Neurometabolite Alterations Associated with Cognitive Performance in Perinatally HIV-Infected Children

Despite treatment with combination antiretroviral therapy (cART), cognitive impairment is still observed in perinatally HIV-infected children. We aimed to evaluate potential underlying cerebral injury by comparing neurometabolite levels between perinatally HIV-infected children and healthy controls. 

This cross-sectional study evaluated neurometabolites, as measured by Magnetic Resonance Spectroscopy (MRS), in perinatally HIV-infected children stable on cART (n = 26) and healthy controls (n = 36).Participants were included from a cohort of perinatally HIV-infected children and healthy controls, matched group-wise for age, gender, ethnicity, and socio-economic status. N-acetylaspartate (NAA), glutamate (Glu), myo-inositol (mI), and choline (Cho) levels were studied as ratios over creatine (Cre). Group differences and associations with HIV-related parameters, cognitive functioning, and neuronal damage markers (neurofilament and total Tau proteins) were determined using age-adjusted linear regression analyses.HIV-infected children had increased Cho:Cre in white matter (HIV-infected = 0.29 ± 0.03; controls = 0.27 ± 0.03; P value = 0.045). Lower nadir CD4+ T-cell Z-scores were associated with reduced neuronal integrity markers NAA:Cre and Glu:Cre. A Centers for Disease Control and Prevention (CDC) stage C diagnosis was associated with higher glial markers Cho:Cre and mI:Cre. Poorer cognitive performance was mainly associated with higher Cho:Cre in HIV-infected children, and with lower NAA:Cre and Glu:Cre in healthy controls. 

There were no associations between neurometabolites and neuronal damage markers in blood or CSF.Compared to controls, perinatally HIV-infected children had increased Cho:Cre in white matter, suggestive of ongoing glial proliferation. Levels of several neurometabolites were associated with cognitive performance, suggesting that MRS may be a useful method to assess cerebral changes potentially linked to cognitive outcomes.

Below:  Exemplar planning of chemical shift imaging (CSI), superimposed on a 3D-T1-weighted image. Based on the 3D-T1-weighted scan (A), gray matter (GM), and white matter (WM) segmentation was performed within the CSI field-of-view (B). Estimated metabolite levels (C) were averaged within all GM and WM voxels to obtain mean GM and WM values (D). CSI = chemical shift imaging, GM = gray matter, WM = white matter.

Full article at:   http://goo.gl/cfpC6B

By:  Van Dalen YW1, Blokhuis C, Cohen S, Ter Stege JA, Teunissen CE, Kuhle J, Kootstra NA, Scherpbier HJ, Kuijpers TW, Reiss P, Majoie CB, Caan MW, Pajkrt D.

• 1From the Department of Pediatric Hematology, Immunology and Infectious Diseases, (YWVD, CB, SC, JATS, HJS, TWK, DP); Psychosocial Department (JATS), Emma Children's Hospital/Academic Medical Center; Neurochemistry Laboratory and Biobank (CET), Department of Clinical Chemistry, VU University Medical Center and Neurocampus Amsterdam, the Netherlands; Neurology (JK), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland; Department of Experimental Immunology (NAK); Department of Global Health and Amsterdam Institute of Global Health and Development (PR), Academic Medical Center; HIV Monitoring Foundation (PR); Department of Internal Medicine (PR), Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA); and Department of Radiology (CBLMM, MWAC), Academic Medical Center, Amsterdam, the Netherlands. 
• Medicine (Baltimore). 2016 Mar;95(12):e3093. doi: 10.1097/MD.0000000000003093.

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Physical Restraint and Antipsychotic Medication Use among Nursing Home Residents with Dementia

PURPOSE:

To explore antipsychotic (AP) medications and physical restraint use and their effects on physical function and cognition in older nursing home residents.

METHODS:

This retrospective cohort studied involved 532 residents with dementia from 57 nursing homes participating in the Services and Health for Elderly in Long-Term Care study. Poisson log regression models explored the effect of physical restraint and/or AP medication use on cognitive or functional decline at 6 months.

RESULTS:

Physical restraint use was associated with a higher risk of both functional and cognitive decline compared with AP medication use alone. These risks were highest among residents receiving both AP medications and physical restraints, suggesting additive effects.

DISCUSSION:

Physical restraint use, and even more strongly, concurrent physical restraint and AP medication use, is related to function and cognitive decline in nursing home residents with dementia. Antipsychotic use is cautioned, but these results suggest physical restraint use is potentially more risky.

Purchase full article at:   http://goo.gl/aDgx74

By:  Foebel AD1, Onder G2, Finne-Soveri H3, Lukas A4, Denkinger MD4, Carfi A2, Vetrano DL2, Brandi V2, Bernabei R2, Liperoti R2.

• 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: andrea.foebel@ki.se.
• 2Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
• 3Aging and Services Unit, National Institute for Health and Welfare, Helsinki, Finland.
• 4AGAPLESION Bethesda Clinic, Geriatric Center, Ulm University, Ulm, Germany.
• J Am Med Dir Assoc. 2016 Jan 5. pii: S1525-8610(15)00725-2. doi: 10.1016/j.jamda.2015.11.014.  

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