期SCLC(LS-SCLC)患者。然而,神经认知功能下降是PCI的主要关注点.针对PCI诱导的神经毒性的新治疗方法,包括海马保护或美金刚,已越来越多地纳入PCI的治疗干预措施。螺旋断层治疗,RapidArc,建议使用带有头部倾斜基板的体积调节电弧疗法(VMAT)进行海马保护。此外,在MRI和免疫治疗时代,PCI在SCLC患者中的意义存在争议.SCLCPCI患者应在临床试验中招募,因为这是改善现有护理标准的唯一方法。本文总结了SCLCPCI的当前治疗策略和困境。为临床决策提供理论依据,为PCI在临床的实践提供建议。
    Small cell lung cancer (SCLC) is the most malignant pathological type of lung cancer with the highest mortality, and the incidence of brain metastasis (BM) is in high frequency. So far, prophylactic cranial irradiation (PCI) has been suggested as an effective treatment for preventing brain metastasis of SCLC. PCI has long been applied to limited-stage SCLC (LS-SCLC) patients who have achieved complete remission after radiotherapy and chemotherapy as a standard treatment. However, the neurocognitive decline is a major concern surrounding PCI. New therapeutic approaches targeting PCI-induced neurotoxicity, including hippocampal protection or memantine, have been increasingly incorporated into the therapeutic interventions of PCI. Helical tomotherapy, RapidArc, and Volumetric-modulated arc therapy (VMAT) with a head-tilting baseplate are recommended for hippocampal protection. Besides, in the MRI and immunotherapy era, the significance of PCI in SCLC patients is controversial. SCLC patients with PCI should be recruited in clinical trials since this is the only way to improve the existing standard of care. This review summarizes the current therapeutic strategy and dilemma over PCI for SCLC, providing a theoretical basis for clinical decision-making and suggestions for PCI practice in clinical.
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  • 文章类型: Journal Article
    脑病是Susac综合征临床三联征的一部分,但是缺乏对这种情况的神经认知和神经精神病学特征的详细了解。现有文献表明,认知缺陷的严重程度从微妙到深刻。执行功能和短期召回经常受到影响。精神病表现可能不存在或可能包括焦虑,情绪障碍或精神病。如果精神病现象在疾病过程中发展,很难弄清楚症状是否与Susac综合征的病理直接相关,还是继发于治疗相关的副作用。在这篇文章中,我们回顾了有关Susac综合征的认知和精神病发病率的已知信息,并确定了知识不足的领域。重要的是,我们还为未来的研究提供了一个框架,认为更好的表型,对病理生理学的理解,对认知和精神病学结果的治疗评估,纵向数据采集对改善患者预后至关重要。
    Encephalopathy is part of the clinical triad of Susac syndrome, but a detailed understanding of the neurocognitive and neuropsychiatric profile of this condition is lacking. Existing literature indicates that cognitive deficits range in severity from subtle to profound. Executive function and short-term recall are affected frequently. Psychiatric manifestations may be absent or may include anxiety, mood disorders or psychosis. If psychiatric phenomena develop during the disease course, it can be hard to disentangle whether symptoms directly relate to the pathology of Susac syndrome or are secondary to treatment-related side effects. In this article, we review what is known about the cognitive and psychiatric morbidity of Susac syndrome and identify areas where knowledge is deficient. Importantly, we also provide a framework for future research, arguing that better phenotyping, understanding of pathophysiology, evaluation of treatments on cognitive and psychiatric outcomes, and longitudinal data capture are vital to improving patient outcomes.
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  • 文章类型: Journal Article
    嗅觉功能障碍(OD)是COVID-19患者最常见的症状之一,可显著影响患者的生活。本综述的目的是调查COVID-19对嗅觉系统的多方面影响,并概述与COVID-19相关OD患者的磁共振(MRI)发现和神经认知障碍。在PubMed进行了广泛的搜索,Scopus,和谷歌学者,直到2023年12月5日。纳入的文章是12项观察性研究和1例病例报告,评估嗅觉结构的结构变化。通过MRI突出显示,和10项研究将嗅觉丧失与COVID-19患者的神经认知障碍或心境障碍相关联。MRI结果一致显示体积异常,嗅觉灯泡(OBs)的信号强度改变,持续OD的COVID-19患者的嗅觉皮层异常。OD和神经认知缺陷之间的相关性揭示了与认知障碍,记忆缺陷,和持续的抑郁症状。治疗方法,包括嗅觉训练和药物干预,讨论,强调持续治疗干预的必要性。这篇评论指出了当前文献中的一些局限性,同时探讨了COVID-19对OD的复杂影响及其与认知缺陷和情绪障碍的关系。一些研究中缺乏客观的嗅觉测量和自我报告中潜在的有效性问题强调了谨慎解释的必要性。我们的研究强调了对更大样本进行广泛研究的迫切需要,适当的控制,和客观测量,以加深我们对COVID-19对神经和嗅觉功能障碍的长期影响的理解。
    Olfactory dysfunction (OD) is one of the most common symptoms in COVID-19 patients and can impact patients\' lives significantly. The aim of this review was to investigate the multifaceted impact of COVID-19 on the olfactory system and to provide an overview of magnetic resonance (MRI) findings and neurocognitive disorders in patients with COVID-19-related OD. Extensive searches were conducted across PubMed, Scopus, and Google Scholar until 5 December 2023. The included articles were 12 observational studies and 1 case report that assess structural changes in olfactory structures, highlighted through MRI, and 10 studies correlating the loss of smell with neurocognitive disorders or mood disorders in COVID-19 patients. MRI findings consistently indicate volumetric abnormalities, altered signal intensity of olfactory bulbs (OBs), and anomalies in the olfactory cortex among COVID-19 patients with persistent OD. The correlation between OD and neurocognitive deficits reveals associations with cognitive impairment, memory deficits, and persistent depressive symptoms. Treatment approaches, including olfactory training and pharmacological interventions, are discussed, emphasizing the need for sustained therapeutic interventions. This review points out several limitations in the current literature while exploring the intricate effects of COVID-19 on OD and its connection to cognitive deficits and mood disorders. The lack of objective olfactory measurements in some studies and potential validity issues in self-reports emphasize the need for cautious interpretation. Our research highlights the critical need for extensive studies with larger samples, proper controls, and objective measurements to deepen our understanding of COVID-19\'s long-term effects on neurological and olfactory dysfunctions.
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  • 文章类型: Meta-Analysis
    背景:体外膜氧合(ECMO)已广泛用于严重的新生儿疾病约50年,虽然很少有研究集中在其神经心理学发育的长期随访上。
    目的:评估婴儿期接受ECMO的儿童的长期神经心理并发症。
    方法:PubMed,WebofScience,科克伦,和EMBASE数据库检索最近10年(直到2022年6月10日)发表的研究。所有研究均符合资格,集中于接受ECMO的新生儿的神经心理学并发症的长期随访。不包括动物研究,先天性颅脑发育不良的新生儿和来自同一中心的数据在不同时间进行的研究。采用RevMan5.3和Stata/SE12.0软件进行统计分析。使用随机效应模型报告结果。敏感性分析用于确定异质性的来源。
    结果:对纳入1199名患者的10项研究进行了荟萃分析,显示智力的合并发病率(合并发病率:20.3%,95%CI:0.16-0.25,I2:9.5%,P=0.33),运动活动(合并发病率:10.3%,95CI:0.07-0.14,I2:43.5%,P=0.15),学习(合并发病率:9.0%,95CI:-0.03-0.21,I2:63.2%,P=0.10),听力(合并发病率:15.7%,95CI:0.02-0.29,I2:94.2%,P=0.00),视力(合并发病率:18.5%,95CI:0.12-0.25,I2:0%,P=0.46),认知(合并发病率:26.3%,95CI:0.19-0.34,I2:0%,P=0.32),注意力(合并发病率:7.4%,95CI:0.02-0.13,I2:38.9%,P=0.20),注意速度(合并发病率:69.9%,95CI:0.62-0.78),和注意力的准确性(合并发病率:39.0%,95CI:0.30-0.48)在接受ECMO的新生儿中。Begg检验和敏感性分析的结果表明,异质性源于样本量以外的因素。
    结论:这项系统综述和荟萃分析显示,接受ECMO的新生儿与各种神经心理并发症有关。需要更大样本量和更高质量的其他随机对照试验(RCT)。
    BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in severe neonatal diseases for approximately 50 years, while few studies have concentrated on the long-term follow-up of its neuropsychological development.
    OBJECTIVE: To assess the long-term neuropsychological complications in children who underwent ECMO in infancy.
    METHODS: The PubMed, Web of Science, Cochrane, and EMBASE databases were searched for retrieving studies published in the recent 10 years (until June 10, 2022). All studies were eligible that concentrated on the long-term follow-up of neuropsychological complications in neonates undergoing ECMO. Excluding animal studies, neonates with congenital craniocerebral dysplasia and studies with data from the same center performed at different times. Statistical analysis was performed using RevMan 5.3 and Stata/SE 12.0 software. A random-effects model was used to report results. The sensitivity analysis was utilized to identify sources of heterogeneity.
    RESULTS: The meta-analysis of 10 studies that enrolled 1199 patients was conducted, showing the pooled morbidity of intelligence (pooled morbidity: 20.3%, 95% CI: 0.16-0.25, I2: 9.5%, P=0.33), motor activity (pooled morbidity: 10.3%, 95%CI: 0.07-0.14, I2: 43.5%, P=0.15), learning (pooled morbidity: 9.0%, 95%CI: -0.03-0.21, I2: 63.2%, P=0.10), hearing (pooled morbidity: 15.7%, 95%CI: 0.02-0.29, I2: 94.2%, P=0.00), vision (pooled morbidity: 18.5%, 95%CI: 0.12-0.25, I2: 0%, P=0.46), cognition (pooled morbidity: 26.3%, 95%CI: 0.19-0.34, I2: 0%, P=0.32), attention (pooled morbidity: 7.4%, 95%CI: 0.02-0.13, I2: 38.9%, P=0.20), speed in attention (pooled morbidity: 69.9%, 95%CI: 0.62-0.78), and accuracy in attention (pooled morbidity: 39.0%, 95%CI: 0.30-0.48) in neonates undergoing ECMO. The results of the Begg\'s test and sensitivity analysis indicated that the heterogeneity was originated from factors other than sample size.
    CONCLUSIONS: This systematic review and meta-analysis showed that neonates undergoing ECMO were associated with various neuropsychological complications. Additional randomized controlled trials (RCTs) with a larger sample size and a higher quality are needed.
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  • 文章类型: Journal Article
    新冠肺炎影响数百万人的生活已经三年多了,他们中的许多人遭受着被称为长途运输者的长期影响。尽管长途运输者有多器官投诉,与通常称为“脑雾”的认知特征相关的体征和症状发生在50岁以上的COVID患者,女性,肥胖,哮喘过度。脑雾是一组症状,包括认知障碍,无法集中注意力和多任务处理,短期和长期记忆丧失。当然,脑雾会导致高水平的焦虑和压力,需要对这组COVID患者进行移情反应。尽管COVID-19脑雾的病因目前尚不清楚,关于发病机制,存在以下假设:激活星形胶质细胞和小胶质细胞释放促炎细胞因子,tau蛋白的聚集,COVID-19进入大脑会引发自身免疫反应。目前没有特定的测试来检测脑雾或任何特定的认知康复方法。然而,健康的生活方式可以在一定程度上帮助减轻症状,和基于症状的临床管理也非常适合减少COVID-19患者的脑雾副作用。因此,这篇综述讨论了SARS-CoV-2可能导致脑雾的发病机制,以及一些可能帮助COVID-19患者避免恼人的脑雾症状的治疗方法。
    It has been more than three years since COVID-19 impacted the lives of millions of people, many of whom suffer from long-term effects known as long-haulers. Notwithstanding multiorgan complaints in long-haulers, signs and symptoms associated with cognitive characteristics commonly known as \"brain fog\" occur in COVID patients over 50, women, obesity, and asthma at excessive. Brain fog is a set of symptoms that include cognitive impairment, inability to concentrate and multitask, and short-term and long-term memory loss. Of course, brain fog contributes to high levels of anxiety and stress, necessitating an empathetic response to this group of COVID patients. Although the etiology of brain fog in COVID-19 is currently unknown, regarding the mechanisms of pathogenesis, the following hypotheses exist: activation of astrocytes and microglia to release pro-inflammatory cytokines, aggregation of tau protein, and COVID-19 entry in the brain can trigger an autoimmune reaction. There are currently no specific tests to detect brain fog or any specific cognitive rehabilitation methods. However, a healthy lifestyle can help reduce symptoms to some extent, and symptom-based clinical management is also well suited to minimize brain fog side effects in COVID-19 patients. Therefore, this review discusses mechanisms of SARS-CoV-2 pathogenesis that may contribute to brain fog, as well as some approaches to providing therapies that may help COVID-19 patients avoid annoying brain fog symptoms.
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  • 文章类型: Review
    心房颤动与神经认知合并症如中风和痴呆相关。证据表明,节律控制-特别是如果早期实施-可以降低认知能力下降的风险。导管消融术对于在心房颤动的情况下恢复窦性心律非常有效;然而,左心房内的消融已被证明会导致MRI检测到的无症状脑部病变。在这篇最新的评论文章中,我们讨论了左心房消融和心律控制之间的风险平衡.我们强调降低风险的建议,以及较新形式的消融背后的证据,如极高功率短时射频消融和脉冲场消融。
    Atrial fibrillation is associated with neurocognitive comorbidities such as stroke and dementia. Evidence suggests that rhythm control-especially if implemented early-may reduce the risk of cognitive decline. Catheter ablation is highly efficacious for restoring sinus rhythm in the setting of atrial fibrillation; however, ablation within the left atrium has been shown to result in MRI-detected silent cerebral lesions. In this state-of-the-art review article, we discuss the balance of risk between left atrial ablation and rhythm control. We highlight suggestions to lower the risk, as well as the evidence behind newer forms of ablation such as very high power short duration radiofrequency ablation and pulsed field ablation.
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  • 文章类型: Journal Article
    青春期是一个以大脑持续发育为标志的过渡阶段。这个时期伴随着海马体形状和功能的物理和神经化学修饰,前额叶皮质,和其他边缘系统结构。青春期的大脑成熟,这通常是由内在因素控制的,药物和酒精等环境影响会极大地改变。与许多其他成瘾物质不同,酗酒在青少年和年轻人中非常普遍和规范。这种青少年过度饮酒的重复模式已被证明会导致行为改变和神经认知障碍,包括焦虑增加,冒险的决策,和学习缺陷,这可能导致酒精使用障碍(AUD)的发展。这份手稿强调了导致青少年暴饮暴食的因素,讨论了青少年大脑中发生的成熟变化,然后评估青少年饮酒对大脑结构的影响,函数,人类研究和动物模型中的神经认知能力。简要讨论了性别/性别和COVID-19的影响。了解促进青少年暴饮暴食的因素及其不良后果可以作为开发治疗剂的催化剂,这些治疗剂可以减少或消除酒精对青少年大脑的破坏性影响。
    Adolescence is a transitional stage marked by continued brain development. This period is accompanied by physical and neurochemical modifications in the shape and function of the hippocampus, prefrontal cortex, and other limbic system structures. Brain maturation during adolescence, which is typically governed by intrinsic factors, can be dramatically altered by environmental influences such as drugs and alcohol. Unlike many other addictive substances, binge drinking is very common and normative among teenagers and young adults. This repeated pattern of excessive alcohol consumption in adolescents has been shown to cause behavioral changes and neurocognitive impairments that include increased anxiety, risky decision-making, and learning deficits, which could lead to the development of alcohol use disorder (AUD). This manuscript highlights factors that lead to adolescent binge drinking, discusses maturational changes that occur in an adolescent\'s brain, and then evaluates the effect of adolescent alcohol consumption on brain structure, function, and neurocognitive abilities in both human studies and animal models. The impact of gender/sex and COVID-19 are briefly discussed. Understanding the factors that promote the onset of adolescent binge drinking and its undesirable consequences could serve as a catalyst for developing therapeutic agents that would decrease or eradicate the damaging effects of alcohol on an adolescent brain.
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  • 文章类型: Journal Article
    Addison病(AD)导致糖皮质激素和盐皮质激素的长期生产不足。疲劳和生活质量下降是经常报告的症状,但对它对认知的影响知之甚少。本研究旨在探讨AD患者是否存在认知障碍及治疗方案的影响。我们进行了系统的审查。10篇文章符合纳入标准,他们中的大多数被列为中等质量。三项研究分析了AD与认知障碍之间的关系;一项研究探讨了延迟治疗对认知表现没有影响的影响,另一个研究了氟氢可的松治疗的效果。情景记忆是研究中最常见的认知领域受损,与健康对照相比。两篇论文研究了睡眠质量受损与认知能力低下之间的关系。两项研究将认知障碍与皮质醇减少症相关。两项研究调查了DHEA取代的作用。总之,患者在口头学习中表现出适度下降的表现。这种损伤的病理生理学可能是多因素的。未来的研究应该包括更大的样本量,使用全面和多领域的神经心理和行为协议,和神经成像。
    Addison\'s disease (AD) entails a chronic insufficient production of gluco- and mineralocorticoids. Fatigue and decreased quality of life are frequently reported symptoms, but little is known about its effects on cognition. This study aims to explore the existence of cognitive impairment in patients with AD and the influence of treatment regimens. We conducted a systematic review. Inclusion criteria were met by 10 articles, most of them ranked as intermediate quality. Three studies analyzed the relationship between AD and cognitive impairment; one explored the effect of delaying treatment showing no effect on cognitive performance, and another one studied the effect of fludrocortisone treatment. Episodic memory was the most frequent cognitive domain impaired across studies, in comparison to healthy controls. Two papers investigated the relationship between impaired sleep quality and poor cognitive performance. Two studies related cognitive impairments with hypocortisolism-derived brain neuroglycopenia. Two studies investigated the effect of DHEA substitution. In conclusion, patients exhibit a moderately reduced performance in verbal learning. The pathophysiology of this impairment is likely multifactorial. Future studies should include larger sample sizes, the use of comprehensive and multi-domain neuropsychological and behavioral protocols, and neuroimaging.
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  • 文章类型: Journal Article
    作为声学事件的基本要素之一,音色通过音调和响度等其他因素共同影响大脑。音色感知研究涉及跨学科领域,包括物理声学,听觉心理学,神经认知科学和音乐理论,等。从心理学和生理学的角度来看,本文总结了音色感知的特点和功能及其相关性,其中定义音色的多维尺度建模方法是重点;音色的神经认知和感知(包括灵敏度,适应性,记忆能力,等。)概述;相关实验结果(通过使用EEG/ERP,功能磁共振成像,等。)从神经认知的角度对音色感知的更深层次进行了总结。同时,还讨论了音色感知实验过程中的潜在问题和未来的可能性。思想梳理现有的研究内容,音色感知的方法和发现,本文旨在为音色感知心理学相关领域的研究者提供启发式指导,生理和神经机制。相信今后对音色感知的研究在各个领域都是必不可少的,包括神经美学,心理干预,艺术创作,康复,等。
    As one of the basic elements in acoustic events, timbre influences the brain collectively with other factors such as pitch and loudness. Research on timbre perception involve interdisciplinary fields, including physical acoustics, auditory psychology, neurocognitive science and music theory, etc. From the perspectives of psychology and physiology, this article summarizes the features and functions of timbre perception as well as their correlation, among which the multi-dimensional scaling modeling methods to define timbre are the focus; the neurocognition and perception of timbre (including sensitivity, adaptability, memory capability, etc.) are outlined; related experiment findings (by using EEG/ERP, fMRI, etc.) on the deeper level of timbre perception in terms of neural cognition are summarized. In the meantime, potential problems in the process of experiments on timbre perception and future possibilities are also discussed. Thought sorting out the existing research contents, methods and findings of timbre perception, this article aims to provide heuristic guidance for researchers in related fields of timbre perception psychology, physiology and neural mechanism. It is believed that the study of timbre perception will be essential in various fields in the future, including neuroaesthetics, psychological intervention, artistic creation, rehabilitation, etc.
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  • 文章类型: Journal Article
    相对于健康对照(HC),处于临床高风险(CHR)的青年精神病存在神经心理障碍,但这些损伤是否与其他精神病理学假定风险较低的同龄人中所见到的损伤有区别,目前尚不清楚.我们假设CHR队列中任何超出其他临床组的过度损伤是最小的,并且由过渡到精神病(CHR-T)的比例所占。
    我们对CHR青年与寻求心理健康服务但不符合CHR标准或有经过验证的非精神病性精神病理学的临床比较者(CC)的认知表现进行了系统评价和荟萃分析。
    纳入了21项研究,代表了近4000名参与者。CHR的个体表现出相对于HC的实质性认知障碍(例如,全球认知:g=-0.48[-0.60,-0.34]),但相对于CC的损害最小(例如,全球认知:g=-0.13[-0.20,-0.06])。CHR中的任何过度损害几乎完全归因于CHR-T;CHR没有过渡(CHR-NT)的年轻人中的损害通常与CC没有区别(例如,全球认知,CHR-T:g=-0.42[-0.64,-0.19],CHR-NT:g=-0.09[-0.18,0.00];处理速度,CHR-T:g=-0.59[-0.82,-0.37],CHR-NT:g=-0.12[-0.25,0.07];工作记忆,CHR-T:g=-0.42[-0.62,-0.22],CHR-NT:g=-0.03[-0.14,0.08])。
    当精神病或甚至CHR状态是感兴趣的特定临床综合征时,应谨慎解释CHR队列中的神经认知障碍,因为这些障碍很可能代表跨诊断性与精神病特异性的脆弱性。
    Youth at clinical high-risk (CHR) for psychosis present with neuropsychological impairments relative to healthy controls (HC), but whether these impairments are distinguishable from those seen among putatively lower risk peers with other psychopathology remains unknown. We hypothesized that any excess impairment among CHR cohorts beyond that seen in other clinical groups is minimal and accounted for by the proportion who transition to psychosis (CHR-T).
    We performed a systematic review and meta-analysis of studies comparing cognitive performance among CHR youth to clinical comparators (CC) who either sought mental health services but did not meet CHR criteria or presented with verified nonpsychotic psychopathology.
    Twenty-one studies were included representing nearly 4000 participants. Individuals at CHR showed substantial cognitive impairments relative to HC (eg, global cognition: g = -0.48 [-0.60, -0.34]), but minimal impairments relative to CC (eg, global cognition: g = -0.13 [-0.20, -0.06]). Any excess impairment among CHR was almost entirely attributable to CHR-T; impairment among youth at CHR without transition (CHR-NT) was typically indistinguishable from CC (eg, global cognition, CHR-T: g = -0.42 [-0.64, -0.19], CHR-NT: g = -0.09 [-0.18, 0.00]; processing speed, CHR-T: g = -0.59 [-0.82, -0.37], CHR-NT: g = -0.12 [-0.25, 0.07]; working memory, CHR-T: g = -0.42 [-0.62, -0.22], CHR-NT: g = -0.03 [-0.14, 0.08]).
    Neurocognitive impairment in CHR cohorts should be interpreted cautiously when psychosis or even CHR status is the specific clinical syndrome of interest as these impairments most likely represent a transdiagnostic vs psychosis-specific vulnerability.
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