The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment

The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: a randomized controlled trial

Exercise benefits patients on maintenance hemodialysis (MHD) by addressing complications and dysfunctions. Elastic band exercise is cost-effective, but its safety, efficacy, and feasibility during dialysis are not well-established. The aim of this study is to investigate the physical and mental effects of intradialytic elastic band exercise in patients on MHD. Sixty patients on MHD were randomly assigned to the exercise or control group (30 patients/group). The control group received routine hemodialysis care, whereas those in the exercise group performed intradialytic elastic band exercises for 0.5-2 h during hemodialysis three times a week for 12 weeks. Physical function (Short Physical Performance Battery [SPPB]), cognitive function (Montreal Cognitive Assessment [MoCA]), fatigue (14-item Fatigue Scale [FS-14]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and anxiety and depression (Hamilton Anxiety Rating Scale [HAMA]/Hamilton Depression Rating Scale [HAMD]) were assessed. The exercise group showed significant improvements in SPPB (p = 0.008) and MoCA (p < 0.001) scores compared to pre-intervention and control groups. FS-14 scores decreased significantly (p = 0.005). PSQI (p < 0.001) and HAMA (p < 0.001) scores improved post-intervention but not versus control. HAMD scores reduced significantly (p < 0.001). Satisfaction and recommendation scores were 9.57 and 9.71. In conclusions, intradialytic elastic band exercise improved physical and cognitive function and alleviated fatigue, sleep issues, depression, and anxiety in patients on MHD. With high compliance, no significant adverse events, and high patient satisfaction, it is recommended as a routine intervention during dialysis.

Altered effective connectivity within brain lesioned regions and cognitive impairment after stroke

Poststroke cognitive impairments (PSCI) reflect widespread network dysfunction due to structural damage, abnormal neural activity, or abnormal connections in affected brain regions. The exact influence of these lesioned regions on the related functional network and their role in PSCI remains unclear. We recruited 35 first-time stroke patients who had basal ganglia infarcts and PSCI, along with 29 age-matched healthy controls. We utilized T1-weighted imaging to inspect structural damage with regional gray matter volume (GMV). Resting-state fMRI data were utilized to examine spontaneous activities with regional Wavelet-ALFF metric, investigate dynamic functional connectivity (dFC) by seeding the region with damaged GMV, and further study effective connectivity within the abnormal dFC network and its impact on PSCI. In comparison to HC, patients showed significant reduced GMV in the bilateral Rolandic operculum (ROL), along with notable abnormal Wavelet-ALFF values in the right Precuneus (PCUN) and left Cerebellum_9 (CER9). Particularly, an abnormal dFC network seeded in the left ROL, demonstrating significantly differential between PSCI and HC groups and remaining consistent across all time windows, was observed. This abnormal dFC network comprised the left ROL as the seed region, the right ROL, bilateral PCUN, bilateral CER9, right Superior Temporal Gyrus (STG), and right Parahippocampal Gyrus (PHG). Notably, in patients, impaired functions across various cognitive domains significantly influenced the altered effective connections among the abnormal regions, particularly impacting the connections between structurally damaged regions and those with abnormal spontaneous activity. These findings suggest that altered effective connectivity networks within lesioned regions may contribute to deficits in various cognitive domains in PSCI.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-024-10209-7.

CSL-CTEA: a systematic method for evaluating novel intelligent cognitive assessment tools

With the intensification of global population aging, the incidence of cognitive disorders such as dementia continues to rise. The Mini-Mental State Examination (MMSE) and other alternative tools can help doctors detect subtle changes in cognitive function at an early stage. These assessment tools can make a diagnosis before symptoms become severe, providing opportunities for early intervention, which is crucial for delaying disease progression and improving the quality of life of patients. However, traditional cognitive assessment methods are overly complex and affected by various factors. With the development of artificial intelligence technology, many new assessment tools are constantly being developed and improved. How to evaluate the effectiveness of intelligent electronic cognitive assessment tools is particularly important. We have proposed the Correlation and Supervised Learning-based Cognitive Tool Effectiveness Assessment Method (CSL-CTEA) to evaluate the effectiveness of intelligent electronic cognitive assessment tools, including: (1) experimental design and data collection based on traditional scales and intelligent electronic assessment tools, (2) consistency and correlation tests; (3) accuracy analysis of assessment results based on supervised learning. We used CSL-CTEA to explore the effectiveness of a certain electronic assessment. This intelligent electronic cognitive assessment tool includes voice tests, orientation tests, and picture recognition tests to assess cognitive abilities from multiple perspectives. The results show that the electronic assessment is in good agreement with traditional cognitive assessment methods. The various indicators of the electronic assessment can explain the changes in MMSE scores to some extent. The study also found that the electronic assessment performs well in determining whether the subject is at cognitive risk. To some extent, the electronic assessment can replace traditional cognitive assessment methods such as MMSE to help people judge whether they are at risk of cognitive decline.

The impact of intimate partner violence on facial emotion recognition among Korean baby boomers

ABSTRACTBackground: Intimate partner violence (IPV) can have lasting psychological and cognitive effects, potentially impairing facial emotion recognition (FER). This study examines the accuracy of FER among IPV survivors compared to individuals without IPV experience within the Korean baby boomer generation, aged 60-69, exploring the relationship between IPV, post-traumatic stress disorder (PTSD) symptoms, and FER abilities.Objective: To assess whether IPV impacts FER accuracy and intensity and to investigate whether symptoms of PTSD moderate this relationship.Method: The study included 80 participants, with 31 % identified as IPV survivors. A self-administered survey collected information on lifetime experiences of physical, emotional, and sexual abuse, as well as assessments for PTSD symptoms. Participants completed the Korean Montreal Cognitive Assessment (K-MOCA) and performed 70 FER tasks to evaluate accuracy and intensity of facial emotions. Logistic regressions were used to analyse the relationship between IPV, PTSD symptoms, and FER performance.Results: IPV survivors demonstrated 0.64 times lower accuracy in recognizing overall facial emotions, including anger, sadness, surprise, and neutral expressions Additionally, IPV survivors exhibited significantly lower intensity scores for overall facial expressions. Significant interaction terms between IPV and PTSD symptoms indicate that PTSD symptoms moderate the effect of IPV on the FER, as well as neutral and sad facial expressions.Conclusions: IPV can disrupt one's ability to recognize facial emotions, and PTSD symptoms may moderate this impairment. This highlights the potential benefits of assisting IPV survivors with emotion recognition as part of their recovery process, which could enhance both social connections and their safety.

Analysis of the trajectory of cognitive function changes and influencing factors in maintenance hemodialysis patients: a prospective longitudinal study

OBJECTIVES

To explore the trajectory of cognitive function changes and influencing factors in maintenance hemodialysis (MHD) patients.

METHODS

A convenience sampling method was used to select MHD patients from a tertiary hospital in Chengdu from August 2023 to April 2024. The general information questionnaire, Chinese version of the Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Appetite Visual Analogue Scale (VAS), and Family Care Index (APGAR) were used for the investigation. Patients' cognitive function levels were assessed at baseline and at 3, 6, and 9 months after the initial survey. A latent growth model was used to identify potential categories of cognitive function trajectory, and univariate and binary logistic regression analyses were performed to analyze the influencing factors.

RESULTS

A total of 154 MHD patients completed the entire study. The trajectory of cognitive function changes was divided into two potential categories: low cognitive function-fast decline group and high cognitive function-slow decline group. Binary logistic regression results showed that educational level, hypertension, sleep quality, appetite, and family care were influencing factors for the trajectory of cognitive function changes in MHD patients.

CONCLUSIONS

Cognitive function in MHD patients showed an overall declining trend over time. The cognitive function change trajectory could be divided into two potential categories: fast decline group and high cognitive function-slow decline group. Healthcare professionals can develop targeted nursing intervention programs based on the characteristics of different patient types and their influencing factors to improve cognitive function and enhance quality of life.

Plasma circulating cell-free DNA integrity and relative telomere length as diagnostic biomarkers for Parkinson's disease and multiple system atrophy: a cross-sectional study

JOURNAL/nrgr/04.03/01300535-202512000-00025/figure1/v/2025-01-31T122243Z/r/image-tiff In clinical specialties focusing on neurological disorders, there is a need for comprehensive and integrated non-invasive, sensitive, and specific testing methods. Both Parkinson's disease and multiple system atrophy are classified as α-synucleinopathies, characterized by abnormal accumulation of α-synuclein protein, which provides a shared pathological background for their comparative study. In addition, both Parkinson's disease and multiple system atrophy involve neuronal death, a process that may release circulating cell-free DNA (cfDNA) into the bloodstream, leading to specific alterations. This premise formed the basis for investigating cell-free DNA as a potential biomarker. Cell-free DNA has garnered attention for its potential pathological significance, yet its characteristics in the context of Parkinson's disease and multiple system atrophy are not fully understood. This study investigated the total concentration, nonapoptotic level, integrity, and cell-free DNA relative telomere length of cell-free DNA in the peripheral blood of 171 participants, comprising 76 normal controls, 62 patients with Parkinson's disease, and 33 patients with multiple system atrophy. In our cohort, 75.8% of patients with Parkinson's disease (stage 1-2 of Hoehn & Yahr) and 60.6% of patients with multiple system atrophy (disease duration less than 3 years) were in the early stages. The diagnostic potential of the cell-free DNA parameters was evaluated using receiver operating characteristic (ROC) analysis, and their association with disease prevalence was examined through logistic regression models, adjusting for confounders such as age, sex, body mass index, and education level. The results showed that cell-free DNA integrity was significantly elevated in both Parkinson's disease and multiple system atrophy patients compared with normal controls ( P < 0.001 for both groups), whereas cell-free DNA relative telomere length was markedly shorter ( P = 0.003 for Parkinson's disease and P = 0.010 for multiple system atrophy). Receiver operating characteristic analysis indicated that both cell-free DNA integrity and cell-free DNA relative telomere length possessed good diagnostic accuracy for differentiating Parkinson's disease and multiple system atrophy from normal controls. Specifically, higher cell-free DNA integrity was associated with increased risk of Parkinson's disease (odds ratio [OR]: 5.72; 95% confidence interval [CI]: 1.54-24.19) and multiple system atrophy (OR: 10.10; 95% CI: 1.55-122.98). Conversely, longer cell-free DNA relative telomere length was linked to reduced risk of Parkinson's disease (OR: 0.16; 95% CI: 0.04-0.54) and multiple system atrophy (OR: 0.10; 95% CI: 0.01-0.57). These findings suggest that cell-free DNA integrity and cell-free DNA relative telomere length may serve as promising biomarkers for the early diagnosis of Parkinson's disease and multiple system atrophy, potentially reflecting specific underlying pathophysiological processes of these neurodegenerative disorders.

Storage time affects the level and diagnostic efficacy of plasma biomarkers for neurodegenerative diseases

JOURNAL/nrgr/04.03/01300535-202508000-00027/figure1/v/2024-09-30T120553Z/r/image-tiff Several promising plasma biomarker proteins, such as amyloid-β (Aβ), tau, neurofilament light chain, and glial fibrillary acidic protein, are widely used for the diagnosis of neurodegenerative diseases. However, little is known about the long-term stability of these biomarker proteins in plasma samples stored at -80°C. We aimed to explore how storage time would affect the diagnostic accuracy of these biomarkers using a large cohort. Plasma samples from 229 cognitively unimpaired individuals, encompassing healthy controls and those experiencing subjective cognitive decline, as well as 99 patients with cognitive impairment, comprising those with mild cognitive impairment and dementia, were acquired from the Sino Longitudinal Study on Cognitive Decline project. These samples were stored at -80°C for up to 6 years before being used in this study. Our results showed that plasma levels of Aβ42, Aβ40, neurofilament light chain, and glial fibrillary acidic protein were not significantly correlated with sample storage time. However, the level of total tau showed a negative correlation with sample storage time. Notably, in individuals without cognitive impairment, plasma levels of total protein and tau phosphorylated protein threonine 181 (p-tau181)also showed a negative correlation with sample storage time. This was not observed in individuals with cognitive impairment. Consequently, we speculate that the diagnostic accuracy of plasma p-tau181 and the p-tau181 to total tau ratio may be influenced by sample storage time. Therefore, caution is advised when using these plasma biomarkers for the identification of neurodegenerative diseases, such as Alzheimer's disease. Furthermore, in cohort studies, it is important to consider the impact of storage time on the overall results.

Mnemonic brain state engagement is diminished in healthy aging

Healthy older adults typically show impaired episodic memory - memory for when and where an event occurred. This selective episodic memory deficit may arise from differential engagement in the retrieval state, a brain state in which attention is focused internally in an attempt to access prior knowledge, and the encoding state, a brain state which supports the formation of new memories and that trades off with the retrieval state. We hypothesize that older adults are biased toward a retrieval state. We recorded scalp electroencephalography while young, middle-aged and older adults performed a memory task in which they were explicitly directed to either encode or retrieve on a given trial. We used multivariate pattern analysis of spectral activity to decode retrieval vs. encoding state engagement. We find that whereas all age groups can follow task demands to selectively engage in encoding or retrieval, mnemonic brain state engagement is diminished for older adults relative to young and middle-aged adults. These findings suggest that differential mnemonic state engagement may underlie age-related memory changes.

Practical clinical measures highlight cognition-balance associations in Parkinson's disease

INTRODUCTION

Cognitive impairment in people with Parkinson's disease (PD) is associated with balance deficits and fall risk. Despite this, cognition is not routinely assessed by rehabilitation professionals. Establishing associations between specific domains of balance and cognition in PD using practical clinical measures could help inform evaluation and intervention by clinicians.

RESEARCH QUESTION

Is there a relationship between subsections of the Montreal Cognitive Assessment (MoCA) and Mini Balance Evaluation Systems Test (MiniBESTest) in people with PD that could inform clinical practice?

METHODS

One hundred and eight participants were included in this cross-sectional study (83.3 % male, mean age 70 ± 8.3). Motor function, balance, and cognition were assessed using the Unified Parkinson's Disease Rating Scale Part III: Motor Examination, MiniBESTest, and MoCA, respectively. Pearson correlations, Spearman's rho correlations, and multiple regression analysis were used to assess relationships.

RESULTS

Statistically significant positive correlations were found between MoCA and MiniBESTest total and subsection scores. The strongest correlation between domains of balance and cognition was between MoCA Delayed Recall and MiniBESTest Dynamic Gait (rho=0.441, p < 0.001), which were also the strongest predictors of performance on the other measure (the MiniBESTest and MoCA, respectively).

SIGNIFICANCE

Associations between domains of balance and cognition in PD can be demonstrated without a full battery of cognitive tests. The MoCA (an easy-to-use measure of global cognition) and MiniBESTest (a commonly used balance measure for PD) are sensitive to these associations and easily incorporated into clinical practice. Alternatively, delayed recall and dynamic gait can be quickly assessed and have potential as fall risk screens themselves. These associations could be used to inform both dual task and cognitive training in PD.

Cerebral peak alpha frequency: Associations with chronic pain onset and pain modulation

Chronic pain is highly prevalent in the U.S. and leads to myriad negative sequalae and suffering. One way to address chronic pain is to identify who is at risk and intervene prior to symptom onset. Research suggests resting peak alpha frequency (PAF), the speed of alpha oscillations at rest, is slower in healthy individuals with greater pain sensitivity and in chronic pain patients. Thus, slower PAF may denote chronic pain vulnerability. Other research has shown that individuals at higher risk of chronic pain exhibit disrupted pain modulation, i.e., less efficient pain inhibition and increased pain facilitation. Currently, the ability of PAF to predict chronic pain and its relation to pain modulation is under-researched. This investigation aimed to address this gap by characterizing associations between PAF, onset of chronic pain, and pain modulation. Using archival data from three independent studies, this investigation assessed whether slower PAF is associated with prospectively-determined chronic pain onset, decreased pain inhibition (i.e., impaired conditioned pain modulation, impaired erotica-induced pain inhibition), and increased pain facilitation (i.e., increased temporal summation of pain, augmented mutilation-induced pain facilitation). Results show that slower PAF was associated with greater facilitation of spinal (i.e., nociceptive flexion reflex) and supraspinal (i.e., N2 potential) nociception in response to unpleasant pictures (i.e., human injury images). This suggests that slower PAF is associated with threat-enhanced spinal and supraspinal nociception and may be relevant for chronic pain conditions with disrupted threat systems. Slower PAF was not associated with any other pain outcome, including prospectively determined chronic pain onset. However, chronic pain onset could only be assessed in one study with a mixed eyes open/eyes closed recording, limiting the significance of this finding.

Sex-specific immune-biological profiles in Parkinson's disease

Depending on age, both the risk and characteristics of Parkinson's disease (PD) differ between the sexes. The immune system might have a role; however, human-based evidence remains scarce. Here, we investigated the relationship between peripheral immune cellular composition and the clinical-biological sexual dimorphism of PD. The leukocyte population count (neutrophils, lymphocytes, monocytes, eosinophils, and basophils), the neutrophil-to-lymphocyte ratio (NLR), and the monocytes-to-lymphocytes ratio (MLR) were collected and compared in 117 PD patients and 86 controls (CTLs), and then related to blood levels of sex hormones, CSF markers of neurodegeneration (α-synuclein, amyloid-β-42, amyloid-β-40, total tau, and phosphorylated-181-tau), and clinical features in male and female PD patients. Finally, a cluster analysis based on the three main leukocyte populations (neutrophils, lymphocytes, monocytes) was performed for the entire PD cohort. Male PD patients had lower lymphocyte counts and higher NLR than male CTLs. Females with PD had lower monocyte counts, NLR, and MLR than males with PD. Lymphocyte counts correlated with cognition in male, but not female, PD patients. Finally, two clusters of peripheral immune cellular composition were identified: the "high peripheral inflammation" one, mostly comprising male patients, with worse clinical features and greater central α-synuclein burden, and the "low peripheral inflammation cluster", which mainly comprised female patients, with milder clinical features and lower central synucleinopathy. In conclusion, the peripheral immune pattern entails sex-specific clinical-biological profiles in PD. Moreover, systemic inflammation clusters with sex, sexual hormones, clinical features, and central synucleinopathy in PD, supporting the relevance of immunity in sexual dimorphism of the disease.

Equating conversion norms for the Mini-Mental State Examination and Montreal Cognitive Assessment in healthy subjects and patients with neurodegenerative disorders

INTRODUCTION

The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are globally recognized as validated cognitive screening tests widely used.

OBJECTIVE/AIM

The present study attempted to provide conversion tables from the MMSE to the MoCA and vice versa, deriving them from a large population of healthy older adults and a representative clinical sample of subjects with different types of cognitive decline within the spectrum of Alzheimer's (AD) and Parkinson's (PD) diseases.

METHODS

A total of 1423 Italian participants, including healthy adults (n = 1203), individuals with AD (n = 93), and with PD (n = 127) were assessed using the MMSE and MoCA. Conversion tables were developed using log-linear smoothing equipercentile equating (LSEE). The reliability of the conversion was assessed through the Root Mean Square Error (RMSE) in a train-test approach confirmed in the whole sample.

RESULTS

The findings demonstrated that the LSEE method enables the development of conversion tables allowing users to identify the corresponding MoCA score for each MMSE score within the studied groups, and vice versa. The estimation error RMSE was 1.8, 2.9, and 3.2 for the conversion of MoCA from MMSE and 1.2, 2.3, and 2.2 for the conversion of MMSE from MoCA in healthy subjects, AD, and PD, respectively. The reliability of the conversion is higher in healthy subjects and for higher values of MoCA and MMSE.

CONCLUSION

Results report easy-to-use conversion norms for transforming raw MMSE score to MoCA and vice versa, highlighting areas were the conversion has a strong or low reliability depending on the score range.

Background and design of the Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF) study: A mixed methods study

Background

Many adults with heart failure (HF) are physically frail and have worse outcomes. While the biological profile of physical frailty in HF has been examined, the behavioral profile remains unstudied. Physical frailty may impact self-care behaviors, particularly symptom monitoring and management (SMM), which in turn results in adverse outcomes. This paper describes the background and design of a study that addresses this knowledge gap, entitled "Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure" (PRISM-HF).

Study design and methods

PRISM-HF is a sequential mixed methods study where in Phase 1, we collect quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we collect qualitative data from ∼32-40 adults from this sample, aiming to: (1) quantify associations among physical frailty, SMM behaviors, and outcomes; (2) describe the experience of SMM behaviors for physically frail and non-physically frail adults with HF; and (3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. At baseline, we measure symptoms, SMM behaviors, and physical frailty and collect clinical events at 6-months. We will use generalized linear modeling and survival analysis in Aim 1, directed content analysis in Aim 2, and triangulation analyses using an informational matrix in Aim 3.

Conclusions

This innovative study will investigate the behavioral underpinnings of physical frailty in HF, incorporate the patient's perspective of SMM behaviors in the context of physical frailty, and identify possible explanations for the effect of physical frailty on outcomes.

Evaluation and management of non-epileptic (functional) seizures: Lessons learned

In this article focusing on patients with non-epileptic (functional) seizures (NES/FS), senior and rising academicians discuss lessons learned over decades of clinical practice, teaching, and research in the field. Lessons include that non-epileptic (functional) seizures (NES/FS) can be reliably differentiated from epilepsy and diagnosed by a trained neurologist/epileptologist using video EEG long-term monitoring in the seizure monitoring unit. We note that some patients have concurrent NES/FS and epilepsy, meaning that clinicians should carefully document each seizure and teach the patient to differentiate epileptic from non-epileptic events. Neuropsychiatric and neuropsychological evaluations can inform treatment in patients with NES/FS, particularly given the need to comprehensively assess and understand diverse neurological, psychiatric, cognitive, and medical symptoms. Finally, evidence-based psychotherapies for NES/FS include cognitive behavioral therapy and neurobehavioral therapy, which can be administered by a trained seizure counselor.

Age-related differences in task-related modulation of cerebellar brain inhibition

Age-related reductions in cerebellar integrity predict motor impairments in older adults (OA), but the contribution of cerebro-cerebellar interactions to these impairments remains unclear. Understanding these interactions could reveal underlying mechanisms associated with age-related deficits in motor control. To explore this, twenty younger adults (YA) and twenty OA, all right-handed, participated in a dual-site transcranial magnetic stimulation protocol. Cerebellar brain inhibition (CBI) was measured at rest and during the anticipatory period of a bimanual tracking task (BTT). The results revealed that YA outperformed OA on the BTT. Both age groups demonstrated reduced CBI during the anticipatory period of the BTT compared to CBI at rest, with no differences in CBI levels between both groups. Notably, motor performance was influenced by CBI modulation, as learning progressed (early vs. slightly later short-term learning), and this influence differed between age groups. In summary, resting-state CBI and the task-related release of CBI were maintained in OA, challenging previous assumptions of reduced inhibitory function in OA. However, the modulation of CBI appears to influence short-term motor learning differently for both groups, suggesting potential functional reorganization of the cerebellar neural system.

Inflammation levels in type 2 diabetes mellitus patients with mild cognitive impairment: Assessment followed by amelioration via dapagliflozin therapy

AIMS

To investigate systemic inflammation and the effect of dapagliflozin treatment in (type 2 diabetes mellitus) T2DM patients with mild cognitive impairment (MCI).

METHODS

Between January and December 2023, 200 participants were recruited from the Department of Endocrinology of Hefei First People's Hospital. Baseline data collected included medical history, fasting blood glucose, HbA1c, liver and kidney function, lipid profiles, IL-1β, TNF-α, sVCAM-1 level, and the urinary albumin-creatinine ratio (uACR). Based on their Montreal Cognitive Assessment Scale (MoCA) scores, these participants were categorized into two groups: 127 in the MCI group and 73 in the non-MCI group. MCI group received dapagliflozin (10 mg daily) alongside standard treatment.

RESULTS

The MCI group showed higher age, height, weight, BMI, HbA1c, FBG, disease duration, carotid plaques, stenosis rates, and elevated IL-1β, TNF-α, and sVCAM-1. MoCA scores were significantly lower in the MCI group. Correlation analysis showed a negative correlation of MoCA scores with IL-1β, TNF-α, sVCAM-1, plaques, stenosis, FBG, and HbA1c, and a positive correlation with height. Binary logistic regression identified age, BMI, IL-1β, sVCAM-1, and FBG as predictors of cognitive impairment in T2DM. Dapagliflozin treatment reduced BMI, HbA1c, inflammatory markers, and FBG, improving MoCA scores.

CONCLUSION

Dapagliflozin treatment may improve cognitive function by reducing inflammation.

Aberrant information flow within resting-state triple network model in schizophrenia-An EEG effective connectivity study

Schizophrenia is a psychiatric disorder with heterogeneous clinical manifestations and complex aetiology. Notably, the triple-network model proposes an interesting framework for investigating abnormal neurocircuit activity at rest in schizophrenia. The present study on 30 chronic schizophrenia individuals and 30 controls aimed to explore the differences in EEG resting state effective connectivity within a triple-network model using source-localization-based Directed Transfer Function. Our findings revealed multiband effective connectivity disturbances within default mode (DMN), central executive (CEN), and salience (SN) networks in schizophrenia. The most significant difference was manifested in a global DMN hyperconnectivity, accompanied by low-band hyperconnectivity and high-band hypoconnectivity in CEN, along with the aberrant information flows in SN. In conclusion, our study presents novel insights into schizophrenia neuropathology, with a particular emphasis on the reversed directionality in information flows between hubs of SN, DMN, and CEN. This may be suggested as a promising biomarker of schizophrenia.

Protective effects of elastic band training-detraining on Fall risk, power, body composition, and cognition in older adults with mild cognitive impairment: A 40-week trial

BACKGROUND

Physical inactivity exacerbates muscle function and mass loss, increasing the risk of falls in older adults. Regular exercise can prevent muscle loss, cognitive decline, and comorbidities, potentially reducing fall risk. Given the multifactorial nature of fall risk, a comprehensive assessment is required.

OBJECTIVE

To investigate the effects of a 40-week intervention, including a long-term exercise program (16-weeks), detraining (8-weeks), and retraining (16-weeks), on fall risk and cognitive status in older adults with mild cognitive impairment.

METHODS

Participants (≥70 years old) were divided into two groups: Elastic Band Resistance Training (EBRT, n = 22) and a control group with no treatment (n = 20). Cognitive profile, body composition, muscle power, and multifactorial fall risk assessments (Timed Up-and-Go Test (TUG), Falls Efficacy Scale (FES), Fall Risk Assessment Tool (FRAT), and sensorimotor platform) were evaluated at four time points.

RESULTS

Significant correlations between muscle power, fat-free mass, and cognitive status with fall risk assessments were observed at baseline. Both phases of the exercise intervention improved muscle power, body composition, cognitive profile, and fall risk status. The EBRT group showed significant improvements in muscle power (p ≤ 0.01), fall risk (FRAT, p ≤ 0.01), FES (p ≤ 0.05), sensorimotor performance (p ≤ 0.001), TUG (p ≤ 0.001), and cognitive status (MoCA, p ≤ 0.05). Protective effects persisted during the detraining phase.

CONCLUSION

This study highlights significant improvements in fall risk assessment induced by EBRT, demonstrating its protective effects. The findings suggest that EBRT can enhance aspects related to fall risk, offering promising avenues for improving independence and quality of life in older adults prone to falls.

Routine comprehensive geriatric assessment is associated with improved detection of cognitive disorders in older people with giant cell arteritis

OBJECTIVES

Giant cell arteritis (GCA) carries an increased risk of stroke and blindness. International guidelines recommend older people receive routine comprehensive geriatric assessment (RCGA) during unplanned hospital admissions to improve health outcomes. This quality improvement study addressed the need for RCGA in older people with GCA at an Australian tertiary hospital. The aims of this study were to co-design, implement and evaluate a referral process for RCGA for hospitalised people 65 years or older with a new diagnosis of GCA and evaluate changes to the identification and management of falls and cognitive disorders (delirium, dementia and mild cognitive impairment).

METHODS

Hospital stakeholders co-designed an RCGA referral pathway as a quality improvement change initiative. An observational cohort design measured implementation and outcomes. Consecutive patients aged 65 years or older with a new diagnosis of GCA were recruited for 15 months (n = 18), and outcomes were compared with a retrospective cohort of similar patients (n = 55). Descriptive summaries were compared between groups using non-parametric tests.

RESULTS

Following implementation, all eligible patients received both RCGA and individualised interventions. Forty-four per cent of patients in the RCGA group were diagnosed with delirium, dementia or mild cognitive impairment compared to 18% in the usual care group (p = .03).

CONCLUSIONS

In this small population, implementation of an RCGA pathway was associated with increased detection of delirium, mild cognitive impairment and dementia, and allowed for implementation of individualised interventions.

White matter hyperintensities in dementia with lewy bodies and posterior cortical atrophy

Dementia with Lewy bodies (DLB) and posterior cortical atrophy (PCA) are neurodegenerative disorders that can overlap clinically and in patterns of regional hypometabolism and show elevated white matter hyperintensity (WMH) burden. Little is known about the regional WMH burden in DLB patients without any interference of AD pathology and how these patterns compare to PCA patients. Twenty-two amyloid-negative DLB patients, 40 amyloid-positive PCA patients, and 49 amyloid-negative cognitively unimpaired (CU) healthy individuals were recruited at Mayo Clinic, Rochester, MN. They underwent a 3 T head MRI, a Pittsburgh Compound B (PiB) PET scan, and a fluid-attenuated inversion recovery scan (FLAIR). The relationship between regional WMH volume and diagnosis was evaluated while adjusting for age and sex. DLB showed greater periventricular WMH burden in the temporal, occipital, and frontal lobes and greater WMH burden in the posterior corpus callosum compared to CU. PCA showed greater subcortical WMH burden in temporal, parietal, and occipital lobes, and greater periventricular WMH burden in the temporal, occipital, and frontal lobes, compared to CU. On comparing both dementia groups, PCA showed greater subcortical WMH burden in the temporal and occipital lobes compared to DLB, while DLB showed greater WMH burden in the posterior corpus callosum compared to PCA. Hence, DLB and PCA are both associated with periventricular WMHs, with deep subcortical WMHs being more characteristic of PCA, and callosal WMHs more characteristic of Aβ-negative DLB patients, suggesting different pathophysiological mechanisms underlying the development of WMHs in these two neurodegenerative diseases.

Psychometric Reliability, Validity, and Generalizability of MoCA in American Indian Adults: The Strong Heart Study

Standardized neuropsychological instruments are used to evaluate cognitive impairment, but few have been psychometrically evaluated in American Indians. We collected Montreal Cognitive Assessment (MoCA) in 403 American Indians 70 to 95 years, as well as age, sex, education, bilingual status, depression symptoms, and other neuropsychological instruments. We evaluated inferences of psychometric validity, including scoring inference using confirmatory factor analysis and structural equation modeling, generalizability inference using reliability coefficient, and extrapolation inference by examining performance across different contexts and substrata. The unidimensional (total score) model had good fit criteria. Internal consistency reliability was high. MoCA scores were positively associated with crystallized cognition (ρ = 0.48, p < .001) and inversely with depression symptoms (ρ = -0.27, p < .001). Significant differences were found by education (d = 0.79, p < .05) depression (d = 0.484, p < .05), and adjudicated cognitive status (p = .0001) strata; however, MoCA was not sensitive or specific in discriminating cognitive impairment from normal cognition (area under the curve <0.5). MoCA scores had psychometric validity in older American Indians, but education and depression are important contextual features for score interpretability. Future research should evaluate cultural or community-specific adaptations, to improve test discriminability in this underserved population.

Correlation between mild behavioral impairment and peripheral blood biomarkers in patients with mild cognitive impairment

BACKGROUND

Mild behavioral impairment (MBI) refers to the neurobehavioral symptoms observed in older adults that may be potential risk factors for neurodegenerative diseases. While a significant number studies have explored the association between cerebrospinal fluid and MBI, only a few have examined the connection between plasma biomarkers and MBI.

AIM

To examine the prevalence of MBI in healthy older adults (HOAs) and individuals with mild cognitive impairment (MCI), as well as the association between MBI and plasma biomarkers of Alzheimer’s disease (AD).

METHODS

We enrolled a total of 241 subjects, which included 136 HOAs and 105 MCIs, from the Yuhua District of Shijiazhuang City, Hebei Province, China. The MBI symptom checklist (MBI-C) was utilized for the assessment and diagnosis of MBI, and a score of MBI-C ≥ 6.5 was considered indicative of the condition. Fasting venous blood samples were collected from 70 patients, 32 HOAs and 38 MCIs, and levels of amyloid β-protein (Aβ) 40, Aβ42, and hyperphosphorylated tau (p-Tau217) in these samples were measured using an enzyme-linked immunosorbent assay.

RESULTS

The prevalence of MBI in the HOAs and MCI groups was 4.4% and 15.3%, respectively (χ² = 7.262, P = 0.007), with particularly notable decreases in motivation and increases in impulse dyscontrol (the highest detection rate) and social inappropriateness (P < 0.05). The total MBI score correlated with Aβ42 and p-Tau217 (r = -0.385, P = 0.019; r = -0.330, P = 0.041), but not with Aβ40 or the Aβ42/40 ratio. Among the subdomains, impulse dyscontrol was correlated with Aβ42 (r = -0.401, P = 0.025).

CONCLUSION

Both MCI and HOAs have exhibited a higher prevalence of MBI, with changes in impulse control behavior being the most common. MBI not only presents as an independent risk factor for cognitive decline but is also linked with AD-related peripheral biomarkers.

Serum sortilin-derived propeptide concentrations as markers of depression in chronic stroke

INTRODUCTION

Post-stroke depression is a common and debilitating consequence of stroke that significantly impacts functional recovery and quality of life. Identifying new biological markers and treatments is essential to enhance patient care. This study aimed to assess the relationship between serum levels of the sortilin-derived propeptide and depression scores in the STROKDEM cohort (NCT01330160).

METHODS

The study enrolled 204 stroke patients and followed them at 6, 12, 36, and 60 months post-stroke. Serum sortilin-derived propeptide levels were measured at each visit, along with comprehensive clinical assessments including depression and anxiety scales.

RESULTS

The results showed a significant main effect of serum sortilin-derived propeptide levels on depression scores (p = 0.006). There was also a significant interaction between propeptide levels and follow-up visit (p = 0.05). In contrast, propeptide levels did not have a significant effect on anxiety scores (p = 0.75).

DISCUSSION

These findings suggest serum sortilin-derived propeptide could be a useful biomarker for post-stroke depression. This opens up potential new treatment approaches, including the consideration of the drug spadin, which targets this peptide, for managing post-stroke depression in humans.

Association between cognitive function and relaxation rates of the cerebral cortex

OBJECTIVE

We aimed to elucidate the correlation between cognitive function and relaxation rates of the cerebral cortex in the early stages of cognitive decline.

METHODS

Brain MRI was performed on 97 community-dwelling elderly participants aged 65-84 years. R1 (1/T1) and R2 (1/T2) maps were obtained with synthetic MRI (SyMRI). Cognitive function was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA). Participants were categorized into mild cognitive impairment (n = 47) and healthy control (n = 50) groups. Voxel-based quantification (VBQ) and voxel-based morphometry (VBM) analyses were conducted using two-sample t-tests and multiple regression models, with age and sex as covariates.

RESULTS

VBQ revealed a significant negative correlation between R1 values and MoCA visuospatial/executive score in the bilateral frontal pole and left superior frontal gyrus (family-wise error-corrected p < 0.05). No significant correlations were found between R2 values and visuospatial/executive score. The multiple regression analysis for VBM showed no significant correlations, and the two-sample t-tests for both VBQ and VBM revealed no significant group differences.

CONCLUSION

Visuospatial/executive impairment correlated with higher R1 and R2 values in the frontal cortex, suggesting their potential as biomarkers for early cognitive decline.

Health-related quality of life, physical and mental capacity at one year follow up of COVID-19 ICU patients: A prospective cohort study

PURPOSE

In 2020 as COVID-19 rapidly overwhelmed ICU resources, patient care capacity was reduced thus increasing the risk of development of post intensive care syndrome (PICS). Therefore, an increased incidence of survivors with neurocognitive and neuromuscular impairment could be anticipated. This study aimed to describe residual reductions in health-related quality of life (HRQoL) and risk factors for PICS as they pertain to outcomes one year after intensive care.

PATIENTS AND METHODS

Between 01-03-2020 and 31-08-2020, all adult COVID-19 ICU patients discharged alive in two Swedish ICU were included. At 2-, 6- and, 12-months post discharge follow up was conducted. Primary outcome parameters were HRQoL up to 12-months after ICU discharge. Secondary outcome parameters were clinimetric results for physical, mental, and cognitive functions at 6 months after intensive care stay.

RESULTS

Data from 41 patients were analyzed. Fatigue, anxiety, respiratory impairments, and experienced decline in physical stamina were the dominating findings at 6 months. Criteria for PICS were fulfilled in 93% of the study population and a 60% reduction in overall HRQoL, compared with a normal age adjusted population, was seen at follow up. A slight improvement was seen at 6 months whereafter no further significant improvement in HRQoL was detected. Fatigue was the most dominant complaint, expressed by almost all patients at follow up.

CONCLUSION

Long term outcome reported in this study showed longstanding impairment in HRQoL, mostly related to reduced well-being and perceived limitations in physical ability. Overall, our findings show similarities with previously reported recovery patterns after intensive care. However, the COVID-19 cohort displayed a more profound reduction in HRQoL paralleled with severe fatigue and respiratory limitations. This signals the need for a deeper understanding of pathophysiological mechanisms of COVID-19 induced residual impairments and more precise instruments to tailor an individually designed aftercare.

Is β- amyloid a reliable marker for assessing neurocognitive functions in middle-aged OSAS patients??

BACKGROUND

Obstructive sleep apnea syndrome (OSAS) is a condition defined by recurrent episodes of airflow cessation or significant reduction during sleep, resulting in fragmented sleep patterns and intermittent hypoxemia. These physiological disturbances are known to contribute to cognitive deficits, including impairments in attention, memory, and overall cognitive function. In parallel, amyloid beta (β-Amyloid, Aβ) has gained prominence as a crucial biomarker in Alzheimer's disease pathogenesis, raising interest in its potential role in the early detection of neurocognitive dysfunction. This study aims to explore the association between plasma Aβ levels, neurocognitive performance, and polysomnographic parameters in middle-aged patients diagnosed with OSAS.

METHODS

This prospective, cross-sectional study was conducted over a four-month period in a sleep disorders clinic. Patients who diagnosed as OSA in polysomnographic evaluation with no pre-existing neurocognitive conditions and possessed at least a primary school education were included. The study participants were evaluated using Montreal Cognitive Assessment (MoCA) test and Epworth Sleepiness Scale (ESS). Morning fasting blood samples were collected to measure plasma total Aβ levels.

RESULTS

A total of 126 individuals (mean age: 54.7 ± 7.5 years; 53 females, 42%) participated in the study. Based on their apnea-hypopnea index (AHI), patients were categorized into two groups: Group 1 (AHI < 15, 23.8% mild OSA) and Group 2 (AHI ≥ 15, moderate-severe OSA, 76.2%). The mean MoCA scores were 25 ± 7 in Group 1 and 24 ± 6 in Group 2. Following multivariable adjustment, reduced sleep duration, lower mean nocturnal oxygen saturation, and prolonged time with SpO2 below 90% (T90%) were significantly correlated with lower MoCA scores. Serum Aβ concentrations were notably elevated in patients with severe OSAS, exhibiting a negative correlation with MoCA scores and slow wave sleep stage. Additionally, serum Aβ levels showed a direct correlation with both AHI and oxygen desaturation index (ODI), while an inverse correlation was found with minimum oxygen saturation.

CONCLUSION

Neurocognitive impairment was common in OSAS patients. Elevated serum Aβ levels were found to be directly associated with OSA severity, and OSA-related hypoxemia was linked to diminished cognitive function.

Application of Upper Limb Multimodal Tasks Combined With fNIRS Technology in the Assessment of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is primarily characterized by a gradual decline in cognitive function, where early detection and intervention are crucial to preventing Alzheimer's disease progression. This study integrates upper limb multimodal tasks (ULMTs) with functional near-infrared spectroscopy (fNIRS) to assess cognitive and motor functions in MCI patients. Thirty-seven elderly participants were categorized into healthy control (HC) and MCI groups. The experiment consisted of resting state, numerical cognitive task (NCT), motor task (MT), and ULMT phases. fNIRS measured hemodynamic responses in the prefrontal and motor cortices, while an upper limb trainer recorded motor data. Results showed weaker cortical responses in the MCI group during rest and reduced motor cortex activation during NCT. Both groups displayed increased cortical activity during ULMT compared to NCT but reduced motor performance compared to MT. These findings demonstrate the potential of ULMTs combined with fNIRS for early MCI assessment and intervention.

Knowledge, confidence, and behavioral changes after an Alzheimer's disease continuing education program for nurse practitioners

ABSTRACT

Alzheimer's disease (AD) is a progressive, neurodegenerative disorder that currently affects an estimated 6.9 million people in the United States. Despite the growing prevalence of AD, management of this common condition remains suboptimal. To address knowledge and practice gaps related to cognitive evaluation and Alzheimer's diagnosis and treatment, the American Association of Nurse Practitioners (NPs) developed a 1.5-contact hour NP-focused continuing education (CE) program on AD. Changes in learner knowledge, competence, and confidence were assessed with preactivity and postactivity surveys; qualitative follow-up interviews were conducted to evaluate retention of CE material and behavior changes. In total, 4,793 learners (NPs, 93.6%) who completed the activity and self-reported providing patient care were included in the outcomes analysis. In the pre-activity assessment, notable knowledge and competence deficiencies were identified related to the diagnosis, classification, and pharmacotherapeutic management of AD. The CE activity was associated with significant improvements in knowledge and competence, with a 20-percentage point increase in correct response rate from the pre-activity to post-activity survey (p < .001). Learner confidence in their ability to perform key clinical tasks related to Alzheimer's management also improved. Twelve NPs participated in follow-up interviews; most reported that the CE activity reinforced their current practices. Despite improvements in knowledge and competence, certain knowledge gaps persisted, and learners identified several ongoing barriers to optimal management, including lack of access to specialists. Given the changing Alzheimer's landscape, ongoing educational interventions targeted to the NP workforce are needed to serve the growing population of adults at risk for AD.

Clinical and genetic characteristics of PLA2G6-related parkinsonism in Southwest China and a comprehensive literature review

BACKGROUND

Biallelic PLA2G6 mutations are associated with early onset autosomal recessive parkinsonism, exhibiting a broad spectrum of clinical heterogeneity.

OBJECTIVE

To comprehensively characterise the clinical, imaging and genetic features of PLA2G6-related parkinsonism.

METHODS

We report 14 new cases of PLA2G6-related parkinsonism in Southwest China and conduct a systematic literature review.

RESULTS

Among the 14 patients in our cohort, 16 PLA2G6 variants were identified, including seven novel and nine previously reported variants. The mean age at symptom onset was 26.50±6.57 years. The most common initial presentation was parkinsonism (9/14, 64.3%), followed by gait disturbance (6/14, 42.9%) and psychiatric symptoms (1/14, 7.1%). A literature review identified 118 patients with PLA2G6-related parkinsonism, with a mean age at onset of 24.53±8.84 years. The most common initial clinical features included parkinsonism (61/117, 52.1%), cerebellar signs (46/85, 54.1%), cognitive impairment (65/92, 70.7%) and psychiatric symptoms (80/93, 86.0%). Subgroup analysis showed that the mean age at symptom onset was older in Chinese patients (26.65±7.08 years) compared with those of European ancestry (20.83±9.79 years) (p=0.016). Additionally, patients of European ancestry showed delayed parkinsonism 5.35±8.14 years after onset. Iron deposition was reported more frequently in patients of European ancestry (10/16, 62.5%) than that in Chinese patients (6/37, 16.2%) (p=0.0002).

CONCLUSION

Our study provides new insights on the diverse clinical spectrum of PLA2G6-related parkinsonism, encompassing parkinsonian features, psychiatric symptoms, cognitive impairment and early levodopa-induced motor complications.

Safety and tolerability of intravenous liposomal GM1 in patients with Parkinson disease: A single-center open-label clinical phase I trial (NEON trial)

BACKGROUND

Parkinson disease (PD) is a chronic progressive neurodegenerative disorder leading to motor and non-motor impairment, often resulting in severe loss of quality of life. There are symptomatic treatments without effect on the progression of PD. A disease-modifying treatment that could ideally stop the neurodegenerative process is direly needed. Monosialotetrahexosylganglioside (GM1) is a promising molecule with neuroprotective effects in preclinical models of PD and has yielded encouraging results in patients with PD in a randomized placebo-controlled trial. Talineuren (TLN) is a liposomal formulation of GM1 that has been shown to cross the blood-brain barrier in animals. We assessed the safety and pharmacokinetics (PK) of TLN in patients with PD.

METHODS AND FINDINGS

We prospectively enrolled 12 patients with PD into a single-center, open-label phase I trial to assess the safety and tolerability of weekly infusions with TLN. The maximum suitable dose of TLN was determined by dose escalation in three patients. All three patients tolerated the predetermined maximal dose of 720 mg. Subsequently, these and nine additional patients received weekly infusions at the maximum suitable dose of 720 mg TLN over two months (1 patient stopped prematurely). PK were determined for the additional nine patients as a secondary outcome measure. Cmax was reached 4 h after infusion start for all but one participant, who reached Cmax after 1 h, while the median plasma half-life was reached at 12.6 h. All adverse events were continuously assessed as the primary objective and coded according to the Medical Dictionary for Regulatory Activities (MedDRA). Clinical manifestations of PD were assessed as secondary outcomes using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), including a levodopa challenge test at baseline and end. In addition to weekly history taking, scales to measure mood, behavior, quality of life, sleepiness, non-motor symptoms of PD, and cognition were used as further secondary outcomes as well as assessing the Levodopa-equivalent daily dose (LEDD). Overall, 304 adverse events (mean: 25.33; 6-75 events per patient) occurred, 267 of which were mild (mean: 22.25; 3-72 events per patient). 23 were considered related to the study treatment (0-8 events per patient). Very mild-to-severe acute infusion reactions at the second, third, or fourth administration of TLN within the first minutes of the infusion occurred in seven patients. All reported back or neck pain. Other acute infusion reactions were urticaria, plethora, nausea, and chest pain. These adverse reactions disappeared within minutes of stopping the infusion and did not recur when TLN administration was resumed at a very low rate. Beyond the fourth administration, infusions could be given at increased rates up to 370 ml/h, and no acute reaction occurred anymore. The mechanism of this acute infusion reaction remains unclear. Some patients reported mild dizziness for a few hours after TLN following many but not all administrations throughout the study. Non-motor symptoms of PD, motor parkinsonian signs off medication, and quality of life improved significantly during the treatment phase, including the MDS-UPDRS total score (mean decrease -11.09; 95% confidence interval [CI]; -18, -4.1; p = 0.006), the Parkinson's disease Questionnaire-39 (PDQ-39) summary index(mean decrease -2.91; 95% CI; -4.4, -1.4; p = 0.005), and the Non-Motor Symptoms Questionnaire (NMS-Quest) (mean decrease -4.27; 95% CI; -6.5, -2.1; p = 0.009). No statistically significant improvements were seen in the Montreal Cognitive Assessment (MoCA) (mean decrease -0.73; 95% CI; -2.1, 0.62; p = 0.255), Epworth Sleepiness Scale (mean increase 0.09; 95% CI; -2.6, 2.8; p > 0.999), Beck Depression Inventory (BDI) (mean decrease -1.27; 95% CI; -3.8, 1.3; p = 0.257), and the Starkstein Apathy Scale (mean increase 0.36; 95% CI; -1.6, 2.4; p = 0.822). Dopaminergic medications remained stable during the study (LEDD mean increase 8.18; 95% CI; -7.7, 24; p = 0.423). While clinical improvements indicate a benefit associated with TLN treatment, the trial design does not allow for definite conclusions regarding efficacy. A randomized, placebo-controlled trial will be required to corroborate our exploratory findings.

CONCLUSION

TLN is safe and well-tolerated in general. This prospective phase I trial revealed non-allergic habituating acute infusion reactions at the second, third, or fourth treatment that can be prevented by a slower rate of infusion. Importantly, the exploratory results suggest a consistent improvement of signs and symptoms of PD.

TRIAL REGISTRATION

The NEON trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04976127 and in the Swiss National Clinical Trials Portal (SNCTP000004631).

Feasibility of direct-to-home teleneuropsychological evaluations in U.S. Veterans with functional seizures

INTRODUCTION

Functional seizures (FS) present with cognitive dysfunction that impacts quality of life, suggesting that neuropsychological evaluations would be beneficial. However, these patients often face barriers to in-person appointments, leading to a gap in care. The current study objective is to examine aspects of feasibility of direct-to-home (DtH) teleneuropsychology for patients with FS.

METHOD

U.S. Veterans with FS were prospectively recruited from a national VA program from October 2023 to February 2025. Participants completed DtH cognitive testing and neurological/mental health assessments. We measured satisfaction with teleneuropsychology using an adapted questionnaire. We implemented a Seizure Safety Protocol to direct management of acute events. Descriptive analyses report on relevant feasibility metrics.

RESULTS

Of 60 referrals, 22 participants (37%) consented. Of those 22 participants, 20 (91%) completed the full study. Two of 22 (9%) participants were discontinued partway through data collection due to prolonged symptoms following a seizure. Five participants experienced 11 total seizures during the study, but these events did not appear to impact the validity of test data, with a few exceptions (11/720 [<2%] missing cognitive test indices). Satisfaction with the telehealth study was high such that 20/22 (91%) participants agreed or strongly agreed that they were satisfied with the study overall. Participants reported enjoying the convenience, safety, and comfort of the DtH method, although some preferred traditional in-person sessions.

CONCLUSIONS

Findings support the use of teleneuropsychology in FS. A Seizure Safety Protocol can provide guidance on handling presumed medical emergencies and can mitigate risk of invalid cognitive data. Neuropsychologists may consider declining to use telehealth if seizures are common and likely to lead to (i) the request for acute medical care and/or (ii) prolonged symptoms that interfere with the assessment. More widespread use of teleneuropsychology for patients with FS in the future may improve access to beneficial clinical services.

ENGAGE-TBI: adaptation of a community-based intervention to improve social participation after brain injury

BACKGROUND

Social isolation is prevalent after traumatic brain injury (TBI) and has negative implications for health and well-being. Interventions targeting social participation show promise for reducing social isolation. We adapted a social participation intervention, ENGAGE, to meet the needs of people with TBI. ENGAGE relies on social learning and guided problem-solving to achieve social participation goals.

METHODS

This study was conducted in two phases. First, we conducted focus groups with 12 participants with TBI to inform adaptations. We then tested the adapted protocol (n = 6). Post-intervention interviews informed additional refinements. We collected preliminary data on feasibility and effects on social participation (Activity Card Sort, PROMIS Ability to Participate in Social Roles, PROMIS Satisfaction with Participation in Social Roles) and social isolation (PROMIS Social Isolation).

RESULTS

Intervention adaptations included simplified processes for developing goals and plans, simplified workbook materials, greater time for reflection on lessons learned, and expanded peer mentorship. ENGAGE-TBI resulted in high satisfaction for 80% of participants and high engagement in intervention for 100% of participants. Attendance and retention benchmarks were achieved. Improvements in social participation exceeded the minimal clinically important difference on all measures.

CONCLUSIONS

The promising preliminary data support further investigation into the feasibility and effects of ENGAGE-TBI.

Brain structural alterations and cognitive dysfunction in lung cancer patients without brain metastasis

This study explored the relationship between cognitive function and brain structure in lung cancer (LCs) patients without brain metastases and healthy controls (HCs). A cohort of 75 chemotherapy-naive LCs without brain metastases and 29 age-, sex-, and education-matched HCs underwent cognitive assessments and structural MRI. The MRI focused on cortical thickness, surface area, and volume of subcortical structures. We examined the relationships among these parameters. The volume of twelve subcortical structures was significantly reduced in patients with advanced-stage lung cancer (aLCs) compared to HCs (p < 0.05). In aLCs, cortical thickness decreased in one brain region and surface area in five regions (p < 0.05). Patients with early-stage lung cancer (eLCs) exhibited increased cortical thickness in three regions. When comparing eLCs to aLCs, there was a notable decrease in cortical thickness and surface area (p < 0.05). Visuospatial/executive and delayed memory functions were impaired in aLCs and worsened with disease progression. These impairments correlated positively with the thickness of several cerebral cortices and the surface area and volume of subcortical structures (p < 0.05). Structural brain changes and cognitive dysfunction are evident in aLC patients, independent of metastasis. Since none of the patients received chemotherapy, the observed abnormalities in aLCs, absent in eLCs, are likely attributable to the disease itself rather than chemotherapy effects.

Anxiety, depression, and poor sleep quality in two-year survivors of mild to severe SARS-CoV-2 infection and matched comparison groups

OBJECTIVE

This study explores differences in the co-distribution of anxiety and depression symptoms and sleep quality scores between survivors of COVID-19 and comparison groups, nearly two years after COVID-19 diagnosis.

METHODS

Individuals enrolled at primary healthcare centers of Matosinhos were selected and grouped according to hospitalization and SARS-CoV-2 infection between March 2020 and February 2021: group#1, hospitalized due to COVID-19 (n = 96); group#2, hospitalized, uninfected (n = 81); group#3, infected, non-hospitalized (n = 205); group#4, uninfected, non-hospitalized (n = 236). Groups #2 and #4 were matched to groups #1 and #3, respectively, in a ratio of 1:1, by age, sex and level of care. They were evaluated between July 2022 and October 2023 with the Hospital Anxiety and Depression Scale (subscales HADS-A, anxiety, and HADS-D, depression) and the Pittsburgh Sleep Quality Index (PSQI). Partition clustering centered on the median of HADS-A, HADS-D, and PSQI scores was used to identify two clusters. Logistic regression was used to compute adjusted Odds Ratios (aOR) and 95 % confidence intervals (CI) of the associations between the study group and the two clusters.

RESULTS

The cluster of worse mental health (n = 338) presented scores mostly above five, while the best mental health cluster (n = 280) presented scores up to five. Participants infected with SARS-CoV-2 during the first year of the pandemic were more likely to have worse mental health (aOR, 95%CI: 1.46, 1.03-2.05).

CONCLUSIONS

Survivors of COVID-19 of the first year of the pandemic may require a special clinical attention to ensure that care is provided to improve mental health and prevent a worsening of anxiety and depression symptoms, and sleep problems.

The profile of gastrointestinal dysfunction in prodromal to late-stage Parkinson's disease

Gastrointestinal dysfunction (GID) may play a key role in Parkinson's disease (PD) but its relationship with disease progression remains unclear. We recruited 404 PD cases, 37 iRBD (isolated REM Sleep Behaviour Disorder) and 105 controls. Participants completed the Gastrointestinal Dysfunction Scale for PD (GIDS-PD) and standardised disease severity assessments. Whole gut transit time (WGTT) was measured by ingestion of blue dye and recorded time to blue stools appearance ('Blue Poop Challenge') in a subset of PD cases. Gastrointestinal symptoms were more common and prevalent in iRBD and PD versus controls, and WGTT was significantly higher in PD versus controls. After adjustment for confounding factors, disease stage was not a significant predictor of GIDS-PD Constipation or Bowel Irritability scores. Longitudinal assessment of GIDS-PD scores and WGTT confirmed stability over a 4 year period. Bowel dysfunction may be a phenotypic feature in a subset of Parkinson's with implications for patient stratification and management.

Does a Real-Life Cognitively Enriched Walking Program "Take a Walk With Your Brain" Benefit Cognitive Functioning and Physical Activity in Community-Dwelling Older Adults? A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Most studies examining combined cognitive and physical activity are conducted in laboratory settings. This randomized controlled trial (RCT) examines the effects of a real-life cognitively enriched walking program on cognitive functioning and moderate-to-vigorous physical activity (MVPA) in adults aged ≥65 years.

RESEARCH DESIGN AND METHODS

A three-arm RCT was conducted, comparing the cognitively enriched walking program (WALK+, doing cognitive tasks while walking) with a walking program without enrichment (WALK-only) and a passive control condition (CONT). Both WALK+ and WALK-only had a duration of 6 months, with 2 outdoors, supervised group-based sessions per week (60-90 min/session). Cognitive functioning (short- and long-term memory, executive functioning, and processing speed) and MVPA were measured at baseline, 3, 6, and 12 months using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and ActiGraph GT3X+ accelerometers, respectively.

RESULTS

A total of 148 community-dwelling adults (median age: 69 years, range: 65-85; 72% [n = 107] female) were included. Comparing WALK+ to WALK-only and CONT, and WALK-only to CONT, there were no significant intervention effects on cognitive functioning at 3, 6, or 12 months. MVPA decreased with 13 min/day in WALK+ between baseline and 12 months, while it increased between baseline and 6 months with 12 min/day in WALK-only and between 3 and 6 months with 16 min/day in CONT.

DISCUSSION AND IMPLICATIONS

The WALK+ program did not lead to statistically significant benefits for cognitive functioning or MVPA compared to WALK-only or CONT. Future studies should explore for whom combined interventions may work and determine the optimal dosage.

Apolipoprotein E (APOE) and Alzheimer's disease risk in a Ugandan population: A pilot case-control study

Alzheimer's disease (AD) is a neurodegenerative disorder that is characterized by cognitive decline and progressive functional impairment. The Apolipoprotein E (APOE) gene, particularly its ε2, ε3, and ε4 alleles, plays a crucial role in lipid metabolism, and has been implicated in AD pathogenesis. Although the APOE ε4 status is associated with an increased risk of AD, its impact varies across populations. This study investigated the prevalence of and association between APOE alleles and AD risk in a Ugandan cohort. This case-control study was conducted in Uganda, and included 87 participants (45 patients with AD and 42 healthy controls). Cognitive assessment was performed using the Montreal Cognitive Assessment (MoCA) and clinical diagnoses were based on the ICD-11 and DSM-5 criteria. Venous blood was collected for APOE genotyping by polymerase chain reaction. Statistical analyses, including logistic regression and generalized additive models (GAMs), were used to assess the association between APOE alleles and AD risk after adjusting for age, education, and sex. This study included 45 patients with AD and 42 healthy controls. The AD group was significantly older than controls (79.6 vs 73.0 years; P = .0006). The ε4 allele was common in both the AD (42.2%) and control groups (44.0%), which was higher than the 1000 Genomes African ancestry data. No significant association was found between the APOE genotype or allele dosage and AD risk after adjusting for age, sex, and education. However, the probability of AD increases with age, particularly among ε4 carriers with lower educational levels. While APOE ε4 status was associated with a higher predicted probability of AD in older adults, no statistically significant relationship was observed in the Ugandan cohort. These findings support the need for larger population-specific studies to explore APOE's role of APOE in AD risk across sub-Saharan Africa.

Heuristic pruning of decision trees at low probabilities and probability discounting in sequential planning in young and older adults

When planning an action sequence, it has been shown that humans prune decision trees to reduce computational complexity, instead of considering all possible options. However, little is understood about pruning employed in probabilistic environments, where actions result in multiple outcomes with varying probabilities, and how decision biases, such as discounting of probabilistic rewards, influence decisions. This study investigates whether participants prune low-probability options in a three-step decision-making task and analyzes the impact of probability discounting on planning. Potential age-related differences in planning strategies are explored in groups of young (aged 18-35 years; n = 57) and older (aged 65-75 years; n = 50) adults. By using reinforcement-learning modeling and model comparison, we show that participants reduce computational demands by pruning decision tree branches of lower probability-a highly efficient strategy in this environment. Additionally, participants reduce their planning depth, i.e., the number of considered steps. Planning is further influenced by discounting high-probability outcomes. Older individuals show stronger reductions in planning depth, an increase in decision noise, and more pronounced probability discounting, which contributes to the observed age-related decline in planning performance. Our findings suggest directions for future research to elucidate the underlying meta-control mechanisms guiding the application of planning strategies.

Age-Related Differences in Comprehending Speech in Competition

PURPOSE

The ability to discriminate speech with background noise decreases with age. This study examined the effect of masker type and spatial location in older and young adults.

METHOD

Using Portable Automated Rapid Testing software on an iPad, participants were asked to understand target speech (always simulated at 0° azimuth) in the presence of speech or "garbled speech" maskers (simulated from 0°, 6°, or 45° azimuth spatial locations). Additionally, suprathreshold sensitivities to temporal (TM), spectral (SM), and spectrotemporal (STM) modulation as well as binaural temporal fine structure (TFS) were estimated.

RESULTS

Older adults showed worse speech in competition (SiC) performance with 6° and 45°, but not 0°, masker spatial locations and benefited less from only 45° of spatial separation compared to young controls for speech masking. For garbled-speech masking, older adults showed worse performance overall, but benefited similarly from spatial separation compared to young controls. Older adults also showed worse sensitivity for binaural TFS, but comparable TM, SM, and STM sensitivity. Age as well as TM and SM sensitivities predicted SiC performance, whereas STM and binaural TFS sensitivities did not.

CONCLUSION

These findings expand our knowledge of how aging and suprathreshold sensitivities affect SiC comprehension.

Language Dominance and Education Considerations in the Neuropsychological Assessment of Southwestern American Indians Using the National Alzheimer Coordinating Center's Uniform Data Set Version 3

To address disparities in dementia diagnosis and care in American Indian and Alaska Native communities, it is crucial to understand how sociocultural factors, such as language dominance and education, impact performances on standardized neuropsychological assessments. We discuss sociocultural considerations that are important to consider when evaluating cognition in American Indians. We conducted t tests/Kruskal-Wallis tests and correlation analyses to evaluate the impact of language and education factors on performances on the National Alzheimer Coordinating Center's Uniform Data Set Version 3 Neuropsychological assessments in a community of Southwestern American Indians. There were no significant differences in cognitive performances between the Zuni (Shiwi)-dominant and English-dominant individuals. Number of years of education had a greater effect on cognitive performances relative to language dominance, particularly for the common cognitive screening measure, the Montreal Cognitive Assessment. Our results highlight that education factors have a greater effect on cognitive performances relative to language dominance in this unique cohort. The associations with the Montreal Cognitive Assessment raise concerns for the use of this tool in this population, highlighting a need to develop culturally appropriate cognitive testing tools as well as ensuring comprehensive, culturally competent neuropsychological assessments are accessible.

Resting-state functional MRI metrics to detect freezing of gait in Parkinson's disease: a machine learning approach

Among the symptoms that can occur in Parkinson's disease (PD), Freezing of Gait (FOG) is a disabling phenomenon affecting a large proportion of patients, and it remains not fully understood. Accurate classification of FOG in PD is crucial for tailoring effective interventions and is necessary for a better understanding of its underlying mechanisms. In the present work, we applied four Machine Learning (ML) classifiers (Decision Tree - DT, Random Forest - RF, Multilayer Perceptron - MLP, Logistic Regression - LOG) to different four metrics derived from resting-state functional Magnetic Resonance Imaging (rs-fMRI) data processing to assess their accuracy in automatically classifying PD patients based on the presence or absence of Freezing of Gait (FOG). To validate our approach, we applied the same methodologies to distinguish PD patients from a group of Healthy Subject (HS). The performance of the four ML algorithms was validated by repeated k-fold cross-validation on randomly selected independent training and validation subsets. The results showed that when discriminating PD from HS, the best performance was achieved using RF applied to fractional Amplitude of Low-Frequency Fluctuations (fALFF) data (AUC 96.8 ± 2 %). Similarly, when discriminating PD-FOG from PD-nFOG, the RF algorithm was again the best performer on all four metrics, with AUCs above 90 %. Finally, trying to unbox how AI system black-box choices were made, we extracted features' importance scores for the best-performing method(s) and discussed them based on the results obtained to date in rs-fMRI studies on FOG in PD and, more generally, in PD. In summary, regions that were more frequently selected when differentiating both PD from HS and PD-FOG from PD-nFOG patients were mainly relevant to the extrapyramidal system, as well as visual and default mode networks. In addition, the salience network and the supplementary motor area played an additional major role in differentiating PD-FOG from PD-nFOG patients.

Mild cognitive impairment is associated with effect of uremic metabolites on gray matter structural changes in end-stage kidney disease

To investigate the grey matter volume (GMV) changes and uremic metabolites in end-stage kidney disease (ESKD) patients with mild cognitive impairment (MCI) (ESKD-MCI) and further examine the classification and diagnostic efficacy of these features for ESKD-MCI patients. A total of 65 patients with ESKD, including 34 ESKD-MCI and 31 with non-cognitive impairment (ESKD-NCI), and 55 health controls (HCs) were enrolled. All participants underwent brain structural magnetic resonance imaging (MRI) scanning and Montreal cognitive assessment test. Clinical characteristics and GMV differences among these three groups were analyzed. In addition, mediation analysis was performed to determine the mediating effect of GMV changes on the association between clinical risk factors and MCI. Finally, support vector machine were employed to examine the classification and diagnostic efficacy of GMV changes and clinical features for MCI. Both patient groups exhibited widespread structural brain injury compared with the HCs. Moreover, compared with ESKD-NCI, ESKD-MCI patients demonstrated reduced GMV specifically in the left middle temporal gyrus and inferior temporal gyrus. Notably, these GMV changes completely mediates the effect of serum phosphorus levels on MCI. Furthermore, imaging features rather than serum phosphorus levels had good classification and diagnostic efficacy for ESKD-MCI. Our findings underscore the significance of the left temporal gyrus as a pivotal brain region in ESKD-MCI patients, fully mediating the link between uremic metabolite and MCI. GMV alterations presents a promising avenue for effectively detecting MCI in individuals with ESKD.

Addressing Phonological Deficit in Primary Progressive Aphasia With Behavioral Intervention and Transcranial Direct Current Stimulation

PURPOSE

Despite recognition of the underlying phonological impairment observed in the logopenic and nonfluent variants of primary progressive aphasia (PPA), there is relatively little treatment research directed toward strengthening phonological skills. In this study, we focused on remediating phonological deficits in logopenic and nonfluent PPA. Specifically, we hypothesized that behavioral intervention intended to strengthen phonological manipulation skills and sound-letter correspondences-coupled with transcranial direct current stimulation (tDCS)-would improve language abilities, especially in the written modality.

METHOD

Twelve individuals with logopenic or nonfluent variants of PPA and 24 neurotypical adults completed neuropsychological assessment that documented spoken and written language deficits in those with PPA. Phonological skills were consistently impaired in relation to other language processes. Following a double-blind, crossover design, six individuals with PPA were randomized to receive active tDCS with phonological intervention during the first treatment phase, and after a 2-month break, they received a second phase of behavioral intervention paired with sham tDCS. The other six individuals were randomized to receive sham first and active tDCS second. Language skills were evaluated before and after each treatment phase and 2 months after the intervention.

RESULTS

Both treatment groups (tDCS-first and sham-first) made significant improvement in phonological transcoding skills in response to behavioral intervention, but those who received active tDCS first showed stronger gains in phonological manipulation ability. This group also showed positive changes in written narratives, which contained more grammatical sentences with increased meaningful content and more accurate spelling.

CONCLUSIONS

These data provide compelling evidence supporting an approach that targets phonological deficits in logopenic and nonfluent PPA. Specifically, we found that improved phonological skills resulted in better functional communication ability (text-level writing) relevant to everyday life. Positive outcomes were strongest when tDCS was combined with behavioral treatment from the beginning, suggesting that this combination may potentiate positive changes that extend beyond the initial stimulation period.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28598195.

Impact of disease activity on cognitive and psychological outcomes in acromegaly: A prospective study

PURPOSE

To investigate the cognitive and psychological aspects of acromegaly and to assess how disease activity may affect these outcomes.

METHODS

This prospective study included patients with acromegaly who consecutively admitted to Pituitary Center between June 2021 and July 2023. Cognitive functions were assessed using a series of standardized tests targeting memory, attention, executive function, verbal fluency, and visuospatial skills. Additionally, Beck Depression Inventory (BDI), Beck Anxiety Inventory, and Acromegaly Quality of Life Questionnaire (AcroQoL) assessments were conducted. These evaluations were performed preoperatively and at the 9th month postoperatively following transsphenoidal surgery (TSS) to assess the anticipated changes in neuropsychological functions based on disease activity.

RESULTS

A total of 19 patients with acromegaly were included. Remission was achieved through TSS alone in 9 patients, while 10 patients required postoperative somatostatin receptor ligands. Cognitive functions (Montreal Cognitive Assessment Test) were better in the remission phase compared to the initial active disease phase (23.36 ± 3.46 vs 24.93 ± 3.73; p = 0.035). Cognitive flexibility and selective attention (Stroop Test) were impaired during the active period of the disease (17.79 ± 12.31 vs 12.29 ± 8.23; p = 0.016). Memory functions (Wechsler Memory Scale-Logical Memory Test: immediate recall, delayed recall, recognition) showed improvement from the active phase to remission (p = 0.016, p = 0.003, p = 0.008; respectively). BDI scores were significantly higher in the active phase compared to remission (7.36 ± 3.48 vs 5.43 ± 3.03; p = 0.009). Additionally, AcroQoL scores were lower during the active disease phase than in the remission phase (65.30 ± 17.75 vs 80.43 ± 13.61; p = 0.007).

CONCLUSION

Acromegaly may impair cognitive and psychological functions, which appear to improve with effective treatment.

Predictive ability of Mini-Cog for postoperative delirium: A systematic review and meta-analysis

AIM

This study aims to determine the predictive value of the preoperative Mini-Cognitive Assessment Instrument (Mini-Cog) for postoperative delirium (POD), a significant complication in older surgical patients. Given its widespread recommendation despite unclear predictive utility, we will conduct the first meta-analysis to synthesize the available evidence.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (Medline, CINAHL, Cochrane Library, and Web of Science) were searched from inception to May 2024. Studies evaluating the association between preoperative Mini-Cog scores and POD were included. Two independent reviewers performed study selection and data extraction. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Random-effects models were used to calculate pooled odds ratios (ORs), sensitivity, and specificity. Sensitivity analyses were performed based on standardized cutoff values and POD assessment methods.

RESULTS

Sixteen studies involving 4980 patients were included. Participants' mean/median ages ranged from 70 to 80 years, and the percentage of patients scoring below the Mini-Cog cutoff varied from 12.5% to 60.5%. Low Mini-Cog scores were significantly associated with increased POD risk (OR = 3.79; 95% confidence interval [CI] = 2.81-5.12; I2 = 57%). The Mini-Cog demonstrated a pooled specificity of 0.80 and sensitivity of 0.50 for POD prediction. Sensitivity analysis of studies using standardized cutoffs (<3) and validated POD assessment tools yielded an OR of 3.40 (95% CI = 2.56-4.53). Half of the included studies showed a low risk of bias across all QUADAS-2 domains. Publication bias assessment using funnel plots and Egger's test showed no significant bias.

CONCLUSIONS

The Mini-Cog shows moderate predictive ability for POD, with high specificity but limited sensitivity. While it may be valuable as part of comprehensive preoperative assessment, its moderate sensitivity suggests it should not be used as the sole predictor. The variability in surgical populations and assessment methods highlights the need for standardization. Future research should focus on establishing consistent methodologies and exploring the Mini-Cog's efficacy in specific surgical populations to enhance its clinical utility in POD risk stratification. Geriatr Gerontol Int 2025; ••: ••-••.

Blood biomarkers of amyloid and tau pathologies, brain degeneration, inflammation, and oxidative stress in early- and late-onset Alzheimer's disease

BackgroundNumerous blood biomarkers have emerged as promising biomarkers for Alzheimer's disease (AD) and cognitive decline, but limited knowledge exists concerning the difference of blood biomarkers between early-onset and late-onset cases.ObjectiveInvestigate blood biomarkers associated with amyloid and tau pathologies, brain degeneration, inflammation, and oxidative stress in individuals afflicted with both early-onset and late-onset AD, as well as in age-matched healthy controls.MethodsA total of 125 participants were enrolled. We assessed levels of 18 distinct blood biomarkers and their associations with cerebrospinal fluid biomarkers, neuropsychological test scores, APOE ε4 carrier status, and neuroimaging markers. The diagnostic potential of blood biomarkers was investigated.ResultsIn early-onset AD patients, levels of blood Interleukin (IL)-4, IL-6, and Tumor necrosis factor-alpha (TNF-α) were notably lower comparing to late-onset patients. AD patients exhibited higher blood levels of phosphorylated-tau181 (p-tau181), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), as well as lower levels of amyloid-β (Aβ)42 and IL-12p70. Oxidative stress markers, including malondialdehyde, total antioxidant capacity, and superoxide dismutase, exhibited a progressive trend across the continuum of AD. Inflammatory markers demonstrating correlations with neuroimaging markers. Blood levels of Aβ42, p-tau181, NfL, and GFAP associated with neuropsychological scores and effectively discriminated AD, with GFAP exhibiting particular relevance in early-onset cases.ConclusionsInflammatory markers exhibited differences between patients with early- and late-onset AD, associated with alterations in brain structure and function. With the progression of disease continuum, a decrement in antioxidant capacity was observed. Blood Aβ42, p-tau181, NfL, and GFAP showed promise in detecting cognitive decline and AD.

Fusing GPS, Activity Monitors, and Self-Report to Improve Assessment of Walking Activity and Community Participation After Stroke

BACKGROUND AND PURPOSE

Walking and participation in the community are important goals for people post-stroke (PPS). These constructs are challenging to measure given limitations in current data collection methodologies. The purpose of this study was to (1) develop a data fusion approach that combined data from global positioning system (GPS), activity monitor (AM), and daily trip log to identify walking activity and participation in the community, and (2) to examine the construct validity of the data fusion method.

METHODS

At 60 days post-stroke, PPS wore a GPS and AM and completed a daily trip log for 7 days. Using a combination of a density-based spatial clustering algorithm and geocoding GPS, AM, and daily trip log data were time synched and fused to identify total trips taken outside the home; locations visited per trip; number of steps taken in the home, in the community, at each location visited, and in total. Associations between stroke outcomes and the data fusion metrics were determined to support the construct validity of the data fusion method.

RESULTS

Forty-four PPS took a mean of 2,541 steps/day, of which 56% were in the community, and took a mean of 0.39 trips/day outside the home and visited a mean of 0.42 locations. A social visit was the most common reason for going into the community. There were fair associations between number of trips outside the home and gait speed (GS), r = 0.49, Berg Balance Scale (BBS), r = 0.48, modified Rankin Scale (mRS), r = -0.47, and Stroke Impact Scale participation subscale (SIS-P) (0.45). There were moderate associations between steps taken in the community and GS, r = 0.63, BBS, r = 0.51, mRS, r = -0.61, and SIS-P, r = 0.43.

DISCUSSION AND CONCLUSIONS

Participants did not often access their community. Fusing GPS, AM, and trip log data may provide a comprehensive method to identify walking activity and community participation in PPS.

VIDEO ABSTRACT AVAILABLE

for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A529).

Creative support: Enhancing well-being in mild and moderate cognitive impairment through museum interventions

BackgroundThe global incidence of dementia is increasing, establishing it as a significant cause of disability and diminished quality of life. The World Health Organization underscores the necessity of enhancing the well-being of individuals with dementia and their caregivers. Research has indicated that art-based interventions can improve cognitive functions and overall quality of life. This pilot study aimed to evaluate the impact of a museum-based intervention program on the well-being (quality of life, depression, and mood) of individuals with mild-to-moderate cognitive impairment (MCI-moderate), which may indicate early to moderate stages of dementia that was not formally diagnosed.MethodsWe recruited 29 participants with MCI-moderate (median MoCA score: 22). The intervention group consisted of 16 individuals (11 females, 5 males; mean age 83.5 years) who attended sessions at an art museum in Israel every once a week from March to April 2023. Thirteen age-matched individuals formed the control group, which did not participate in the museum program. Measures of well-being were assessed before and after the intervention, along with collecting participants' feedback. Well-being changes within and between-groups were analyzed using mixed model analysis of variance. Effect sizes were also calculated.ResultsThe intervention group showed significant improvements in quality of life with large effect sizes in all domains, and a significant reduction in depression symptoms; the control group experienced non-significant changes. Additionally, mood significantly improved following museum activities. Most participants positively reviewed the program, with a significant majority reporting enhanced mood (81.2%) and a strong intention to recommend it (93.7%); 62.5% expressed a desire for future participation.ConclusionsOur findings suggest that art interventions, such as museum programs, can significantly boost well-being in people with MCI-moderate, suggesting further exploration of the specific elements of such programs and their long-lasting effects.

Treatment Acceptability and Satisfaction With Cough Skill Training in Parkinson's Disease: A Mixed-Methods Study

PURPOSE

Despite evidence to suggest that rehabilitation can improve airway protection in people with Parkinson's disease (pwPD), rehabilitative therapies are underutilized. One newer treatment approach with growing evidence to support its efficacy is cough skill training (CST). To improve utilization of rehabilitations such as CST, it is important to understand patient treatment experience. Therefore, the aim of this study was to define treatment acceptability and satisfaction of CST in pwPD.

METHOD

Thirteen pwPD were consecutively recruited from a trial during which participants completed two in-person sessions of CST via spirometry over 2 weeks. A mixed-methods approach was used, whereby quantitative data (obtained from questionnaires) and qualitative data (obtained from semistructured interviews) were integrated to provide a holistic understanding of patient experience. Data collection and thematic analyses (of qualitative data) were guided by the Systems Engineering Initiative for Patient Safety framework.

RESULTS

While treatment demonstrated adequate acceptability with a System Usability Scale median score of 70/100 (scores ≥ 70 indicate acceptability), integrative examination of patient experience revealed several themes that highlight barriers and facilitators to treatment acceptability-as they relate to CST tools (visualization, lip seal, and measurement accuracy) and tasks (practice targets, feedback, practice amount, and future training). Most (61.5%) participants were "satisfied" or "very satisfied" with CST. Four themes emerged related to satisfaction: treatment relevance, patient awareness and control over their disease, skill acquisition, and skill transference to real-life choking events.

CONCLUSIONS

In this study, patient responses indicated that small, personalized adaptations to equipment, training targets, and feedback may enhance their experiences, while education and personalized goal setting may enhance treatment relevance and perceived benefit. Patient perspectives and needs can inform the refinement of person-centered clinical implementation of CST and improve treatment uptake.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28887167.

Clinical and Neuropathological Evaluations of the New Brunswick Neurological Syndrome of Unknown Cause

Importance

In 2019, an alleged "mystery" neurological illness emerged in New Brunswick, Canada. Despite extensive media attention, no case description has been published to date.

Objective

To report on 25 patients with a diagnosis of New Brunswick neurological syndrome of unknown cause (NSUC) who subsequently received a second, independent clinical reassessment or neuropathological examination between 2020 and 2025.

Design, Setting, and Participants

This cross-sectional study of cases derived from a cohort of patients (n = 222) who had received an NSUC diagnosis. Four movement disorder neurologists and 2 behavioral neurologists carried out clinical evaluations at 2 hospitals in New Brunswick and Ontario, Canada. Neuropathological diagnoses were obtained in Ontario by a neuropathologist and a second reviewer, both blinded to the case histories. Eligible patients were offered a second opinion; 4 families of deceased patients provided consent for reporting autopsies and waivers of consent were obtained for 7.

Exposure

NSUC as described in the case definition circulated by Public Health New Brunswick in 2021.

Main Outcomes and Measures

Findings from the independent clinical evaluations and diagnoses obtained through neuropathological examination.

Results

Among 105 eligible patients, 14 patients (aged 20-55 years; 8 female, 6 male) received clinical evaluations, and 11 patients (aged 56-82 years; 5 female, 6 male) had neuropathological diagnoses. Well-known conditions were identified in all 25 cases, including common neurodegenerative diseases, functional neurological disorder, traumatic brain injury, and metastatic cancer. Based on the 11 autopsy cases, a new disease was extremely unlikely, with a probability less than .001. When applying the 95% confidence interval for the true probability of no new disease, the data revealed a high probability between 87% and 100%.

Conclusions and Relevance

There was no evidence supporting a diagnosis of NSUC in this cohort. The data inclusive of independent examinations and neuropathology strongly supported the presence of several neurodegenerative and non-neurodegenerative conditions. Unfounded concerns that a potentially fatal mystery disease, possibly induced by an environmental toxin, is causing the patients' neurological symptoms has been amplified in traditional and social media. Second, independent clinical evaluations are needed for any patient given a diagnosis of NSUC.