Publications by authors named "Gyanwali B"

Objectives: This study aims to determine the usage pattern, effectiveness and safety of oral tramadol 75 mg and dexketoprofen trometamol 25 mg fixed-dose combination (TRAM/DKP FDC) in the short-term treatment of moderate-to-severe acute pain in real-world clinical practice in Asia.

Design: Real-world, prospective, multicentre, observational, phase IV study.

Setting: 13 tertiary-care hospital sites across the Philippines, Thailand, Malaysia and Singapore.

View Article and Find Full Text PDF

Introduction: Satisfactory management of acute pain remains a major medical challenge despite the availability of multiple therapeutic options including the fixed-dose combination (FDC) drugs. Tramadol and dexketoprofen trometamol (TRAM/DKP) 75/25 mg FDC was launched in 2018 in Asia and is widely used in the management of moderate to severe acute pain. There are limited data on its effectiveness and safety in Asian patients, and therefore, a need to better understand its usage patterns in clinical practice.

View Article and Find Full Text PDF

Introduction: Cranial computed tomography (CT) is an affordable and widely available imaging modality that is used to assess structural abnormalities, but not to quantify neurodegeneration. Previously we developed a deep-learning-based model that produced accurate and robust cranial CT tissue classification.

Materials And Methods: We analyzed 917 CT and 744 magnetic resonance (MR) scans from the Gothenburg H70 Birth Cohort, and 204 CT and 241 MR scans from participants of the Memory Clinic Cohort, Singapore.

View Article and Find Full Text PDF

Declines in cognitive performance, such as those seen in neurocognitive disorders (NCDs) are often associated with ageing. Both physical activity and cognitive training are common interventional strategies that can mitigate the decline in cognitive and physical performance. This review aims to (1) to evaluate the effects of Physio-Cognitive Dual-task Training (PCDT) intervention on cognition, physical performance, activities of daily living (ADL) and health-related quality of life (HRQoL) in pre-ageing and older adults with neurocognitive disorders, (2) explore the effects of covariates on intervention outcomes.

View Article and Find Full Text PDF
Article Synopsis
  • PSCI affects about half of stroke survivors, with the study showing no difference in overall occurrence between men and women but notable differences in specific cognitive impairments.
  • Male stroke survivors tend to have less impairment in attention, executive functioning, and language, but a higher risk for verbal memory impairment compared to females.
  • The Mini-Mental State Examination is more sensitive but less specific for detecting PSCI in women, while the Montreal Cognitive Assessment shows similar sensitivity and specificity for both sexes.
View Article and Find Full Text PDF

Objective: Median and peak height of fractional anisotropy (FA) and mean diffusivity (MD) are diffusion tensor imaging (DTI) markers used to quantify white matter microstructure changes. We examine the association of DTI histogram-derived measures in global normal appearing white matter (NAWM) and cognitive decline in patients with normal cognition and cognitive impairment no dementia from a memory clinic in Singapore.

Methods: A total of 252 patients (mean age: 71.

View Article and Find Full Text PDF

Cardiopulmonary exercise testing (CPET) is an important tool to measure the cardiopulmonary fitness of an individual and has been widely used in athletic, clinical and research settings. Most CPET focus on analyzing physiological responses during exercise. We contend that the post-CPET recovery physiological responses offer further diagnostic and prognostic information about the health of the cardiopulmonary and metabolic systems, especially when testing apparently healthy middle-aged and older adults.

View Article and Find Full Text PDF

Tumor necrosis factor-receptor 1 (TNF-R1)-mediated signaling is critical to the regulation of inflammatory responses. TNF-R1 can be proteolytically released into systemic blood circulation in a soluble form (sTNF-R1), where it binds to circulating TNF and functions to attenuate TNF-mediated inflammation. Increases of peripheral sTNF-R1 have been reported in both Alzheimer's disease (AD) dementia and vascular dementia (VaD).

View Article and Find Full Text PDF
Article Synopsis
  • Cerebral microbleeds increase the risk of both ischemic stroke and intracranial hemorrhage, complicating treatment choices for patients with atrial fibrillation on various antithrombotic therapies.
  • A study analyzed 7,839 patients, finding that microbleeds significantly raised the relative risk of intracranial hemorrhage (2.74 times) and ischemic stroke (1.29 times), particularly with combination therapies of anticoagulants and antiplatelets.
  • For patients on combination therapy, those with multiple microbleeds faced a higher absolute risk of intracranial hemorrhage compared to ischemic stroke, indicating a need for more research to develop effective preventive strategies.
View Article and Find Full Text PDF

Background: Neuroinflammation has been postulated to play an important role in cognitive impairment, cognitive decline, and dementia. Inflammatory biomarkers such as interleukin-6 (IL-6) and IL-8 are found to be associated with the neuro-inflammatory process and worse cognitive function. However, it is unknown whether these interleukins are associated with long-term cognitive function.

View Article and Find Full Text PDF

Background And Purpose: Cerebral small-vessel disease may alter cerebral blood flow (CBF) leading to brain changes and, hence, cognitive impairment and dementia. CBF and the spatial coefficient of variation can be measured quantitatively by arterial spin-labeling. We aimed to investigate the associations of demographics, vascular risk factors, location, and severity of cerebral small-vessel disease as well as the etiologic subtypes of cognitive impairment and dementia with CBF and the spatial coefficient of variation.

View Article and Find Full Text PDF
Article Synopsis
  • Researchers studied patients with certain types of strokes (IS or TIA) to find out how a brain condition called cortical superficial siderosis (cSS) affects their risk of having more strokes in the future.
  • They looked at data from a large group of patients and found that those with cSS had a higher chance of having more strokes than those without it.
  • Patients with cSS who took both types of blood-thinning medicines had an even higher risk of severe strokes and intracranial hemorrhage (bleeding in the brain).
View Article and Find Full Text PDF

Background: Intracranial stenosis (ICS) and brain amyloid-beta (Aβ) have been associated with cognition and dementia. We aimed to investigate the association between ICS and brain Aβ and their independent and joint associations with cognition.

Methods: We conducted a cross-sectional study of 185 patients recruited from a memory clinic.

View Article and Find Full Text PDF
Article Synopsis
  • Carotid artery stiffness is linked to cognitive impairment and dementia, with a study involving 272 participants using advanced imaging and assessments revealing significant associations between carotid stiffness and various markers of cerebral small-vessel disease.
  • Specific metrics of carotid stiffness (like β-index and pulse-wave velocity) were found to correlate with increased white matter hyperintensities and lacunes, indicating potential brain damage linked to vascular changes.
  • Though the associations were strong, adjusting for small-vessel disease markers diminished the significance, suggesting that cerebral small-vessel damage may mediate the relationship between carotid stiffness and cognitive decline.
View Article and Find Full Text PDF

Previous studies have explored the associations of retinal vessel calibre, measured from retinal photographs or fundus images using semi-automated computer programs, with cognitive impairment and dementia, supporting the concept that retinal blood vessels reflect microvascular changes in the brain. Recently, artificial intelligence deep-learning algorithms have been developed for the fully automated assessment of retinal vessel calibres. Therefore, we aimed to determine whether deep-learning-based retinal vessel calibre measurements are predictive of risk of cognitive decline and dementia.

View Article and Find Full Text PDF

Objectives: This study aimed to assess the processing of clicks and tone pips in the auditory brainstem of tree shrews and analyze the long-term evolution of postlesion plasticity in the auditory system and its ability to self-repair.

Methods: The auditory brainstem response (ABR) was measured in the normal control group (n=10) and the electrolytic damage group (n=10) before and 0 h, 24 h, 48 h, 72 h, and 25 d after electrolytic damage. Recordings were performed under closed-field conditions using clicks and tone pips, followed by statistical analysis of the ABR threshold, amplitude and latency.

View Article and Find Full Text PDF

Background: Cognitive decline in older adults has been attributed to reduced cerebral blood flow (CBF). Recently, the spatial coefficient of variation (sCoV) of ASL has been proposed as a proxy marker of cerebrovascular insufficiency. We investigated the association between baseline ASL parameters with cognitive decline, incident cerebrovascular disease, and risk of vascular events and mortality.

View Article and Find Full Text PDF

Background: Post-stroke cognitive impairment (PSCI) is a common consequence of stroke. Accurate prediction of PSCI risk is challenging. The recently developed network impact score, which integrates information on infarct location and size with brain network topology, may improve PSCI risk prediction.

View Article and Find Full Text PDF

Background: The underlying cause of cognitive decline in individuals who are positive for biomarkers of neurodegeneration (N) but negative for biomarkers of amyloid-beta (A), designated as Suspected non-Alzheimer's pathophysiology (SNAP), remains unclear. We evaluate whether cerebrovascular disease (CeVD) is more prevalent in those with SNAP compared to A-N- and A+N+ individuals and whether CeVD is associated with cognitive decline over time in SNAP patients.

Methods: A total of 216 individuals from a prospective memory clinic cohort (mean [SD] age, 72.

View Article and Find Full Text PDF

Background: P-wave terminal force in lead V1 (PTFV1) on electrocardiography has been associated with atrial fibrillation and ischemic stroke.

Objective: To investigate whether PTFV1 is associated with cerebral small vessel disease (CSVD) markers and etiological subtypes of cognitive impairment and dementia.

Methods: Participants were recruited from ongoing memory clinic study between August 2010 to January 2019.

View Article and Find Full Text PDF

Alpha-ketoglutarate (AKG) is an intermediate in the Krebs cycle involved in various metabolic and cellular pathways. As an antioxidant, AKG interferes in nitrogen and ammonia balance, and affects epigenetic and immune regulation. These pleiotropic functions of AKG suggest it may also extend human healthspan.

View Article and Find Full Text PDF

Core cerebrospinal fluid (CSF) biomarkers (Aβ42, T-tau, P-tau) were included as supporting diagnostic criteria for Alzheimer's Disease (AD), but they lack the power to predict AD progression. On the other hand, a new biomarker CSF Neurogranin (Ng) has been shown to predict cognitive decline. This systematic review aims to synthesise the prognostic utility of CSF Ng in predicting cognitive decline in the AD continuum.

View Article and Find Full Text PDF

Background: Cerebral Small Vessel Disease (SVD); lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH) have a vital role in cognitive impairment and dementia. SVD in lobar location is related to cerebral amyloid angiopathy, whereas SVD in a deep location with hypertensive arteriopathy. It remains unclear how different locations of SVD affect long-term cognitive decline.

View Article and Find Full Text PDF

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear.

Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up.

View Article and Find Full Text PDF