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Movement Disorders : Official Journal... Apr 2018Mild cognitive impairment has gained recognition as a construct and a potential prodromal stage to dementia in both Alzheimer's disease and Parkinson's disease (PD).... (Review)
Review
Mild cognitive impairment has gained recognition as a construct and a potential prodromal stage to dementia in both Alzheimer's disease and Parkinson's disease (PD). Although mild cognitive impairment has been recognized in the Alzheimer's disease field, it is a relatively more recent topic of interest in PD. Recent advances include the development of diagnostic criteria for PD mild cognitive impairment to provide more uniform definitions for clinical and research use. Studies reveal that mild cognitive impairment in PD is frequent, but also heterogeneous, with variable clinical presentations, differences in its progression to dementia, and likely differences in underlying pathophysiology. Application of the International Parkinson and Movement Disorder Society PD Mild Cognitive Impairment Task Force diagnostic criteria has provided insights regarding cognitive measures, functional assessments, and other key topics that may require additional refinement. Furthermore, it is important to consider definitions of PD mild cognitive impairment in the landscape of other related Lewy body disorders, such as dementia with Lewy bodies, and in the context of prodromal and early-stage PD. This article examines the evolution of mild cognitive impairment in concept and definition, particularly in PD, but also in related disorders such as Alzheimer's disease and dementia with Lewy bodies; the development and application of International Parkinson and Movement Disorder Society PD Mild Cognitive Impairment diagnostic criteria; and insights and future directions for the field of PD mild cognitive impairment. © 2018 International Parkinson and Movement Disorder Society.
Topics: Cognitive Dysfunction; Humans; Neuropsychological Tests; Parkinson Disease
PubMed: 29488270
DOI: 10.1002/mds.27323 -
Journal of Geriatric Psychiatry and... Nov 2021The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized...
INTRODUCTION
The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications.
METHODS
We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports.
RESULTS
Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving.
CONCLUSION
Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
Topics: Cognitive Dysfunction; Executive Function; Humans; Neuropsychological Tests
PubMed: 32935606
DOI: 10.1177/0891988720957092 -
Catheterization and Cardiovascular... Jul 2023Post-procedural aortic insufficiency (AI) continues to be prevalent following transcatheter aortic valve replacement (TAVR). While several studies have assessed the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Post-procedural aortic insufficiency (AI) continues to be prevalent following transcatheter aortic valve replacement (TAVR). While several studies have assessed the outcomes of moderate-severe AI following TAVR, the incidence, predictors, and outcomes of mild AI remain unclear.
METHODS
A systematic literature review was performed to identify studies reporting on mild AI following TAVR. The primary outcome was pooled incidence of post-TAVR mild AI. Secondary outcomes included pooled incidence of mild AI at 30 days and long term. The pooled incidence of midterm mortality in patients with post-TAVR mild AI was also evaluated. The random effect generalized linear mixed-effects model with logit-transformed proportions and Hartung-Knapp adjustment was used to calculate pooled incidence rates. Meta-regression was performed to identify predictors of mild AI.
RESULTS
The pooled analysis included 19,241 patients undergoing TAVR across 50 studies. The mean age of patients ranged from 73 to 85 years, and female patients ranged from 20.0% to 83.3%. The overall pooled incidence of post-TAVR mild AI was 56.1% (95% confidence interval [CI] 0.31-0.64). The pooled incidence of mild AI at 30 days was 33.7% (95% CI 0.12-0.37). At mean follow-up of 1.15 years, the pooled incidence of mild AI was 37.0% (95% CI 0.16-0.45). The overall pooled incidence of Midterm mortality (mean follow-up 1.22 years) in patients with mild AI was 14.8% (95% CI 0.10-0.25). At meta-regression, none of the explored variables correlated with a difference in mild AI incidence.
CONCLUSIONS
In published studies to date, 50% of patients undergoing TAVR develop mild AI postoperatively. In 37% of patients, this persists in long term. Though the incidence of AI is likely improving with newer generation TAVR valves, the prevalence and outcomes of mild AI should be closely monitored as TAVR volume and indications expand to younger patients with long life expectancy. The long-term outcomes of mild AI remain unclear. Further dedicated studies on post-TAVR mild AI are needed.
Topics: Humans; Female; Aged; Aged, 80 and over; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis; Risk Factors; Treatment Outcome; Aortic Valve Insufficiency
PubMed: 37172208
DOI: 10.1002/ccd.30674 -
Brain Injury 2015To systematically review existing empirical evidence concerning neuropsychological, psychosocial and academic outcomes following mild and moderate TBI during childhood... (Review)
Review
AIM
To systematically review existing empirical evidence concerning neuropsychological, psychosocial and academic outcomes following mild and moderate TBI during childhood and adolescence.
METHOD
The studies reviewed include data on 8553 children and adolescents from ages 0-18 that experienced mild and moderate TBIs. A literature search using MeSH terms for 'children' cross-referenced with terms associated with 'head injuries' and 'cognition' was conducted using Pubmed, CINAHL Plus and Scopus databases as well as other data sources to retrieve grey literature results. Articles published between 1 January 2008 and 22 April 2013 were included.
RESULTS
Fifty-five studies were included in the review, with multiple studies including information on both mild and moderate TBI; 46 studies focused on mild TBI outcomes and 22 studies focused on moderate TBI outcomes. The majority of outcomes were described as psychosocial (50%) or neuropsychological (40%); 51% of studies presented adverse outcomes.
CONCLUSIONS
The results suggest that not all children with mild or moderate TBI recover without long-term problems. Few studies followed children and adolescents with mild TBIs for extended periods of time, although it is clinically important to monitor patients over time.
Topics: Adolescent; Brain Injuries; Child; Female; Humans; Male; Neuropsychological Tests; Treatment Outcome
PubMed: 25790086
DOI: 10.3109/02699052.2014.1002003 -
PloS One 2023During mild moxibustion treatment, uncertainties are involved in the operating parameters, such as the moxa-burning temperature, the moxa stick sizes, the stick-to-skin...
During mild moxibustion treatment, uncertainties are involved in the operating parameters, such as the moxa-burning temperature, the moxa stick sizes, the stick-to-skin distance, and the skin moisture content. It results in fluctuations in skin surface temperature during mild moxibustion. Existing mild moxibustion treatments almost ignore the uncertainty of operating parameters. The uncertainties lead to excessive skin surface temperature causing intense pain, or over-low temperature reducing efficacy. Therefore, the interval model was employed to measure the uncertainty of the operation parameters in mild moxibustion, and the uncertainty optimization design was performed for the operation parameters. It aimed to provide the maximum thermal penetration of mild moxibustion to enhance efficacy while meeting the surface temperature requirements. The interval uncertainty optimization can fully consider the operating parameter uncertainties to ensure optimal thermal penetration and avoid patient discomfort caused by excessive skin surface temperature. To reduce the computational burden of the optimization solution, a high-precision surrogate model was established through a radial basis neural network (RBNN), and a nonlinear interval model for mild moxibustion treatment was formulated. By introducing the reliability-based possibility degree of interval (RPDI), the interval uncertainty optimization was transformed into a deterministic optimization problem, solved by the genetic algorithm. The results showed that this method could significantly improve the thermal penetration of mild moxibustion while meeting the skin surface temperature requirements, thereby enhancing efficacy.
Topics: Humans; Moxibustion; Reproducibility of Results; Uncertainty; Skin; Skin Temperature
PubMed: 37068075
DOI: 10.1371/journal.pone.0282355 -
Frontiers in Microbiology Sep 2013Tristeza, caused by Citrus tristeza virus (CTV), has long been present in Florida but outbreaks of decline on sour orange rootstock were occasional events until the late... (Review)
Review
Tristeza, caused by Citrus tristeza virus (CTV), has long been present in Florida but outbreaks of decline on sour orange rootstock were occasional events until the late 1970s. Sour orange rootstock was valued for the high quality of fruit produced and was widely used because of its tolerance of citrus blight, a disease of unknown etiology. Research was directed towards the selection and screening of mild strains of CTV which could protect against sour orange decline strains. Following the introduction of Toxoptera citricida (also known as the brown citrus aphid) in 1995 there was a greater concern for maintaining production of existing blocks of citrus on sour orange rootstock. Availability of the CTV genome sequence around the same time as well as molecular characterization of in planta CTV populations led to the selection of mild CTV isolates which when inoculated into existing field trees, extended the productive life of the groves and enabled a more graduate replanting of trees on CTV-tolerant rootstocks. The history of CTV in Florida and the methods developed to select mild isolates for use for mild strain cross protection will be reviewed.
PubMed: 24046764
DOI: 10.3389/fmicb.2013.00259 -
Reproductive Biomedicine Online Dec 2022The practice of ovarian stimulation for IVF is undergoing a fundamental re-evaluation as recent data begin to successfully challenge the traditional paradigm that... (Review)
Review
The practice of ovarian stimulation for IVF is undergoing a fundamental re-evaluation as recent data begin to successfully challenge the traditional paradigm that ovarian stimulation should be aimed at the retrieval of as many oocytes as possible, in the belief that this will increase pregnancy rates. An opposing view is that live birth rate should not be the only end-point in evaluating the success of IVF treatment and that equal emphasis should be placed on safety and affordability. The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) committee has carried out an up-to-date literature search, with the evidence being graded according to the University of Oxford's Centre for Evidence-Based Medicine. The recommendations were formulated taking into account the quality of evidence on the efficacy, risk and cost of each intervention. ISMAAR recommends adopting a mild approach to ovarian stimulation in all clinical settings as an increasing body of evidence suggests that mild stimulation is as effective as conventional stimulation, while being safer and less expensive. Mild ovarian stimulation could replace conventional stimulation, thus making IVF safer and more accessible worldwide.
Topics: Pregnancy; Female; Humans; Fertilization in Vitro; Ovulation Induction; Pregnancy Rate; Birth Rate; Reproduction
PubMed: 36220713
DOI: 10.1016/j.rbmo.2022.07.019 -
Thyroid : Official Journal of the... Jul 2007The cardiovascular risk is increased in patients with overt hypothyroidism, and several potential cardiovascular risk factors were similarly reported in patients with... (Review)
Review
The cardiovascular risk is increased in patients with overt hypothyroidism, and several potential cardiovascular risk factors were similarly reported in patients with subclinical hypothyroidism. Only recently have more data become available about the effects of mild hypothyroidism on the cardiovascular system. An impaired left ventricular diastolic function, which is characterized by slowed myocardial relaxation and impaired ventricular filling, is the most consistent cardiac abnormality in patients with mild thyroid hormone deficiency. Impaired left ventricular diastolic function on effort was also documented by radionuclide ventriculography. Studies performed by ultrasonic myocardial textural analysis suggest an altered myocardial composition in patients with mild hypothyroidism. Moreover, pulsed tissue Doppler analysis revealed that patients with mild hypothyroidism had changes in myocardial time intervals in several left ventricular segments. Finally, alterations in cardiac hemodynamic were documented by cardiac magnetic resonance imaging in presence of mild disease. Vascular function is impaired in patients with mild and subclinical hypothyroidism, as documented by the increase in systemic vascular resistance and arterial stiffness and by the impaired endothelial function. The negative effect induced by mild hypothyroidism on cardiovascular system can be reverted restoring euthyroidism with levothyroxine (L-T4) therapy. Based on the data available, it appears that L-T4 replacement should be considered in patients with mild hypothyroidism in presence of associated cardiovascular risk factors in the attempt to reverse these negative prognostic factors and improve the cardiovascular risk.
Topics: Cardiovascular Physiological Phenomena; Hashimoto Disease; Heart; Humans; Hypothyroidism; Magnetic Resonance Imaging; Reference Values; Thyroid Function Tests
PubMed: 17696831
DOI: 10.1089/thy.2007.0158 -
Journal of Physical Therapy Science May 2022[Purpose] This study aimed to investigate the changes in blood pressure due to mild hyperbaric oxygen at 1.3 atmospheres absolute with approximately 30% oxygen....
[Purpose] This study aimed to investigate the changes in blood pressure due to mild hyperbaric oxygen at 1.3 atmospheres absolute with approximately 30% oxygen. [Participants and Methods] Ten healthy adults participated in two trials: the control (1 atmosphere absolute with 20.9% oxygen) and the mild hyperbaric oxygen (1.3 atmospheres absolute with approximately 30% oxygen) trials. All participants were exposed to either the control or mild hyperbaric oxygen conditions in a chamber for 45 min on each experiment day. [Results] A lower heart rate and higher peripheral oxygen saturation were observed after exposure in the mild hyperbaric oxygen trial than those in the control trial. After exposure, the change in ratios from the premeasurement of systolic and diastolic blood pressure in the mild hyperbaric oxygen trial was more than that in the control trial, despite no change in the absolute blood pressure values between the two groups during the exposure. [Conclusion] This is the first study to reveal that mild hyperbaric oxygen exposure might be a control method for chronic hypotension. In addition, these results suggest that people with hypertension might require some attention when using mild hyperbaric oxygen.
PubMed: 35527838
DOI: 10.1589/jpts.34.360 -
Expert Review of Respiratory Medicine 2022Asthma exacerbations and, more rarely, fatal asthma attacks have been reported in mild asthma patients, suggesting poor disease control and awareness of its potential...
OBJECTIVES
Asthma exacerbations and, more rarely, fatal asthma attacks have been reported in mild asthma patients, suggesting poor disease control and awareness of its potential burden. Our study aimed to explore outside the hospital/specialist setting the perspective and disease treatment behavior of patients self-reporting a mild asthma diagnosis.
METHODS
Computer-Assisted Personal Interviewing (CAPI) technique was used to investigate the identified study population. Questions about diagnosis, symptoms, comorbidities, treatment strategy, ongoing assessments, and quality of life were administered.
RESULTS
Overall, 258 patients were considered for the analysis. As the most relevant results, 22% of them reported severe respiratory symptoms, 52% experienced at least one exacerbation/year, and 7% needed Emergency Room care. Sixty-six percent of the respondents assumed as needing short-acting bronchodilators only. Of note, 22% of patients were using oral steroids (OCS) intermittently and 72% of them considered their quality of life unsatisfying.
CONCLUSION
Outside the hospital/specialist setting, mild asthma burden is still not negligible and the treatment approach is not correct. In particular, the reported OCS use is disproportionate. Our data suggest that mild asthma, especially when self-assessed might be other than mild, suggesting that efforts to increase disease awareness, improve the disease control limiting the OCS abuse are required.
Topics: Humans; Quality of Life; Disease Progression; Asthma; Bronchodilator Agents; Comorbidity; Anti-Asthmatic Agents; Adrenal Cortex Hormones
PubMed: 36633404
DOI: 10.1080/17476348.2023.2167714