Undrestanding postoperative cognitive dysfunction: novel insights

ABSTRACT: Background: Sleep is integral to biological function and sleep disruption can result in both physiological and psychological dysfunction. The acute cognitive consequences of sleep loss has been an active field of recent investigation, evidence suggests that sleep disruption in critically ill older adults can result in acute decrements in cognitive functioning. Surgery activates the innate immune system, inducing neuroinflammatory changes that interfere with cognition. The fact that patients with sleep disorders have an increased likelihood of exhibiting postoperative delirium encourages us to investigate the contribution of perioperative SF to the neuroinflammatory and cognitive responses of surgery. Methods: The effects of 24h sleep fragmentation (SF) and surgery were explored on adult C57BL/6J male mice. SF procedure started at 7 am with the home-cages being placed on a large platform orbital shaker cycled every 120 seconds (30 sec on/90 sec off). This procedure lasted for 24h. Stabilized tibia fracture was performed either before or after the 24h SF procedure. Separate cohorts of mice were tested for systemic and hippocampal inflammation and cognition. Results: Twenty-four hours of SF induced non-hippocampal memory dysfunction and increase in systemic IL-6. SF and surgery caused hippocampal-dependent memory impairment, although memory impairment was not exacerbated by combining SF with surgery. One day after either SF or surgery there was a significant increase in IL6 mRNA and TNF-alpha mRNA. These increments were more pronounced when either pre or post operative SF was combined with surgery. Conclusions: We show that while SF and surgery can independently produce significant memory impairment, perioperative SF significantly increased hippocampal inflammation without further cognitive impairment. The dissociation between neuroinflammation and cognitive decline may relate to our use of a sole memory paradigm that does not capture other aspects of cognition, especially learning.

eHealth e a ado����o da inova����o em assisted living technologies : o caso das dem��ncias

RESUMO - Assistimos hoje a um contexto marcado (i) pelo progressivo envelhecimento das sociedades ocidentais, (ii) pelo aumento da preval��ncia das doen��as cr��nicas, de que as dem��ncias s��o um exemplo, (iii) pelo significativo aumento dos custos associados a estas patologias, (iv) por or��amentos p��blicos fortemente pressionadas pelo controlo da despesa, (v) por uma vida moderna que dificulta o apoio intergeracional, tornando o suporte proporcionado pelos filhos particularmente dif��cil, (vi) por fortes expectativas relativamente �� presta����o de cuidados de sa��de com qualidade. Teremos assim de ser capazes de conseguir melhorar os servi��os de sa��de, ao mesmo tempo que recorremos a menos recursos financeiros e humanos, pelo que a inova����o parece ser cr��tica para a sustentabilidade do sistema. Contudo a difus��o das Assistive Living Technologies, apesar do seu potencial, tem sido bastante baixa, nomeadamente em Portugal. Porqu��? Hamer, Plochg e Moreira (2012), no editorial do International Journal of Healthcare Management, enquadram a Inova����o como ���podendo ser imprevis��vel e mesmo dolorosa, pelo que talvez possamos n��o ficar surpreendidos se surgirem resist��ncias e que, inova����es bastante necess��rias, capazes de melhorar os indicadores de sa��de, tenham sido de ado����o lenta ou que tenham mesmo sido insustent��veis���. Em Portugal n��o h�� bibliografia que procure caracterizar o modelo de difus��o da inova����o em eHealth ou das tecnologias de viv��ncia assistida. A bibliografia internacional �� igualmente escassa. O presente projeto de investiga����o, de natureza explorat��ria, tem como objetivo principal, identificar barreiras e oportunidades para a implementa����o de tecnologias eHealth, aplicadas ao campo das dem��ncias. Como objetivos secund��rios pretendemse identificar as oportunidades e limita����es em Portugal: mapa de compet��ncias nacionais, e propor medidas que possa acelerar a inova����o em ALT, no contexto nacional. O projeto seguir�� o modelo de um estudo qualitativo. Para o efeito foram conduzidas entrevistas em profundidade junto de experts em ALT, procurando obter a vis��o daqueles que participam do lado da Oferta- a Ind��stria; do lado da Procura- doentes, cuidadores e profissionais de sa��de; bem como dos Reguladores. O instrumento utilizado para a recolha da informa����o pretendida foi o question��rio n��o estruturado. A an��lise e interpreta����o da informa����o recolhida foram feitas atrav��s da t��cnica de An��lise de Conte��do. Os resultados da An��lise de Conte��do efetuada permitiram expressar a dicotomia barreira/oportunidade, nas seguintes categorias aqui descritas como contextos (i) Contexto Tecnol��gico, nas subcategorias de Acesso ��s Infraestruturas; Custo da Tecnologia; Interoperabilidade, (ii) Contexto do Valor Percecionado, nas subcategorias de Utilidade; Efici��ncia; Divulga����o, (iii) Contexto Pol��tico, compreendendo a Lideran��a; Organiza����o; Regula����o; Recursos, (iv) Contexto Sociocultural, incluindo nomeadamente Idade; Literacia; Capacidade Econ��mica, (v) Contexto Individual, incluindo como subcategorias, Capacidade de Adapta����o a Novas tecnologias; Motiva����o; Acesso a equipamentos (vi) Contexto Espec��fico da Doen��a, nomeadamente o Impacto Cognitivo; Tipologia Heterog��nea e a Import��ncia do Cuidador. Foi proposto um modelo explorat��rio, designado de Modelo de Contextos e For��as, que estudos subsequentes poder��o validar. Neste modelo o Contexto Tecnol��gico �� um For��a B��sica ou Fundamental; o Contexto do Valor Percecionado, constitui-se numa For��a Cr��tica para a ado����o de inova����o, que assenta na sua capacidade para oferecer valor aos diversos stakeholders da cadeia de cuidados. Temos tamb��m o Contexto Pol��tico, com capacidade de modelar a ado����o da inova����o e nomeadamente com capacidade para o acelerar, se dele emitir um sinal de urg��ncia para a mudan��a. O Contexto Sociocultural e Individual expressam uma For��a Intr��nseca, dado que elas s��o caracter��sticas internas, pr��prias e imut��veis no curto-prazo, das sociedade e das pessoas. Por fim h�� que considerar o Contexto Espec��fico da Doen��a, nesta caso o das dem��ncias. Das conclus��es do estudo parece evidente que as condi����es tecnol��gicas est��o medianamente satisfeitas em Portugal, com evidentes progressos nos ��ltimos anos (exce����o para a interoperabilidade aonde h�� necessidade de maiores progressos), n��o constituindo portanto barreira �� introdu����o de ALT. Aonde h�� necessidade de investir �� nas ��reas do valor percebido. Da an��lise feita, esta �� uma ��rea que constitui uma barreira �� introdu����o e ado����o das ALT em Portugal. A falta de perce����o do valor que estas tecnologias trazem, por parte dos profissionais de sa��de, doentes, cuidadores e decisores pol��ticos, parece ser o principal entrave �� sua ado����o. S��o recomendadas estrat��gias de modelos colaborativos de Investiga����o e Desenvolvimento e de abordagens de cocria����o com a contribui����o de todos os intervenientes na cadeia de cuidados. H�� tamb��m um papel que cabe ao estado no ��mbito das prioridades e da mobiliza����o de recursos, sendo-lhe requerida a express��o do sentido de urg��ncia para que esta mudan��a aconte��a. Foram tamb��m identificadas oportunidades em diversas ��reas, como na preven����o, no diagn��stico, na compliance medicamentosa, na terap��utica, na monitoriza����o, no apoio �� vida di��ria e na integra����o social. O que �� necess��rio �� que as solu����es encontradas constituam respostas ��quilo que s��o as verdadeiras necessidades dos intervenientes e n��o uma imposi����o tecnol��gica que s�� por si nada resolve. Do estudo resultou tamb��m a perce����o de que h�� que (i) continuar a trabalhar no sentido de aproximar a comunidade cient��fica, da cl��nica e do doente, (ii) fomentar a colabora����o entre centros, com vista �� cria����o de escala a n��vel global. Essa colabora����o j�� parece acontecer a n��vel empresarial, tendo sido identificadas empresas Portuguesas com voca����o global. A qualidade individual das institui����es de ensino, dos centros de investiga����o, das empresas, permite criar as condi����es para que Portugal possa ser pa��s um piloto e um case-study internacional em ALT, desde que para tal pud��ssemos contar com um trabalho colaborativo entre institui����es e com decis��es pol��ticas arrojadas.

Map-it ��� Mapeamento tridimensional de interiores

A perce����o tridimensional �� uma ��rea em crescente desenvolvimento. N��o existindo uma tecnologia ideal capaz de percecionar todo o tipo de cen��rios, t��m surgido estudos sobre a aplicabilidade de diferentes tecnologias de forma a obter modelos que melhor se aproximem da realidade. Prop��e-se nesta disserta����o o desenvolvimento de um sistema de baixo-custo de percep����o tridimensional que seja port��til e acess��vel na sua aplicabilidade, de forma a ter a capacidade de percecionar tridimensionalmente espa��os interiores com pouca ilumina����o, tais como as divis��es de um edif��cio ou os canais de uma mina subterr��nea. Utilizou-se a triangula����o entre uma c��mara digital, os pontos de uma linha laser e um emissor laser para a obten����o dos dados tridimensionais do cen��rio. Para isso, recorreu-se a metodologias de processamento digital de imagens para a constru����o dos modelos dos cen��rios. Para se obter a valida����o desta disserta����o, realizaram-se testes do prot��tipo de forma a determinar as suas capacidades percecionais. Em primeiro lugar realizou-se uma bateria de testes de calibra����o onde, repetidamente, se estudaram isoladamente pontos do cen��rio para verificar a precis��o do sensor. Ap��s esta calibra����o, estudou-se a capacidade de transforma����o de uma linha laser projetada num conjunto de coordenadas. Finalmente testou-se a capacidade de perce����o tridimensional por rota����o do sensor, de forma a realizar a transforma����o de m��ltiplas proje����es de linhas laser num conjunto de coordenadas em torno do sensor. Verificou-se: no teste de calibra����o, a obten����o de dist��ncias com erro m��dio relativo inferior a 1%; no teste da linha laser, a capacidade de perce����o de profundidade de m��ltiplos pontos ao longo da mesma; no teste de rota����o, a aquisi����o de m��ltiplos conjuntos de linhas de profundidade no cen��rio, por rota����o do sensor. Os resultados dos testes de valida����o permitiram concluir a viabilidade de utilizar a triangula����o na aquisi����o de conjuntos de coordenadas de espa��os interiores.

Untitled: Figurations of memory

The next pages will describe my experience and results of making connections between cognitive sciences and art; the transformations of my memories being the object of study and motivation for this process of self-discovery. The human body reacts according to innumerable neural functions and external stimuli. Neurons respond to the evocation of experienced events, building virtual images, map-like constellations sometimes fulfilled by imagination, desires or knowledge promoting in this way their constant reshaping. This document offers an insight into my recollections as matter. As matter these recollections take on different states and I hope to give you a better sense of my personal voice using my experience with glass to explore this transformation and accompanying my journey with lectures and scientific readings about the mind functions.

Development of cognitive abilities of children infected with helminths through health education

INTRODUCTION: The aim of this study was to evaluate the effect of health education in learning and cognitive development of children infected, previously treated in an endemic area for helminthiasis. METHODS: It is a longitudinal, experimental, with random allocation of participants. The study included 87 children of both sexes enrolled in the school hall of Maranh��o, State of Minas Gerais, Brazil, and divided into two groups: intervention and control. Initially the children were submitted to the parasitological fecal examination for infection diagnosis and, when positive, they were treated. For the data collection, a structured questionnaire and the psychological tests Raven, Wisc-III and DAP III were applied, before and after the educational intervention. For the group comparison, the Mann Whitney test was used, and established significance level of 5%. RESULTS: It was found that previously infected children who received the educational intervention, children showed higher performance than the control group in strutured questionnaire (p<0.05). CONCLUSIONS: It is acceptable to suppose the positive influence and the importance in the use of educational interventions in the cognitive recovery and learning of children previously treated with anthelmintics.

Fate map of zebrafish left-right organizer

The organizer is a ciliated signalling transient organ, responsible for the patterning of embryo tissues during embryonic development. In higher vertebrates, such as mouse and chick, this organizer (the node and the Hensen���s node, respectively) performs dorsalventral and anteriorposterior axis definition, as well as left-right patterning of the internal organs. In lower vertebrates, such as frog and zebrafish, there is a separate specialized organ for left-right purposes called the Gastrocoel Roof Plate (GRP) and Kupffer���s Vesicle (KV), respectively. It is known that mouse and chick organizer cells give rise to structures like floor plate, notochord, hypochord and somites. Frog GRP originates all these but floor plate. In zebrafish, at 13-14 somite stage (ss) the KV finished its left-right patterning but what happens to this organizer��� cells is still poorly studied. This research attempts to understand the fate and behaviour of the KV cells. We followed the fate of KV cells by live imaging and by tight time-courses with fixed larvae. We assessed in detail their proliferative and death profile, as well as cilia length progression from 9-10 ss until 29-30 ss. We conclude that the KV cells mostly follow the evolutionarily conserved fates described for other organizers. These cells mainly incorporate the notochord and hypochord; few cells incorporate the floor plate and the somites. As a novelty, it is also hypothesized that the hypural cell fate may be among the KV cell fates.

Design and implementation of an assurance map at Sonae retail business

The present Working Project aims at studying the topic of assurance mapping in a specific organizational context of a Portuguese retail company. For this purpose, an assurance map framework was designed to support the decision making process of stakeholders, through the delivery of comfort concerning risks, operations and control. In the end, the framework was successfully implemented for the process sourcing of goods in two business units of the company. Although, further implementation of the framework proved not to be feasible during the project���s timespan, it is expected to occur in the near future.

Effector memory CD4+ T cells are associated with cognitive performance in a senior population

Objective: Immunosenescence and cognitive decline are common markers of the aging process. Taking into consideration the heterogeneity observed in aging processes and the recently described link between lymphocytes and cognition, we herein explored the possibility of an association between alterations in lymphocytic populations and cognitive performance. Methods: In a cohort of cognitively healthy adults (n = 114), previously characterized by diverse neurocognitive/psychological performance patterns, detailed peripheral blood immunophenotyping of both the innate and adaptive immune systems was performed by flow cytometry. Results: Better cognitive performance was associated with lower numbers of effector memory CD4(+) T cells and higher numbers of naive CD8(+) T cells and B cells. Furthermore, effector memory CD4(+) T cells were found to be predictors of general and executive function and memory, even when factors known to influence cognitive performance in older individuals (e.g., age, sex, education, and mood) were taken into account. Conclusions: This is the first study in humans associating specific phenotypes of the immune system with distinct cognitive performance in healthy aging.

Cognitive stimulation for portuguese older adults with cognitive impairment: a randomized controlled trial of efficacy, comparative duration, feasibility and experiential relevance

Although some studies point to cognitive stimulation as a beneficial therapy for older adults with cognitive impairments, this area of research and practice is still lacking dissemination and is underrepresented in many countries. Moreover, the comparative effects of different intervention durations remain to be established and, besides cognitive effects, pragmatic parameters, such as cost-effectiveness and experiential relevance to participants, are seldom explored. In this work, we present a randomized con- trolled wait-list trial evaluating 2 different intervention durations (standard 1���4 17 vs brief 1���4 11 sessions) of a cognitive stimulation program developed for older adults with cognitive impairments with or without dementia. 20 participants were randomly assigned to the standard duration intervention program (17 sessions, 1.5 months) or to a wait-list group. At postintervention of the standard intervention group, the wait-list group crossed over to receive the brief intervention program (11 sessions, 1 month). Changes in neuropsychological, functionality, quality of life, and caregiver outcomes were evaluated. Experience during intervention and costs and feasibility were also evaluated. The current cognitive stimulation programs (ie, standard and brief) showed high values of experiential relevance for both intervention durations. High adherence, completion rates, and reasonable costs were found for both formats. Further studies are needed to definitively establish the potential efficacy, optimal duration, cost-effectiveness, and experiential relevance for participants of cognitive intervention approaches.

Facilitative effects of bi-hemispheric tDCS in cognitive deficits of Parkinson Disease patients

Parkinson���s disease (PD) is a progressive neurodegenerative disorder, primarily characterized by motor symptoms such as tremor, rigidity, bradykinesia, stiffness, slowness and impaired equilibrium. Although the motor symptoms have been the focus in PD, slight cognitive deficits are commonly found in non-demented and non-depressed PD patients, even in early stages of the disease, which have been linked to the subsequent development of pathological dementia. Thus, strongly reducing the quality of life (QoL). Both levodopa therapy and deep brain stimulation (DBS) have yield controversial results concerning the cognitive symptoms amelioration in PD patients. That does not seems to be the case with transcranial direct current stimulation (tDCS), although better stimulation parameters are needed. Therefore we hypothesize that simultaneously delivering cathodal tDCS (or ctDCS), over the right prefrontal cortex delivered with anodal tDCS (or atDCS) to left prefrontal cortex could be potentially beneficial for PD patients, either by mechanisms of homeostatic plasticity and by increases in the extracellular dopamine levels over the striatum.

Are cognitive interventions for multiple sclerosis effective and feasible?

Purpose: Fifty percent of patients with Multiple Sclerosis (MS) are estimated to have cognitive impairments leading to considerable decline in productivity and quality of life. Cognitive intervention has been considered to complement pharmacological treatments. However, a lack of agreement concerning the efficacy of cognitive interventions in MS still exists. A systematic review and meta-analysis was conducted to assess the effects of cognitive interventions in MS. Methods: To overcome limitations of previous meta-analyses, several databases were searched only for Randomized Clinical Trials (RCTs) with low risk of bias. Results: Five studies (total of 139 participants) met our eligibility criteria. Although good completion and adherence rates were evident, we found no evidence of intervention effects on cognition or mood in post-intervention or follow-up assessments. Conclusions: This is the first meta-analysis assessing the effects of cognitive intervention in MS including only RCTs with comparable conditions. Research regarding efficacy, cost-effectiveness and feasibility is still in its infancy. Caution is advised when interpreting these results due to the small number of RCTs meeting the inclusion criteria. Considering the costs of disease, good completion and adherence rates of this approach, further research is warranted. Recommendations concerning improved research practices in the field are presented as well.

Cognitive rehabilitation in a visual variant of Alzheimer's disease

Alzheimer's disease (AD) is commonly associated with marked memory deficits; however, nonamnestic variants have been consistently described as well. Posterior cortical atrophy (PCA) is a progressive degenerative condition in which posterior regions of the brain are predominantly affected, therefore resulting in a pattern of distinctive and marked visuospatial symptoms, such as apraxia, alexia, and spatial neglect. Despite the growing number of studies on cognitive and neural bases of the visual variant of AD, intervention studies remain relatively sparse. Current pharmacological treatments offer modest efficacy. Also, there is a scarcity of complementary nonpharmacological interventions with only two previous studies of PCA. Here we describe a highly educated 57-year-old patient diagnosed with a visual variant of AD who participated in a cognitive intervention program (comprising reality orientation, cognitive stimulation, and cognitive training exercises). Neuropsychological assessment was performed across moments (baseline, postintervention, follow-up) and consisted mainly of verbal and visual memory. Baseline neuropsychological assessment showed deficits in perceptive and visual-constructive abilities, learning and memory, and temporal orientation. After neuropsychological rehabilitation, we observed small improvements in the patient's cognitive functioning, namely in verbal memory, attention, and psychomotor abilities. This study shows evidence of small beneficial effects of cognitive intervention in PCA and is the first report of this approach with a highly educated patient in a moderate stage of the disease. Controlled studies are needed to assess the potential efficacy of cognition-focused approaches in these patients, and, if relevant, to grant their availability as a complementary therapy to pharmacological treatment and visual aids.

Nicolas Sanson and his Map: The Course of the Amazon River

One of the first scientific maps of the Amazon region, The Course of the Amazon River (Le Cours de La Rivi��re des Amazones), was constructed by Nicolas Sanson, a French cartographer of the seventeenth century, and served as the prototype for many others. The evaluation of this chart, until now, has been that it is a very defective map, a sketch based on a historical account, according to the opinion of La Condamine. Thus, the aim of the present work was to prove that the map of the Amazon River traced by Nicolas Sanson is a scientific work, a map that presents precise geographic coordinates considering its time, shows a well-determined prime meridian, and also employs a creative methodology to deduce longitudes from latitudes and distances that had been covered. To show such characteristics, an analysis of the accuracy of the map was made by comparing its latitudes and longitudes with those of a current map. We determined the prime meridian of this map and analyzed the methodology used for the calculation of longitudes. The conclusion is that it is actually a good map for the time, particularly considering the technology and the limited information that Sanson had at his disposal. This proves that the negative assertion of La Condamine is unfounded.

Neurocognitive profile and cognitive intervention in Alzheimer's disease

Tese de Doutoramento em Psicologia (Especialidade de Psicologia Cl��nica)