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Assaf G, Tanielian M. Mild cognitive impairment in primary care: a clinical review. Postgrad Med J 2018; 94:647-652. [DOI: 10.1136/postgradmedj-2018-136035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/07/2018] [Accepted: 10/12/2018] [Indexed: 01/20/2023]
Abstract
Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.
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Rapid review of cognitive screening instruments in MCI: proposal for a process-based approach modification of overlapping tasks in select widely used instruments. Int Psychogeriatr 2018; 30:663-672. [PMID: 29113605 DOI: 10.1017/s1041610217002253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:A detailed neuropsychological assessment plays an important role in the diagnostic process of Mild Cognitive Impairment (MCI). However, available brief cognitive screening tests for this clinical population are administered and interpreted based mainly, or exclusively, on total achievement scores. This score-based approach can lead to erroneous clinical interpretations unless we also pay attention to the test taking behavior or to the type of errors committed during test performance. METHODS The goal of the current study is to perform a rapid review of the literature regarding cognitive screening tools for dementia in primary and secondary care; this will include revisiting previously published systematic reviews on screening tools for dementia, extensive database search, and analysis of individual references cited in selected studies. RESULTS A subset of representative screening tools for dementia was identified that covers as many cognitive functions as possible. How these screening tools overlap with each other (in terms of the cognitive domains being measured and the method used to assess them) was examined and a series of process-based approach (PBA) modifications for these overlapping features was proposed, so that the changes recommended in relation to one particular cognitive task could be extrapolated to other screening tools. CONCLUSION It is expected that future versions of cognitive screening tests, modified using a PBA, will highlight the benefits of attending to qualitative features of test performance when trying to identify subtle features suggestive of MCI and/or dementia.
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Vaughan RM, Coen RF, Kenny R, Lawlor BA. Semantic and Phonemic Verbal Fluency Discrepancy in Mild Cognitive Impairment: Potential Predictor of Progression to Alzheimer's Disease. J Am Geriatr Soc 2018; 66:755-759. [DOI: 10.1111/jgs.15294] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Roisin M. Vaughan
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - Robert F. Coen
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - RoseAnne Kenny
- The Irish Longitudinal Study on Ageing; Trinity College; Dublin Ireland
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
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Roalf DR, Quarmley M, Mechanic-Hamilton D, Wolk DA, Arnold SE, Moberg PJ. Within-Individual Variability: An Index for Subtle Change in Neurocognition in Mild Cognitive Impairment. J Alzheimers Dis 2018; 54:325-35. [PMID: 27567827 DOI: 10.3233/jad-160259] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The transition from mild cognitive impairment (MCI) to Alzheimer's disease is characterized by a decline in cognitive performance in many domains. Cognitive performance profiles in MCI are heterogeneous, however, and additional insights into markers of incipient dementia are needed. Typically, studies focus on average or mean performance, but ignore consistency of performance across domains. WIV (within-individual variability) provides an index of this consistency and is a potential marker of cognitive decline. OBJECTIVE To use neurocognitive data from the Alzheimer's Disease Neuroimaging Initiative cohort to measure neurocognitive variability. METHODS The utility of WIV was measured, in addition to global neurocognitive performance (GNP), for identifying AD and MCI. In addition, the association between changes in neurocognitive variability and diagnostic transition over 12 months was measured. RESULTS As expected, variability was higher in AD and MCI as compared to healthy controls; GNP was lower in both groups as compared to healthy subjects. Global neurocognitive performance alone best distinguished those with dementia from healthy older adults. Yet, for individuals with MCI, including variability along with GNP improved diagnostic classification. Variability was higher at baseline in individuals transitioning from MCI to AD over a 12-month period. CONCLUSION We conclude that variability offers complementary information about neurocognitive performance in dementia, particularly in individuals with MCI, and may provide beneficial information about disease transition.
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Affiliation(s)
| | | | | | - David A Wolk
- Department of Neurology, Philadelphia, PA, USA.,Alzheimer's Disease Center of the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Steven E Arnold
- Department of Psychiatry, Philadelphia, PA, USA.,Department of Neurology, Philadelphia, PA, USA.,Alzheimer's Disease Center of the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul J Moberg
- Department of Psychiatry, Philadelphia, PA, USA.,Department of Neurology, Philadelphia, PA, USA.,Alzheimer's Disease Center of the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Palsetia D, Rao GP, Tiwari SC, Lodha P, De Sousa A. The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: A Clinical Comparison. Indian J Psychol Med 2018; 40:1-10. [PMID: 29403122 PMCID: PMC5795671 DOI: 10.4103/ijpsym.ijpsym_244_17] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a growing incidence of dementia patients in the community, and with this growth, there is need for rapid, valid, and easily administrable tests for the screening of dementia and mild cognitive impairment in the community. This review looks at the two most commonly used tests in dementia screening, namely, the clock drawing test (CDT) and the mini-mental status examination (MMSE). Both these tests have been used in dementia screening over the past three decades and have been the subject of scrutiny of various studies, reviews, and meta-analysis. Both these tests are analyzed on their ability to assess dementia and screen for it in the community, general practice and general hospital settings. The methods of administration and scoring of each test are discussed, and their advantages and disadvantages are explained. There is also a direct comparison made between the MMSE and CDT in dementia screening. Future research needs with these tests are also elucidated.
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Affiliation(s)
- Delnaz Palsetia
- Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India
| | - G. Prasad Rao
- Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India
| | - Sarvada C. Tiwari
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pragya Lodha
- Department of Research Assistant, Desousa Foundation, Mumbai, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Application and Interpretation of Functional Outcome Measures for Testing Individuals With Cognitive Impairment. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klotzbier TJ, Schott N. Cognitive-Motor Interference during Walking in Older Adults with Probable Mild Cognitive Impairment. Front Aging Neurosci 2017; 9:350. [PMID: 29321738 PMCID: PMC5732228 DOI: 10.3389/fnagi.2017.00350] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022] Open
Abstract
Although several studies have shown that dual-tasking (DT) mobility is impaired in Alzheimer's disease, studies on the effects of DT conditions in probable Mild Cognitive Impairment (pMCI) have not yielded unequivocal results. The objectives of the study were to (1) examine the effect of a concurrent task on a complex walking task in adults with cognitive impairment; and (2) determine whether the effect varied with different difficulty levels of the concurrent task. Furthermore, the study was designed to evaluate the Trail-Walking Test (TWT) as a potential detection tool for MCI. We examined DT performance in 42 young adults (mean age 23.9 ± 1.98), and 43 older adults (mean age 68.2 ± 6.42). The MoCA was used to stratify the subjects into those with and without pMCI. DT was assessed using the TWT: participants completed 5 trials each of walking along a fixed pathway, stepping on targets with increasing sequential numbers (i.e., 1-2-…-15), and increasing sequential numbers and letters (i.e., 1-A-2-B-3-…-8). Motor and cognitive DT effects (DTE) were calculated for each task. ROC curves were used to distinguish younger and healthy older adults from older adults with pMCI. The TWT showed excellent test-retest reliability across all conditions and groups (ICC : 0.83–0.97). SEM% was also low (<11%) as was the MDC95% (<30%). Within the DT conditions, the pMCI group showed significantly longer durations for all tasks regardless of the cognitive load compared to the younger and the healthy older adults. The motor DTEs were greatest for the complex condition in older adults with pMCI more so than in comparison with younger and healthy older adults. ROC analyses confirmed that only the tasks with higher cognitive load could differentiate older adults with pMCI from controls (area under the curve >0.7, p < 0.05). The TWT is a reliable DT mobility measure in people with pMCI. However, the condition with high cognitive load is more sensitive than the condition with low cognitive load in identifying pMCI. The TWT-3 thus could serve as a screening tool for early detection of individuals with pMCI. Future studies need to determine the neural correlates for cognitive-motor interference in older adults with pMCI.
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Affiliation(s)
- Thomas J Klotzbier
- Department of Sport and Exercise Science, Institute for Sport and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Nadja Schott
- Department of Sport and Exercise Science, Institute for Sport and Exercise Science, University of Stuttgart, Stuttgart, Germany
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Needham M, Webb C, Bryden D. Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth 2017; 119:i115-i125. [DOI: 10.1093/bja/aex354] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Katakura Y, Totsuka M, Imabayashi E, Matsuda H, Hisatsune T. Anserine/Carnosine Supplementation Suppresses the Expression of the Inflammatory Chemokine CCL24 in Peripheral Blood Mononuclear Cells from Elderly People. Nutrients 2017; 9:nu9111199. [PMID: 29088099 PMCID: PMC5707671 DOI: 10.3390/nu9111199] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 11/16/2022] Open
Abstract
Our goal was to determine whether anserine/carnosine supplementation (ACS) suppresses chemokine levels in elderly people. In a double-blind randomized controlled trial, volunteers were assigned to the ACS or placebo group (1:1). Sixty healthy elderly volunteers (active, n = 30; placebo, n = 30) completed the study. The ACS group was administered 1.0 g of anserine/carnosine (3:1) for 3 months. A microarray analysis and subsequent quantitative real-time polymerase chain reaction (qRT-PCR) analysis of peripheral blood mononuclear cells (PBMCs) showed decreased expression of CCL24, an inflammatory chemokine (p < 0.05). Verbal memory, assessed using the Wechsler memory scale-logical memory, was preserved in the ACS group. An age-restricted sub-analysis showed significant verbal memory preservation by ACS in participants who were in their 60s (active, n = 12; placebo, n = 9; p = 0.048) and 70s (active, n = 7; placebo, n = 11; p = 0.017). The suppression of CCL24 expression was greatest in people who were in their 70s (p < 0.01). There was a significant correlation between the preservation of verbal memory and suppression of CCL24 expression in the group that was in the 70s (Poisson correlation, r = 0.46, p < 0.05). These results suggest that ACS may preserve verbal episodic memory, probably owing to CCL24 suppression in the blood, especially in elderly participants.
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Affiliation(s)
- Yoshinori Katakura
- Faculty of Agriculture, Kyushu University, Higashi-ku, Fukuoka 812-8581, Japan.
| | - Mamoru Totsuka
- Department of Applied Biochemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Tokyo 113-8657, Japan.
| | - Etsuko Imabayashi
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.
| | - Tatsuhiro Hisatsune
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa 277-8562, Japan.
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Lin CH, Cheng HM, Chuang SY, Chen CH. Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain. Pulse (Basel) 2017; 5:127-132. [PMID: 29761088 DOI: 10.1159/000481734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Vascular aging may cause cerebral microvascular damage and cognitive dysfunction. There is incremental evidence that consistently implicates arterial stiffness being involved in the manifestation of cognitive impairment in the elderly. However, few investigations have examined the relationship between arterial stiffness and cognitive impairment in midlife. Summary Past studies inconsistently showed improved cognitive outcomes after antihypertensive therapy in elderly populations. Nevertheless, recent findings revealed that blood-pressure-lowering treatment in young adults might eliminate or halt the progression of the detrimental effects related to arterial stiffness, indicating that younger adults may have more favorable outcomes in cognition than their older counterparts if early intervention is conducted at the subclinical stage. Stiffening of the aorta may lead to an excessive flow pulsatility in the brain that may cause microvascular structural brain damage and worse cognitive performance. Recent investigations have suggested that arterial stiffness is likely to trigger initial silent brain damage, possibly preceding midlife, while the manifestation of cognitive decline and deterioration can be foreseen in the subsequent life span. Key Message Despite the recent novel findings, definite conclusions on causality between vascular aging and cognitive dysfunction cannot be drawn at present. Further well-powered longitudinal studies with superior neuroimaging indicator, vascular mechanical biomarkers, and sensitive cognitive assessment tools that examine a broad range of age populations may help extend our understanding of the association between vascular aging and cognitive dysfunction throughout the life span.
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Affiliation(s)
- Chen-Hua Lin
- Institute of Public Health, National Yang-Ming University, Taipei, ROC
| | - Hao-Min Cheng
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
| | | | - Chen-Huan Chen
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
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Han L, Jia Z, Cao C, Liu Z, Liu F, Wang L, Ren W, Sun M, Wang B, Li C, Chen L. Potential contribution of the neurodegenerative disorders risk loci to cognitive performance in an elderly male gout population. Medicine (Baltimore) 2017; 96:e8195. [PMID: 28953682 PMCID: PMC5626325 DOI: 10.1097/md.0000000000008195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairment has been described in elderly subjects with high normal concentrations of serum uric acid. However, it remains unclear if gout confers an increased poorer cognition than those in individuals with asymptomatic hyperuricemia. The present study aimed at evaluating cognitive function in patients suffering from gout in an elderly male population, and further investigating the genetic contributions to the risk of cognitive function.This study examined the cognitive function as assessed by Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in 205 male gout patients and 204 controls. The genetic basis of these cognitive measures was evaluated by genome-wide association study (GWAS) data in 102 male gout patients. Furthermore, 7 loci associated with cognition in GWAS were studied for correlation with gout in 1179 male gout patients and 1848 healthy male controls.Compared with controls, gout patients had significantly lower MoCA scores [22.78 ± 3.01 vs 23.42 ± 2.95, P = .023, adjusted by age, body mass index (BMI), education, and emotional disorder]. GWAS revealed 7 single-nucleotide polymorphisms (SNPs) associations with MoCA test at a level of conventional genome-wide significance (P < 9.6 × 10). The most significant association was observed between rs12895072 and rs12434554 within the KTN1 gene (Padjusted = 4.2 × 10, Padjusted = 4.7 × 10) at 14q22. The next best signal was in RELN gene (rs155333, Padjusted = 1.3 × 10) at 7q22, while the other variants at rs17458357 (Padjusted = 3.98 × 10), rs2572683 (Padjusted = 8.9 × 10), rs12555895 (Padjusted = 2.6 × 10), and rs3764030 (Padjusted = 9.4 × 10) were also statistically significant. The 7 SNPs were not associated with gout in further analysis (all P > .05).Elderly male subjects with gout exhibit accelerated decline in cognition performance. Several neurodegenerative disorders risk loci were identified for genetic contributors to cognitive performance in our Chinese elderly male gout population. Larger prospective studies of the cognitive performance and genetic analysis in gout subjects are recommended.
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Affiliation(s)
- Lin Han
- Department of Endocrinology Qilu Hospital of Shandong University, Jinan
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Zhaotong Jia
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Chunwei Cao
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Zhen Liu
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Fuqiang Liu
- Department of Endocrinology Qilu Hospital of Shandong University, Jinan
| | - Lin Wang
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Wei Ren
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Mingxia Sun
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Baoping Wang
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Changgui Li
- Gout Laboratory, The Affiliated Hospital of Qingdao University, Qingdao
| | - Li Chen
- Department of Endocrinology Qilu Hospital of Shandong University, Jinan
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Tsoi KK, Chan JY, Hirai HW, Wong A, Mok VC, Lam LC, Kwok TC, Wong SY. Recall Tests Are Effective to Detect Mild Cognitive Impairment: A Systematic Review and Meta-analysis of 108 Diagnostic Studies. J Am Med Dir Assoc 2017; 18:807.e17-807.e29. [DOI: 10.1016/j.jamda.2017.05.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/25/2022]
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Valeriano-Lorenzo L. Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer's Dementia in Population with Low Educational Level. Front Aging Neurosci 2017; 9:278. [PMID: 28878665 PMCID: PMC5572224 DOI: 10.3389/fnagi.2017.00278] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background/Aims: Short tests to early detection of the cognitive impairment are necessary in primary care setting, particularly in populations with low educational level. The aim of this study was to assess the performance of Memory Alteration Test (M@T) to discriminate controls, patients with amnestic Mild Cognitive Impairment (aMCI) and patients with early Alzheimer’s Dementia (AD) in a sample of individuals with low level of education. Methods: Cross-sectional study to assess the performance of the M@T (study test), compared to the neuropsychological evaluation (gold standard test) scores in 247 elderly subjects with low education level from Lima-Peru. The cognitive evaluation included three sequential stages: (1) screening (to detect cases with cognitive impairment); (2) nosological diagnosis (to determinate specific disease); and (3) classification (to differentiate disease subtypes). The subjects with negative results for all stages were considered as cognitively normal (controls). The test performance was assessed by means of area under the receiver operating characteristic (ROC) curve. We calculated validity measures (sensitivity, specificity and correctly classified percentage), the internal consistency (Cronbach’s alpha coefficient), and concurrent validity (Pearson’s ratio coefficient between the M@T and Clinical Dementia Rating (CDR) scores). Results: The Cronbach’s alpha coefficient was 0.79 and Pearson’s ratio coefficient was 0.79 (p < 0.01). The AUC of M@T to discriminate between early AD and aMCI was 99.60% (sensitivity = 100.00%, specificity = 97.53% and correctly classified = 98.41%) and to discriminate between aMCI and controls was 99.56% (sensitivity = 99.17%, specificity = 91.11%, and correctly classified = 96.99%). Conclusions: The M@T is a short test with a good performance to discriminate controls, aMCI and early AD in individuals with low level of education from urban settings.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,GESIDLima, Peru.,Instituto Nacional de Salud del NiñoLima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Medicina de Rehabilitación, Instituto Peruano de NeurocienciasLima, Peru
| | - Sheila Castro-Suarez
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias NeurológicasLima, Peru
| | - José Cuenca-Alfaro
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
| | - Lucía Valeriano-Lorenzo
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
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Ahmadi-Abhari S, Guzman-Castillo M, Bandosz P, Shipley MJ, Muniz-Terrera G, Singh-Manoux A, Kivimäki M, Steptoe A, Capewell S, O'Flaherty M, Brunner EJ. Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study. BMJ 2017; 358:j2856. [PMID: 28679494 PMCID: PMC5497174 DOI: 10.1136/bmj.j2856] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.Design Modelling study.Setting General adult population of England and Wales.Participants The English Longitudinal Study of Ageing (ELSA) is a representative panel study with six waves of data across 2002-13. Men and women aged 50 or more years, selected randomly, and their cohabiting partners were recruited to the first wave of ELSA (2002-03). 11392 adults participated (response rate 67%). To maintain representativeness, refreshment participants were recruited to the study at subsequent waves. The total analytical sample constituted 17 906 people. Constant objective criteria based on cognitive and functional impairment were used to ascertain dementia cases at each wave.Main outcome measures To estimate calendar trends in dementia incidence, correcting for bias due to loss to follow-up of study participants, a joint model of longitudinal and time-to-event data was fitted to ELSA data. To forecast future dementia prevalence, the probabilistic Markov model IMPACT-BAM (IMPACT-Better Ageing Model) was developed. IMPACT-BAM models transitions of the population aged 35 or more years through states of cardiovascular disease, cognitive and functional impairment, and dementia, to death. It enables prediction of dementia prevalence while accounting for the growing pool of susceptible people as a result of increased life expectancy and the competing effects due to changes in mortality, and incidence of cardiovascular disease.Results In ELSA, dementia incidence was estimated at 14.3 per 1000 person years in men and 17.0/1000 person years in women aged 50 or more in 2010. Dementia incidence declined at a relative rate of 2.7% (95% confidence interval 2.4% to 2.9%) for each year during 2002-13. Using IMPACT-BAM, we estimated there were approximately 767 000 (95% uncertainty interval 735 000 to 797 000) people with dementia in England and Wales in 2016. Despite the decrease in incidence and age specific prevalence, the number of people with dementia is projected to increase to 872 000, 1 092 000, and 1 205 000 in 2020, 2030, and 2040, respectively. A sensitivity analysis without the incidence decline gave a much larger projected growth, of more than 1.9 million people with dementia in 2040.Conclusions Age specific dementia incidence is declining. The number of people with dementia in England and Wales is likely to increase by 57% from 2016 to 2040. This increase is mainly driven by improved life expectancy.
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Affiliation(s)
- Sara Ahmadi-Abhari
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
| | | | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Prevention and Medical Education, Medical University of Gdansk, Poland
| | - Martin J Shipley
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
| | | | - Archana Singh-Manoux
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
- INSERM, U1018, Centre for Research in Epidemiology & Public Health, Hôpital Paul Brousse, France
| | - Mika Kivimäki
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
| | - Andrew Steptoe
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
| | | | - Eric J Brunner
- Department of Epidemiology & Public Health, University College London WC1E 7HB, UK
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Brief Report: Using the Internet to Identify Persons with Cognitive Impairment for Participation in Clinical Trials. Brain Sci 2017; 7:brainsci7040036. [PMID: 28379188 PMCID: PMC5406693 DOI: 10.3390/brainsci7040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022] Open
Abstract
Identifying, recruiting, and enrolling persons in clinical trials of dementia treatments is extremely difficult. One approach to first-wave screening of potential participants is the use of online assessment tools. Initial studies using the Dementia Risk Assessment (DRA)—which includes a previously validated recognition memory test—support the use of this self-administered assessment to identify individuals with “suspected MCI” or “suspected dementia.” In this study, we identified between 71 and 622 persons with suspected dementia and between 128 and 1653 persons with suspected mild cognitive impairment (depending on specific criteria) over the course of 22 months. Assessment tools that can inexpensively and easily identify individuals with higher than average risk for cognitive impairment can facilitate recruitment for large-scale clinical trials for dementia treatments.
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66
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Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? Breathe (Sheff) 2017; 13:e1-e9. [PMID: 29184593 PMCID: PMC5702891 DOI: 10.1183/20734735.001417] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/09/2022] Open
Abstract
Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. EDUCATIONAL AIMS To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction.To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy.To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment.
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Affiliation(s)
- Vasileios Andrianopoulos
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
| | - Rainer Gloeckl
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ioannis Vogiatzis
- Dept of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Dept of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Klaus Kenn
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
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67
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O'Caoimh R, Timmons S, Molloy DW. Screening for Mild Cognitive Impairment: Comparison of "MCI Specific" Screening Instruments. J Alzheimers Dis 2016; 51:619-29. [PMID: 26890758 PMCID: PMC4927818 DOI: 10.3233/jad-150881] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Sensitive and specific instruments are required to screen for cognitive impairment (CI) in busy clinical practice. The Montreal Cognitive Assessment (MoCA) is widely validated but few studies compare it to tests designed specifically to detect mild cognitive impairment (MCI). Objective: Comparison of two “MCI specific” screens: the Quick Mild Cognitive Impairment screen (Qmci) and MoCA. Methods: Patients with subjective memory complaints (SMC; n = 73), MCI (n = 103), or dementia (n = 274), were referred to a university hospital memory clinic and underwent comprehensive assessment. Caregivers, without cognitive symptoms, were recruited as normal controls (n = 101). Results: The Qmci was more accurate than the MoCA in differentiating MCI from controls, area under the curve (AUC) of 0.90 versus 0.80, p = 0.009. The Qmci had greater (AUC 0.81), albeit non-significant, accuracy than the MoCA (AUC 0.73) in separating MCI from SMC, p = 0.09. At its recommended cut-off (<62/100), the Qmci had a sensitivity of 90% and specificity of 87% for CI (MCI/dementia). Raising the cut-off to <65 optimized sensitivity (94%), reducing specificity (80%). At <26/30 the MoCA had better sensitivity (96%) but poor specificity (58%). A MoCA cut-off of <24 provided the optimal balance. Median Qmci administration time was 4.5 (±1.3) minutes compared with 9.5 (±2.8) for the MoCA. Conclusions: Although both tests distinguish MCI from dementia, the Qmci is particularly accurate in separating MCI from normal cognition and has shorter administration times, suggesting it is more useful in busy hospital clinics. This study reaffirms the high sensitivity of the MoCA but suggests a lower cut-off (<24) in this setting.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
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68
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Allan CL, Behrman S, Ebmeier KP, Valkanova V. Diagnosing early cognitive decline-When, how and for whom? Maturitas 2016; 96:103-108. [PMID: 28041588 DOI: 10.1016/j.maturitas.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
Mild cognitive impairment (MCI) is a term used to describe cognitive impairment in one or more cognitive domains that is greater than any expected age-related changes, but not of the magnitude to warrant a diagnosis of dementia. This review considers how early cognitive decline is diagnosed, focusing on the use of neuropsychological tests and neuroimaging, as well as the differential diagnosis. Potential treatments, including secondary prevention, post-diagnostic support and self-help are discussed. Finally, medico-legal matters such as driving, lasting power of attorney and employment are outlined.
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Affiliation(s)
- Charlotte L Allan
- Centre for the Health of the Elderly, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Sophie Behrman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Vyara Valkanova
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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69
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Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:1139-1150. [PMID: 26891238 DOI: 10.1002/gps.4444] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/21/2015] [Accepted: 01/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE People with amnestic mild cognitive impairment (aMCI) are at an increased risk of developing dementia. Efficient ways of identifying this 'at risk' population are required for larger-scale research studies. This systematic review describes the diagnostic accuracy of brief cognitive tests for detecting aMCI. METHODS Fifteen databases were searched from 1999 to July 2013 to identify papers for inclusion. Prospective studies assessing the diagnostic test accuracy of simple and brief cognitive tests for identifying people with aMCI against a reference standard (Petersen criteria) were included. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Predictive validity and test-retest reliability were also extracted, when provided. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Thirty-nine studies assessing 42 index tests were included. The Montreal Cognitive Assessment was the most comprehensively assessed test with evidence of high sensitivity for aMCI and good test-retest reliability, but low specificity was reported by the only study judged to be at low risk of bias. Other brief cognitive tests that include an assessment of word recall and multi-task tests that assess several cognitive domains were also found to exhibit high sensitivities and reasonable specificities. However, the confidence of the findings was affected by overall low quality of the contributing studies. CONCLUSION Several brief cognitive tests have shown promising diagnostic test accuracy results for identifying aMCI. However, concerns over the quality of the constituent studies and lack of evidence on the predictive validity of these tests mean that new validation studies are warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Seline Ozer
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK. .,School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - Claire Champ
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Melanie Burke
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Bermejo-Pareja F, Contador I, Trincado R, Lora D, Sánchez-Ferro Á, Mitchell AJ, Boycheva E, Herrero A, Hernández-Gallego J, Llamas S, Villarejo Galende A, Benito-León J. Prognostic Significance of Mild Cognitive Impairment Subtypes for Dementia and Mortality: Data from the NEDICES Cohort. J Alzheimers Dis 2016; 50:719-31. [PMID: 26757038 DOI: 10.3233/jad-150625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The predictive value of diverse subtypes of mild cognitive impairment (MCI) for dementia and death is highly variable. OBJECTIVE To compare the predictive value of several MCI subtypes in progression to dementia and/or mortality in the NEDICES (Neurological Disorders in Central Spain) elderly cohort. METHODS Retrospect algorithmic MCI subgroups were established in a non-dementia baseline NEDICES cohort using Spanish adaptations of the original Mini-Mental State Examination (MMSE-37) and Pfeffer's Functional Activities Questionnaire (Pfeffer-11). The presence of MCI was defined according two cognitive criteria: using two cut-offs points on the total MMSE-37 score. Five cognitive domains were used to establish the MCI subtypes. Functional capacity (Pfeffer-11) was preserved or minimally impaired in all MCI participants. The incident dementia diagnoses were established by specialists and the mortality data obtained from Spanish official registries. RESULTS 3,411 participants without dementia were assessed in 1994-5. The baseline prevalence of MCI varied according to the MCI definition (4.3%-31.8%). The follow-up was a mean of 3.2 years (1997-8). The dementia incidence varied between 14.9 and 71.8 per 1,000/person-years. The dementia conversion rate was increased in almost all MCI subgroups (p > 0.01), and mortality rate was raised only in four MCI subtypes. The amnestic-multi-domain MCI (aMd-MCI) had the best dementia predictive accuracy (highest positive likelihood ratio and highest clinical utility when negative). CONCLUSIONS Those with aMd-MCI were at greatest risk of progression to dementia, as in other surveys and might be explored with increased attention in MCI research and in dementia preventive trials.
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Affiliation(s)
- Félix Bermejo-Pareja
- Consultant Neurologist of the Clinical Research Unit (Imas12), University Hospital "12 de Octubre", Madrid, Spain.,Ciberned, Carlos III Research Institute, Madrid, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain
| | | | - David Lora
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Álvaro Sánchez-Ferro
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.,Centro Integral de Neurociencias A.C., Fundación Hospitales de Madrid, Móstoles, Madrid, Spain
| | - Alex J Mitchell
- Department of Cancer and Molecular Medicine, University of Leicester, UK
| | - Elina Boycheva
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Alejandro Herrero
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | - Jesús Hernández-Gallego
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Complutense University (UCM), Madrid, Spain
| | - Sara Llamas
- Clinical Research Unit (Imas12- CIBERESP), University Hospital "12 de Octubre", Madrid, Spain
| | - Alberto Villarejo Galende
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | - Julián Benito-León
- Ciberned, Carlos III Research Institute, Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
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Zhang H, Zhang XN, Zhang HL, Huang L, Chi QQ, Zhang X, Yun XP. Differences in cognitive profiles between traumatic brain injury and stroke: A comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination. Chin J Traumatol 2016; 19:271-274. [PMID: 27780506 PMCID: PMC5068208 DOI: 10.1016/j.cjtee.2015.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To investigate the profiles of cognitive impairment through Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in patients with chronic traumatic brain injury (TBI) or stroke and to evaluate the sensitivity of the two scales in patients with TBI. METHODS In this cohort study, a total of 230 patients were evaluated, including TBI group (n = 103) and stroke group (n = 127). The cognitive functions of two groups were evaluated by designated specialists using MoCA (Beijing version) and MMSE (Chinese version). RESULTS Comparedwith the patientswith stroke, the patientswith TBI received significantly lower score in orientation subtest and recall subtest in both tests.MoCA abnormal rates in the TBI group and stroke group were 94.17% and 86.61% respectively,whileMMSE abnormal rateswere 69.90% and 57.48%, respectively. In the TBI group, 87.10% patientswith normalMMSE score had abnormalMoCA score and in the stroke group, about 70.37% patients with normal MMSE score had abnormal MoCA score. The diagnostic consistency of two scales in the TBI group and the stroke group were 72% and 69%, respectively. CONCLUSION In our rehabilitation center, patients with TBI may have more extensive and severe cognitive impairments than patients with stroke, prominently in orientation and recall domain. In screening post- TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.
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Affiliation(s)
- Hao Zhang
- Neurorehabilitation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China
| | - Xiao-Nian Zhang
- Neurorehabilitation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China
| | - Hui-Li Zhang
- Rehabilitation Evaluation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China
| | - Liang Huang
- Rehabilitation Department, Huabei Oil Field Huayuan Hospital, Hejian 062450, Hebei, China
| | - Qian-Qian Chi
- Neurorehabilitation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China
| | - Xin Zhang
- Neurorehabilitation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China
| | - Xiao-Ping Yun
- Rehabilitation Evaluation Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing 100068, China,Corresponding author.
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72
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Hisatsune T, Kaneko J, Kurashige H, Cao Y, Satsu H, Totsuka M, Katakura Y, Imabayashi E, Matsuda H. Effect of Anserine/Carnosine Supplementation on Verbal Episodic Memory in Elderly People. J Alzheimers Dis 2016; 50:149-59. [PMID: 26682691 PMCID: PMC4927867 DOI: 10.3233/jad-150767] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Our goal in this study was to determine whether or not anserine/carnosine supplementation (ACS) is capable of preserving cognitive function of elderly people. In a double-blind randomized controlled trial, volunteers were randomly assigned to an ACS or placebo group at a 1:1 ratio. The ACS group took 1.0 g of an anserine/carnosine (3:1) formula daily for 3 months. Participants were evaluated by psychological tests before and after the 3-month supplementation period. Thirty-nine healthy elderly volunteers (60–78 years old) completed the follow-up tests. Among the tests, delayed recall verbal memory assessed by the Wechsler Memory Scale-Logical Memory showed significant preservation in the ACS group, compared to the placebo group (p = 0.0128). Blood analysis revealed a decreased secretion of inflammatory cytokines, including CCL-2 and IL-8, in the ACS group. MRI analysis using arterial spin labeling showed a suppression in the age-related decline in brain blood flow in the posterior cingulate cortex area in the ACS group, compared to the placebo group (p = 0.0248). In another randomized controlled trial, delayed recall verbal memory showed significant preservation in the ACS group, compared to the placebo group (p = 0.0202). These results collectively suggest that ACS may preserve verbal episodic memory and brain perfusion in elderly people, although further study is needed.
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Affiliation(s)
- Tatsuhiro Hisatsune
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Jun Kaneko
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Hiroki Kurashige
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Yuan Cao
- Department of Applied Biochemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Kashiwa, Japan
| | - Hideo Satsu
- Department of Applied Biochemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Kashiwa, Japan
| | - Mamoru Totsuka
- Department of Applied Biochemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Kashiwa, Japan
| | - Yoshinori Katakura
- Graduate School of Systems Life Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Etsuko Imabayashi
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Tokyo, Japan
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73
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Dong Y, Kua ZJ, Khoo EYH, Koo EH, Merchant RA. The Utility of Brief Cognitive Tests for Patients With Type 2 Diabetes Mellitus: A Systematic Review. J Am Med Dir Assoc 2016; 17:889-95. [PMID: 27461866 DOI: 10.1016/j.jamda.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/05/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with an increased risk for mild cognitive impairment and dementia in both middle-aged and older individuals. Brief cognitive tests can potentially serve as a reliable and cost effective approach to detect for cognitive decrements in clinical practice. OBJECTIVE This systematic review examined the utility of brief cognitive tests in studies with patients with T2DM. METHOD This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. "PubMed," "PsychINFO," "ScienceDirect," and "ProQuest" electronic databases were searched to identify articles published from January 1, 2005 to December 31, 2015. RESULTS The search yielded 22 studies, with only 8 using brief tests as a cognitive screening tool, whereas the majority using these tests as a measure of global cognitive functions. In regard to cognitive screening studies, most had failed to fulfil the standard reporting of diagnostic test accuracy criteria such as Standards for Reporting of Diagnostic Accuracy for dementia and cognitive impairment. Moreover, few studies reported discriminant indices such as sensitivity, specificity, and positive and negative predictive values of brief cognitive tests in detecting cognitive impairment in patients with T2DM. Among studies which used brief cognitive tests as a measure of global cognitive function, patients with diabetes tended to perform worse than patients without diabetes. Processing speed appeared to be particularly impaired among patients with diabetes, therefore, measures of processing speed such as the Digit Symbol Substitution Test may add value to brief cognitive tests such as the Montreal Cognitive Assessment. CONCLUSIONS The Montreal Cognitive Assessment supplemented by the Digit Symbol Substitution Test indicate initial promise in screening for cognitive impairment in T2DM.
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Affiliation(s)
- YanHong Dong
- Department of Pharmacology, National University of Singapore, Singapore; Center for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Center-Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhong Jie Kua
- Department of Medicine, National University Hospital, Singapore; School of Psychology, University of Queensland, Brisbane, Australia
| | - Eric Yin Hao Khoo
- Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edward H Koo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kaya D, Isik AT, Usarel C, Soysal P, Ellidokuz H, Grossberg GT. The Saint Louis University Mental Status Examination Is Better than the Mini-Mental State Examination to Determine the Cognitive Impairment in Turkish Elderly People. J Am Med Dir Assoc 2016; 17:370.e11-5. [DOI: 10.1016/j.jamda.2015.12.093] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
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75
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Mini Mental State Examination and Logical Memory scores for entry into Alzheimer's disease trials. ALZHEIMERS RESEARCH & THERAPY 2016; 8:9. [PMID: 26899835 PMCID: PMC4762168 DOI: 10.1186/s13195-016-0176-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022]
Abstract
Background Specific cutoff scores on the Mini Mental State Examination (MMSE) and the Logical Memory (LM) test are used to determine inclusion in Alzheimer’s disease (AD) clinical trials and diagnostic studies. These screening measures have known psychometric limitations, but no study has examined the diagnostic accuracy of the cutoff scores used to determine entry into AD clinical trials and diagnostic studies. Methods ClinicalTrials.gov entries were reviewed for phases II and III active and recruiting AD studies using the MMSE and LM for inclusion. The diagnostic accuracy of MMSE and LM-II cutoffs used in AD trials and diagnostic studies was examined using 23,438 subjects with normal cognition, mild cognitive impairment (MCI), and AD dementia derived from the National Alzheimer’s Coordinating Center database. Results MMSE and LM cutoffs used in current AD clinical trials and diagnostic studies had limited diagnostic accuracy, particularly for distinguishing between normal cognition and MCI, and MCI from AD dementia. The MMSE poorly discriminated dementia stage. Conclusions The MMSE and LM may result in inappropriate subject enrollment in large-scale, multicenter studies designed to develop therapeutics and diagnostic methods for AD.
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76
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Howland M, Tatsuoka C, Smyth KA, Sajatovic M. Detecting Change over Time: A Comparison of the SLUMS Examination and the MMSE in Older Adults at Risk for Cognitive Decline. CNS Neurosci Ther 2016; 22:413-9. [PMID: 26861416 DOI: 10.1111/cns.12515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 01/23/2023] Open
Abstract
AIMS To directly compare the 1-year stability of Mini-Mental State Examination (MMSE) score and Saint Louis University Mental Status (SLUMS) examination score and correlate score changes with demographic variables, clinical factors, and functional domains. METHODS A sample of 304 study participants was recruited from residential and clinical settings in Ohio. Follow-up assessments were administered after 1 year with a retention rate of 92% (n = 281). Functional domains included the Instrumental Activities of Daily Living (IADL) scale. RESULTS MMSE and SLUMS scores correlated with each other (r = 0.65, P < 0.001) and with two functional measures, including the IADL (r = 0.27, r = 0.24, P < 0.001). However, the MMSE and SLUMS frequently placed the same subject into different categories. Rates of reversion and conversion varied between the two tests. The 1-year changes in MMSE raw score correlated with changes in three functional domains as well as age (P < 0.05), while SLUMS raw score changes did not correlate with any functional measures. CONCLUSION Our large, longitudinal data set allowed us to compare the tests' stability, which differed between the SLUMS and MMSE. The MMSE may be more sensitive than the SLUMS to 1-year cognitive changes influencing functional abilities.
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Affiliation(s)
- Molly Howland
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kathleen A Smyth
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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77
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Lister JJ, Harrison Bush AL, Andel R, Matthews C, Morgan D, Edwards JD. Cortical auditory evoked responses of older adults with and without probable mild cognitive impairment. Clin Neurophysiol 2016; 127:1279-1287. [DOI: 10.1016/j.clinph.2015.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 02/01/2023]
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78
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Ruano L, Sousa A, Severo M, Alves I, Colunas M, Barreto R, Mateus C, Moreira S, Conde E, Bento V, Lunet N, Pais J, Tedim Cruz V. Development of a self-administered web-based test for longitudinal cognitive assessment. Sci Rep 2016; 6:19114. [PMID: 26743329 PMCID: PMC4705487 DOI: 10.1038/srep19114] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Sequential testing with brief cognitive tools has been recommended to improve cognitive screening and monitoring, however the few available tools still depend on an external evaluator and periodic visits. We developed a self-administered computerized test intended for longitudinal cognitive testing (Brain on Track). The test can be performed from a home computer and is composed of several subtests, expected to evaluate different cognitive domains, all including random elements to minimize learning effects. An initial (A) and a refined version of the test (B) were applied to patients with mild cognitive impairment or early dementia (n = 88) and age and education-matched controls. A subsample of a population-based cohort (n = 113) performed the test at home every three months to evaluate test-retest reliability. The test’s final version Cronbach’s alpha was 0.90, test scores were significantly different between patients and controls (p = 0.001), the area under the receiver operating characteristic curve was 0.75 and the smallest real difference (43.04) was lower than the clinical relevant difference (56.82). In the test-retest reliability analysis 9/10 subtests showed two-way mixed single intraclass consistency correlation coefficient >0.70. These results imply good internal consistency, discriminative ability and reliability when performed at home, encouraging further longitudinal clinical and population-based studies.
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Affiliation(s)
- Luis Ruano
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, 4200-319 Porto, Portugal.,EPIUnit - Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
| | - Andreia Sousa
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, 4200-319 Porto, Portugal.,EPIUnit - Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
| | - Ivânia Alves
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Márcio Colunas
- Clinical Research Office, Health Sciences Department, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Rui Barreto
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Cátia Mateus
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Sandra Moreira
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Eduardo Conde
- Clinical Research Office, Health Sciences Department, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Virgílio Bento
- University Institute of Maia - ISMAI, 4475-690, Maia, Portugal
| | - Nuno Lunet
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, 4200-319 Porto, Portugal.,EPIUnit - Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
| | - Joana Pais
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal.,EPIUnit - Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
| | - Vítor Tedim Cruz
- Department of Neurology, São Sebastião Hospital, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal.,EPIUnit - Institute of Public Health, University of Porto, 4050-600, Porto, Portugal.,Clinical Research Office, Health Sciences Department, University of Aveiro, 3810-193, Aveiro, Portugal
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Burrell JR, Piguet O. Lifting the veil: how to use clinical neuropsychology to assess dementia. J Neurol Neurosurg Psychiatry 2015; 86:1216-24. [PMID: 25814493 DOI: 10.1136/jnnp-2013-307483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/24/2015] [Indexed: 11/04/2022]
Abstract
Neurologists often struggle to interpret the results of neuropsychological testing, even though cognitive assessments are an integral component of the diagnostic process in dementia syndromes. This article reviews the principles underlying clinical neuropsychology, background on common neuropsychological tests, and tips on how to interpret the results when assessing patients with dementia. General cognitive screening tools, appropriate for use by general neurologists and psychiatrists, as well as specific cognitive tests examining the main cognitive domains (attention and orientation, memory, visuospatial function, language and executive function) in patients with dementia are considered. Finally, the pattern of deficits, helpful in defining clinical dementia phenotypes and sometimes in predicting the underlying molecular pathology, are outlined. Such clinicopathological associations will become invaluable as disease-modifying treatments for dementia are developed and implemented.
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Affiliation(s)
- James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, New South Wales, Australia University of New South Wales, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
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80
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Apostolo J, Holland C, O'Connell MDL, Feeney J, Tabares-Seisdedos R, Tadros G, Campos E, Santos N, Robertson DA, Marcucci M, Varela-Nieto I, Crespo-Facorro B, Vieta E, Navarro-Pardo E, Selva-Vera G, Balanzá-Martínez V, Cano A. Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA). Maturitas 2015; 83:83-93. [PMID: 26520249 DOI: 10.1016/j.maturitas.2015.10.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. AIM To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. METHODS Literature review and consensus of expert opinion. RESULTS AND CONCLUSION MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.
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Affiliation(s)
- Joao Apostolo
- Portugal Centre for Evidence Based Practice, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Portugal.
| | - Carol Holland
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK.
| | | | - Joanne Feeney
- Centre for Public Health, Queen's University Belfast, United Kingdom.
| | - Rafael Tabares-Seisdedos
- Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain.
| | - George Tadros
- Birmingham & Solihull Mental Health Foundation Trust, Old Age Psychiatry, Queen Elizabeth Psychiatric Hospital, Birmingham, UK.
| | - Elzbieta Campos
- Portugal Centre for Evidence Based Practice, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Portugal.
| | - Nadine Santos
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| | | | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Isabel Varela-Nieto
- Institute for Biomedical Research, CSIC-UAM and IdiPAZ-CIBERER, Madrid 28029, Spain.
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University of Cantabria, Marqués de Valdecilla Hospital, Santander, Spain; IDIVAL, Santander, Spain; CIBERSAM, Madrid, Spain.
| | - Eduard Vieta
- Barcelona Bipolar Disorders Programme, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain.
| | | | - Gabriel Selva-Vera
- Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain.
| | - Vicent Balanzá-Martínez
- Department of Medicine, La Fe University and Polytechnic Hospital, CIBERSAM, University of Valencia, Valencia, Spain.
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain; Service of Obstetrics and Gynecology, INCLIVA, Valencia, Spain.
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Trzepacz PT, Hochstetler H, Wang S, Walker B, Saykin AJ. Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatr 2015; 15:107. [PMID: 26346644 PMCID: PMC4562190 DOI: 10.1186/s12877-015-0103-3] [Citation(s) in RCA: 375] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 08/04/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores. METHODS For this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer's disease (AD) dementia cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases. RESULTS Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥ 17 on MoCA (96.3%) and ≥ 24 on MMSE (98.3%). The ceiling effect (28-30 points) for MCI and HC was less using MoCA (18.1%) versus MMSE (71.4%). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3%) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC. CONCLUSIONS MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. A cutoff of ≥ 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, ≥ 18 or 19 could be used. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.
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Affiliation(s)
| | - Helen Hochstetler
- Eli Lilly and Company or one of its subsidiaries, Lilly Corporate Center, Indianapolis, IN, USA.
| | - Shufang Wang
- Eli Lilly and Company or one of its subsidiaries, Lilly Corporate Center, Indianapolis, IN, USA.
| | - Brett Walker
- University College of London, Gower Street, London, UK.
| | - Andrew J Saykin
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Innate Immune Signalling Genetics of Pain, Cognitive Dysfunction and Sickness Symptoms in Cancer Pain Patients Treated with Transdermal Fentanyl. PLoS One 2015; 10:e0137179. [PMID: 26332828 PMCID: PMC4557995 DOI: 10.1371/journal.pone.0137179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/14/2015] [Indexed: 01/23/2023] Open
Abstract
Common adverse symptoms of cancer and chemotherapy are a major health burden; chief among these is pain, with opioids including transdermal fentanyl the mainstay of treatment. Innate immune activation has been implicated generally in pain, opioid analgesia, cognitive dysfunction, and sickness type symptoms reported by cancer patients. We aimed to determine if genetic polymorphisms in neuroimmune activation pathways alter the serum fentanyl concentration-response relationships for pain control, cognitive dysfunction, and other adverse symptoms, in cancer pain patients. Cancer pain patients (468) receiving transdermal fentanyl were genotyped for 31 single nucleotide polymorphisms in 19 genes: CASP1, BDNF, CRP, LY96, IL6, IL1B, TGFB1, TNF, IL10, IL2, TLR2, TLR4, MYD88, IL6R, OPRM1, ARRB2, COMT, STAT6 and ABCB1. Lasso and backward stepwise generalised linear regression were used to identify non-genetic and genetic predictors, respectively, of pain control (average Brief Pain Inventory < 4), cognitive dysfunction (Mini-Mental State Examination ≤ 23), sickness response and opioid adverse event complaint. Serum fentanyl concentrations did not predict between-patient variability in these outcomes, nor did genetic factors predict pain control, sickness response or opioid adverse event complaint. Carriers of the MYD88 rs6853 variant were half as likely to have cognitive dysfunction (11/111) than wild-type patients (69/325), with a relative risk of 0.45 (95% CI: 0.27 to 0.76) when accounting for major non-genetic predictors (age, Karnofsky functional score). This supports the involvement of innate immune signalling in cognitive dysfunction, and identifies MyD88 signalling pathways as a potential focus for predicting and reducing the burden of cognitive dysfunction in cancer pain patients.
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83
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Malmstrom TK, Voss VB, Cruz-Oliver DM, Cummings-Vaughn LA, Tumosa N, Grossberg GT, Morley JE. The Rapid Cognitive Screen (RCS): A Point-of-Care Screening for Dementia and Mild Cognitive Impairment. J Nutr Health Aging 2015; 19:741-4. [PMID: 26193857 DOI: 10.1007/s12603-015-0564-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES There is a need for a rapid screening test for mild cognitive impairment (MCI) and dementia to be used by primary care physicians. The Rapid Cognitive Screen (RCS) is a brief screening tool (< 3 min) for cognitive dysfunction. RCS includes 3-items from the Veterans Affairs Saint Louis University Mental Status (SLUMS) exam: recall, clock drawing, and insight. Study objectives were to: 1) examine the RCS sensitivity and specificity for MCI and dementia, 2) evaluate the RCS predictive validity for nursing home placement and mortality, and 3) compare the RCS to the clock drawing test (CDT) plus recall. METHODS Patients were recruited from the St. Louis, MO Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center (VAMC) hospitals (study 1) or the Saint Louis University Geriatric Medicine and Psychiatry outpatient clinics (study 2). Study 1 participants (N=702; ages 65-92) completed cognitive evaluations and 76% (n=533/706) were followed up to 7.5 years for nursing home placement and mortality. Receiver operator characteristic (ROC) curves were computed to determine sensitivity and specificity for MCI (n=180) and dementia (n=82). Logistic regressions were computed for nursing home placement (n=31) and mortality (n=176). Study 2 participants (N=168; ages 60-90) completed the RCS and SLUMS exam. ROC curves were computed to determine sensitivity and specificity for MCI (n=61) and dementia (n=74). RESULTS RCS predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 5 for dementia (sensitivity=0.89, specificity=0.94) and ≤ 7 for MCI (sensitivity=0.87, specificity=0.70). The CDT plus recall predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 2 for dementia (sensitivity=0.87, specificity=0.85) and ≤ 3 for MCI (sensitivity=0.62, specificity=0.62). Higher RCS scores were protective against nursing home placement and mortality. The RCS predicted dementia and MCI in study 2. CONCLUSIONS The 3-item RCS exhibits good sensitivity and specificity for the detection of MCI and dementia, and higher cognitive function on the RCS is protective against nursing home placement and mortality. The RCS may be a useful screening instrument for the detection of cognitive dysfunction in the primary care setting.
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Affiliation(s)
- T K Malmstrom
- Theodore K. Malmstrom, PhD, Department of Neurology and Psychiatry, School of Medicine, Saint Louis University, 1438 South Grand Boulevard, St. Louis, Missouri 63104, ; Phone: 314-977-4814; Fax: 314-977-4879
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Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients. Alzheimer Dis Assoc Disord 2015; 28:311-9. [PMID: 24614274 DOI: 10.1097/wad.0000000000000036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate. Patients with a diagnosis or previous work-up for dementia were excluded. Primary care physicians indicated whether they, the patient, or family had concerns about each patient's cognition. A total of 130 patients with cognitive concerns and a matched sample of 133 without cognitive concerns were enrolled. The CAMCI was individually administered after instructions to work independently. Comments were recorded verbatim. A total of 259 (98.5%) completed the entire CAMCI. Two hundred and forty-one (91.6%) completed it without any questions or after simple acknowledgment of their question. Lack of computer experience was the only patient characteristic that decreased the odds of independent CAMCI completion. These results support the feasibility of using self-administered computerized cognitive tests with older primary care patients, given the increasing reliance on computers by people of all ages. The optimal cut-off score had a sensitivity of 80% and specificity of 74%.
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85
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Hilsabeck RC, Holdnack JA, Cullum CM, Drozdick LW, Edelstein B, Fiske A, Lacritz L, McCoy KJM, Wahlstrom D. The Brief Cognitive Status Examination (BCSE): Comparing Diagnostic Utility and Equating Scores to the Mini-Mental State Examination (MMSE). Arch Clin Neuropsychol 2015; 30:458-67. [PMID: 26085478 DOI: 10.1093/arclin/acv037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
The study purpose was to compare the diagnostic utility of the Brief Cognitive Status Exam (BCSE) to that of the Mini-Mental State Examination (MMSE) and to develop equated scores to facilitate comparisons. One hundred and eighty-two patients underwent cognitive evaluation and were placed into three groups: dementia (DEM), cognitive impairment, no dementia (CIND), and no cognitive impairment (NCI). One hundred and eighty-two healthy controls from the BCSE standardization sample served as a comparison group. On both measures, the DEM group obtained significantly lower scores than the other two groups, and the CIND group scored significantly lower than the NCI group. The BCSE was more sensitive in all clinical groups, although at extremely low scores, the two tests displayed similar sensitivity. Results indicate the BCSE has diagnostic utility as a cognitive screening measure in a mixed clinical sample and is more sensitive at detecting cognitive impairment, particularly milder levels, than the MMSE.
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Affiliation(s)
- Robin C Hilsabeck
- Psychology Service at South Texas Veterans Health Care System and Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - C Munro Cullum
- Departments of Psychiatry and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Barry Edelstein
- Psychology Department, West Virginia University, Morgantown, WV, USA
| | - Amy Fiske
- Psychology Department, West Virginia University, Morgantown, WV, USA
| | - Laura Lacritz
- Departments of Psychiatry and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karin J M McCoy
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
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86
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Freitas S, Prieto G, Simões MR, Santana I. Scaling Cognitive Domains of the Montreal Cognitive Assessment: An Analysis Using the Partial Credit Model. Arch Clin Neuropsychol 2015; 30:435-47. [PMID: 25944337 DOI: 10.1093/arclin/acv027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/13/2022] Open
Abstract
The psychometric properties of the Montreal Cognitive Assessment (MoCA) were examined by using the Partial Credit Model. The study sample included 897 participants who were distributed into two main subgroups: (I) the clinical group (90 patients with Mild Cognitive Impairment, 90 patients with Alzheimer's disease, 33 patients with Frontotemporal Dementia, and 34 patients with Vascular dementia, whose diagnoses were previously established according to a consensus that was reached by a multidisciplinary team, based on the international criteria) and (II) the healthy group (composed of 650 cognitively healthy community dwellers). The results show (i) an overall good fit for both the items and the persons' values, (ii) high variability for the cognitive performance level of the cognitive domains (ranging between 1.90 and -3.35, where "Short-term Memory" was the most difficult item and "Spatial Orientation" was the easiest item) and between the subjects on the scale, (iii) high reliability for the estimation of the persons' values, (iv) good discriminant validity and high diagnostic utility, and (v) a minimal differential item functioning effect related to of pathology, gender, age, and educational level. MoCA and its cognitive domains are suitable measures to use for screening the cognitive status of cognitively healthy subjects and patients with cognitive impairment.
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Affiliation(s)
- Sandra Freitas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal Psychological Assessment Lab., Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Gerardo Prieto
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Salamanca, Spain
| | - Mário R Simões
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal Psychological Assessment Lab., Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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An investigation of the efficiency of the mini-Kingston standardized cognitive assessment-revised in classifying patients according to DSM-5 major and mild neurocognitive disorders due to possible Alzheimer's disease. Int Psychogeriatr 2015; 27:785-91. [PMID: 25597552 DOI: 10.1017/s1041610214002919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to examine the efficiency of the mini-Kingston standardized cognitive assessment-revised (mini-KSCAr) in classifying patients according to DSM-5 major and mild neurocognitive disorders (NCD) due to possible Alzheimer's disease (AD). METHODS Files of 85 individuals who were tested on the Kingston standardized cognitive assessment-revised were reviewed and scores were calculated for the mini-KSCAr. Medical history, psychiatric and physical status, basic and instrumental activities of daily living, as well as scores on the Cambridge cognitive examination-revised (CAMCOG-R), and the clinical dementia rating (CDR) scale were used to establish DSM-5 diagnoses of major or mild neurocognitive disorders (NCD) due to possible AD or no cognitive decline. All participants were tested on the Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), and a subset (N = 28) were also tested on three well-known memory tasks. RESULTS Scores on the MMSE, CDT, and mini-KSCAr differed across groups, but only the mini-KSCAr significantly distinguished each group from the other two. The mini-KSCAr showed better sensitivity, specificity, and likelihood ratios (LRs) than did the MMSE and the CDT. A regression analysis revealed that the mini-KSCAr accounted for almost half of the variance in memory performance, whereas the MMSE and the CDT contributed nothing to this prediction once the mini-KSCAr was used. CONCLUSIONS The mini-KSCAr is an efficient instrument for the diagnosis of DSM-5 major and mild NCD due to possible AD in a specialized psychogeriatric setting, and its utility is greater than that of the MMSE and the CDT.
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Moro V, Condoleo MT, Valbusa V, Broggio E, Moretto G, Gambina G. Cognitive stimulation of executive functions in mild cognitive impairment: specific efficacy and impact in memory. Am J Alzheimers Dis Other Demen 2015; 30:153-64. [PMID: 24963080 PMCID: PMC10852843 DOI: 10.1177/1533317514539542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Executive functions play an important role in the maintenance of autonomy in day-to-day activities. Nevertheless, there is little research into specific cognitive training for Mild Cognitive Impairment (MCI). We present the results of a program which aims to teach specific strategies and metacognitive abilities in order for patients to be able to carry out attentional and executive tasks. Two groups (A and B) were compared in a cross-over design. After the first evaluation, Group A (but not B) participated in a six month cognitive stimulation program. After a second assessment, only Group B received treatment and then a final evaluation was carried out on both groups. The results show that: i) both groups improved their performance as an effect of training; ii) improvements generalized to memory and general cognitive tasks; iii) in the interval without training, Group B's performance worsened and iv) Group A partially maintained their results over time.
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Affiliation(s)
- V Moro
- NPSY.Lab-Vr, Department of Philosophy, Pedagogy and Psychology, University of Verona, Verona, Italy
| | - M T Condoleo
- NPSY.Lab-Vr, Department of Philosophy, Pedagogy and Psychology, University of Verona, Verona, Italy USO Centro Alzheimer e Disturbi Cognitivi, Neurologia d.O, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - V Valbusa
- NPSY.Lab-Vr, Department of Philosophy, Pedagogy and Psychology, University of Verona, Verona, Italy USO Centro Alzheimer e Disturbi Cognitivi, Neurologia d.O, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - E Broggio
- NPSY.Lab-Vr, Department of Philosophy, Pedagogy and Psychology, University of Verona, Verona, Italy USO Centro Alzheimer e Disturbi Cognitivi, Neurologia d.O, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - G Moretto
- USO Centro Alzheimer e Disturbi Cognitivi, Neurologia d.O, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - G Gambina
- USO Centro Alzheimer e Disturbi Cognitivi, Neurologia d.O, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Fang R, Wang G, Huang Y, Zhuang JP, Tang HD, Wang Y, Deng YL, Xu W, Chen SD, Ren RJ. Validation of the Chinese version of Addenbrooke's cognitive examination-revised for screening mild Alzheimer's disease and mild cognitive impairment. Dement Geriatr Cogn Disord 2014; 37:223-31. [PMID: 24193223 DOI: 10.1159/000353541] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS As a suitable test to screen for Alzheimer's disease (AD) or mild cognitive impairment (MCI), studies to validate the Chinese version of Addenbrooke's Cognitive Examination-Revised (ACE-R) are rare. METHODS A total of 151 subjects were recruited and the neuropsychological assessments were employed. One-way analysis of variance and Bonferroni correction were used to compare scores of different psychometric scales. Intraclass correlation coefficient (ICC) and Cronbach's coefficient α were used to evaluate the reliability of psychometric scales. The validity of ACE-R to screen for mild AD and amnestic subtype of MCI (a-MCI) was assessed by receiver operating characteristic (ROC) curves. RESULTS The Chinese ACE-R had good reliability (inter-rater ICC = 0.994; test-retest ICC = 0.967) as well as reliable internal consistency (Cronbach's coefficient α = 0.859). With its cutoff of 67/68, the sensitivity (0.920) and specificity (0.857) were lower than for the Mini-Mental State Examination (MMSE) cutoff (sensitivity 1.000 and specificity 0.937) to screen for mild AD. However, the sensitivity of ACE-R to screen for a-MCI was superior to the MMSE with a cutoff of 85/86. The specificity of ACE-R was lower than that of the MMSE to screen for a-MCI. The area under the ROC curve of ACE-R was much larger than that of the MMSE (0.836 and 0.751) for detecting a-MCI rather than mild AD. CONCLUSION The Chinese ACE-R is a reliable assessment tool for cognitive impairment. It is more sensitive and accurate in screening for a-MCI rather than for AD compared to the MMSE.
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Affiliation(s)
- Rong Fang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Altered spontaneous activity in the default-mode network and cognitive decline in chronic subcortical stroke. J Neurol Sci 2014; 347:193-8. [DOI: 10.1016/j.jns.2014.08.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/09/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022]
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Solomon TM, deBros GB, Budson AE, Mirkovic N, Murphy CA, Solomon PR. Correlational analysis of 5 commonly used measures of cognitive functioning and mental status: an update. Am J Alzheimers Dis Other Demen 2014; 29:718-22. [PMID: 24829061 PMCID: PMC10852956 DOI: 10.1177/1533317514534761] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
There are numerous measures for detecting the presence of dementia and quantifying its severity and progression. We analyzed the relations between scores on 5 commonly used measures (Mini-Mental State Examination, Montreal Cognitive Assessment, Alzheimer's Disease Assessment Scale-Cognitive Subscale, Activities of Daily Living Scale, and Global Deterioration Scale) of 101 successive admissions to a memory clinic. Patients were included in the analysis only if they received a diagnosis of mild cognitive impairment (MCI) due to Alzheimer's disease (AD) pathophysiological process or probable AD and if they received all measures. Regression analysis yielded 20 linear equations that allow for conversion between test scores on any 2 measures. Further, participants were grouped by MMSE scores with regard to level of disease severity, allowing for the creation of a quick reference table for estimating an approximate score range between measures. Results from this study provide a useful tool for clinicians when comparing between multiple different instruments that measure the mental status and functional ability of individuals with AD and MCI due to AD pathology.
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Affiliation(s)
- Todd M Solomon
- The Memory Clinic, Bennington, VT, USA Boston University Alzheimer's Disease Center, Boston, MA, USA
| | | | - Andrew E Budson
- Boston University Alzheimer's Disease Center, Boston, MA, USA
| | | | | | - Paul R Solomon
- The Memory Clinic, Bennington, VT, USA Williams College Department of Psychology, Williamstown, MA, USA
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Alten F, Motte J, Ewering C, Osada N, Clemens CR, Kadas EM, Eter N, Paul F, Marziniak M. Multimodal retinal vessel analysis in CADASIL patients. PLoS One 2014; 9:e112311. [PMID: 25372785 PMCID: PMC4221286 DOI: 10.1371/journal.pone.0112311] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/06/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To further elucidate retinal findings and retinal vessel changes in Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients by means of high resolution retinal imaging. METHODS 28 eyes of fourteen CADASIL patients and an equal number of control subjects underwent confocal scanning laser ophthalmoscopy (cSLO), spectral-domain optical coherence tomography (SD-OCT), retinal nerve fibre layer (RNFL) measurements, fluorescein and indocyanine angiography. Three vessel measurement techniques were applied: RNFL thickness, a semiautomatic software tool based on cSLO images and manual vessel outlining based on SD-OCT. RESULTS Mean age of patients was 56.2 ± 11.6 years. Arteriovenous nicking was present in 22 (78.6%) eyes and venous dilation in 24 (85.7%) eyes. Retinal volume and choroidal volume were 8.77 ± 0.46 mm(3) and 8.83 ± 2.24 mm(3). RNFL measurements showed a global increase of 105.2 µm ( CONTROL GROUP 98.4 µm; p = 0.015). Based on semi-automatic cSLO measurements, maximum diameters of arteries and veins were 102.5 µm (106.0 µm; p = 0.21) and 128.6 µm (124.4 µm; p = 0.27) respectively. Manual SD-OCT measurements revealed significantly increased mean arterial 138.7 µm (125.4 µm; p<0.001) and venous 160.0 µm (146.9; p = 0.003) outer diameters as well as mean arterial 27.4 µm (19.2 µm; p<0.001) and venous 18.3 µm (15.7 µm; p<0.001) wall thicknesses in CADASIL patients. CONCLUSIONS The findings reflect current knowledge on pathophysiologic changes in vessel morphology in CADASIL patients. SD-OCT may serve as a complementary tool to diagnose and follow-up patients suffering from cerebral small-vessel diseases.
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Affiliation(s)
- Florian Alten
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
- * E-mail:
| | - Jeremias Motte
- Department of Neurology, University of Muenster Medical Center, Muenster, Germany
| | - Carina Ewering
- Department of Neurology, University of Muenster Medical Center, Muenster, Germany
| | - Nani Osada
- Department of Medical Informatics and Biomathematics, University of Muenster, Muenster, Germany
| | - Christoph R. Clemens
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Ella M. Kadas
- Department of Neurology, Charite University Medicine Berlin, Berlin, German
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Friedemann Paul
- Department of Neurology, Charite University Medicine Berlin, Berlin, German
- NeuroCure Clinical Research Center, Berlin, Germany
| | - Martin Marziniak
- Department of Neurology, University of Muenster Medical Center, Muenster, Germany
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Arevalo-Rodriguez I, Segura O, Solà I, Bonfill X, Sanchez E, Alonso-Coello P. Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews. BMC Neurol 2014; 14:183. [PMID: 25248284 PMCID: PMC4189736 DOI: 10.1186/s12883-014-0183-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/11/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dementia includes a group of neurodegenerative disorders characterized by progressive loss of cognitive function and a decrease in the ability to perform activities of daily living. Systematic reviews of diagnostic test accuracy (DTA) focus on how well the index test detects patients with the disease in terms of figures such as sensitivity and specificity. Although DTA reviews about dementia are essential, at present there is no information about their quantity and quality. METHODS We searched for DTA reviews in MEDLINE (1966-2013), EMBASE (1980-2013), The Cochrane Library (from its inception until December 2013) and the Database of Abstracts of Reviews of Effects (DARE). Two reviewers independently assessed the methodological quality of the reviews using the AMSTAR measurement tool, and the quality of the reporting using the PRISMA checklist. We describe the main characteristics of these reviews, including basic characteristics, type of dementia, and diagnostic test evaluated, and we summarize the AMSTAR and PRISMA scores. RESULTS We selected 24 DTA systematic reviews. Only 10 reviews (41.6%), assessed the bias of included studies and few (33%) used this information to report the review results or to develop their conclusions Only one review (4%) reported all methodological items suggested by the PRISMA tool. Assessing methodology quality by means of the AMSTAR tool, we found that six DTA reviews (25%) pooled primary data with the aid of methods that are used for intervention reviews, such as Mantel-Haenszel and separate random-effects models (25%), while five reviews (20.8%) assessed publication bias by means of funnel plots and/or Egger's Test. CONCLUSIONS Our assessment of these DTA reviews reveals that their quality, both in terms of methodology and reporting, is far from optimal. Assessing the quality of diagnostic evidence is fundamental to determining the validity of the operating characteristics of the index test and its usefulness in specific settings. The development of high quality DTA systematic reviews about dementia continues to be a challenge.
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Abstract
Although mild cognitive impairment (MCI) is a widely accepted construct both clinically and in the research literature, it remains a heterogeneous condition that varies in presentation and prognosis. This article first reviews the evolution of the diagnosis of MCI, followed by examination of pros and cons of cognitive assessments commonly used to assess for MCI. Emotional changes commonly seen in MCI are also reviewed. Finally, the relation between cognitive and emotional dysfunction is examined, including a discussion of specific psychological symptoms seen in subtypes of MCI, and how the presence of neuropsychiatric symptoms may affect the risk for progression to dementia.
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Affiliation(s)
- Suzanne Penna
- Atlanta Veteran's Affairs Medical Center, 1670 Clairmont Road, Atlanta, GA 30033, USA; Department of Rehabilitation Medicine, Emory University School of Medicine, Center for Rehabilitation Medicine, 1441 Clifton Road NE, Suite 150, Atlanta, GA 30022, USA.
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Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial. Med Gas Res 2014; 4:6. [PMID: 24666542 PMCID: PMC3976084 DOI: 10.1186/2045-9912-4-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022] Open
Abstract
As life expectancy increases, more patients ≥65 years undergo general anesthesia. Anesthetic agents may contribute to postoperative cognitive dysfunction, and incidence may differ with anesthetic agents or intraoperative anesthesia depth. Responses to anesthetic adjuvants vary among elderly patients. Processed electroencephalography guidance of anesthetic may better ensure equivalent cerebral suppression. This study investigates postoperative cognitive dysfunction differences in elderly patients given desflurane or sevoflurane using processed electroencephalography guidance. IRB approved, randomized trial enrolled consenting patients ≥65 years scheduled for elective surgery requiring general anesthesia ≥120 minute duration. After written informed consent, patients were randomly assigned to sevoflurane or desflurane. No perioperative benzodiazepines were administered. Cognitive impairment was measured by an investigator blinded to group assignment using mini-Mental Status Examination (MMSE) at baseline; 1, 6, and 24 hours after the end of anesthesia. Mean arterial pressure was maintained within 20% of baseline. Anesthetic dose was adjusted to maintain moderate general anesthesia per processed electroencephalograpy (Patient State Index 25 to 50). The primary outcome measure was intergroup difference in MMSE change 1 hour after anesthesia (median; 95% confidence interval). 110 patients consented; 26 were not included for analysis (no general anesthesia; withdrew consent; baseline MMSE abnormality; inability to perform postoperative MMSE; data capture failure); 47 sevoflurane and 37 desflurane were analyzed. There were no significant differences in patient characteristics; intraoperative mean blood pressure (desflurane 86.4; 81.3 to 89.6 versus sevoflurane 82.5; 80.2 to 86.1 mmHg; p = 0.42) or Patient State Index (desflurane 41.9; 39.0 to 44.0 versus sevoflurane 41.0; 37.5 to 44.0; p = 0.60) despite a lower MAC fraction in desflurane (0.82; 0.77 to 0.86) versus sevoflurane (0.96; 0.91 to 1.03; p < 0.001). MMSE decreased 1 hour after anesthesia (p < 0.001). The decrease at one hour was larger in sevoflurane (−2.5; −3.3 to −1.8) than desflurane (−1.3; −2.2 to −0.5; p = 0.03). MMSE returned to baseline by 6 hours after anesthesia.
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Can smartphones enhance telephone-based cognitive assessment (TBCA)? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:7110-25. [PMID: 24351736 PMCID: PMC3881156 DOI: 10.3390/ijerph10127110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/21/2022]
Abstract
TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can be used to enhance the applicability of TBCA, which has previously been administered by conventional telephone. This paper will first review, describe and critique the existing TBCA instruments. It will then discuss the recent developments in tele-technology, the popularity of tele-technology among the elderly, potential benefits and challenges in using smartphones for cognitive assessment, and possible future developments in this technology. In the systematic review, eighteen TBCA instruments were identified. They were found to be valid in differentiating between people with and without dementia. TBCA was previously found to be launched on a conventional telephone platform. The advances in understanding of cognitive impairment may demand that telephones be equipped with more advanced features. Recently, the development and penetration of smartphones among the elderly has been rapid. This may allow the smartphone to enhance its TBCA applicability by overcoming the limitations of the conventional telephone, rendering the TBCA more efficient in addressing the increasing demand and complexity of cognitive assessments in the future. However, more research and technology developments are needed before smartphones can become a valid platform for TBCA.
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Cespón J, Galdo-Álvarez S, Díaz F. Electrophysiological correlates of amnestic mild cognitive impairment in a simon task. PLoS One 2013; 8:e81506. [PMID: 24339941 PMCID: PMC3855269 DOI: 10.1371/journal.pone.0081506] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022] Open
Abstract
Amnestic mild cognitive impairment (aMCI) represents a prodromal stage of Alzheimer`s disease (AD), especially when additional cognitive domains are affected (Petersen et al., 2009). Thus, single-domain amnestic MCI (sdaMCI) and multiple-domain-amnestic MCI (mdaMCI) biomarkers are important for enabling early interventions to help slow down progression of the disease. Recording event-related potentials (ERPs) is a non-invasive and inexpensive measure of brain activity associated with cognitive processes, and it is of interest from a clinical point of view. The ERP technique may also be useful for obtaining early sdaMCI and mdaMCI biomarkers because ERPs are sensitive to impairment in processes that are not manifested at behavioral or clinical levels. In the present study, EEG activity was recorded in 25 healthy participants and 30 amnestic MCI patients (17 sdaMCI and 13 mdaMCI) while they performed a Simon task. The ERPs associated with visuospatial (N2 posterior-contralateral - N2pc -) and motor (lateralized readiness potential - LRP -) processes were examined. The N2pc amplitude was smaller in participants with mdaMCI than in healthy participants, which indicated a decline in the correlates of allocation of attentional resources to the target stimulus. In addition, N2pc amplitude proved to be a moderately good biomarker of mdaMCI subtype (0.77 sensitivity, 0.76 specificity). However, the LRP amplitude was smaller in the two MCI groups (sdaMCI and mdaMCI) than in healthy participants, revealing a reduction in the motor resources available to execute the response in sdaMCI and mdaMCI patients. Furthermore, the LRP amplitude proved to be a valid biomarker (0.80 sensitivity, 0.92 specificity) of both amnestic MCI subtypes.
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Affiliation(s)
- Jesús Cespón
- Department of Clinical Psychology and Biological Psychology, University of Santiago de Compostela, Santiago de Compostela, Galiza, Spain
| | - Santiago Galdo-Álvarez
- Department of Clinical Psychology and Biological Psychology, University of Santiago de Compostela, Santiago de Compostela, Galiza, Spain
| | - Fernando Díaz
- Department of Clinical Psychology and Biological Psychology, University of Santiago de Compostela, Santiago de Compostela, Galiza, Spain
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Carnero-Pardo C. Should the mini-mental state examination be retired? Neurologia 2013; 29:473-81. [PMID: 24140158 DOI: 10.1016/j.nrl.2013.07.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/30/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Short cognitive tests are routinely used in clinical practice to detect and screen for cognitive impairment and dementia. These cognitive tests should meet minimum criteria for both applicability and psychometric qualities. DEVELOPMENT The Mini-Mental State Examination (MMSE) is the most frequently applied short cognitive test, and the article introducing it remains a milestone in the history of medicine. Its main advantages are its widespread use and the extensive empirical evidence that supports it. However, the MMSE has important shortcomings, including lack of standardisation, its lack of suitability for illiterate subjects, the considerable effect of socio-educational variables on results, and its limited effectiveness for detecting cognitive impairment. Lastly, since the test is copyright-protected, using it is necessarily either costly or fraudulent. Newer available instruments do not share these shortcomings and have demonstrated greater diagnostic accuracy for detecting cognitive impairment and dementia, as well as being more cost-effective than the MMSE CONCLUSION: It is time to acknowledge the MMSE's important role in the history of medicine and grant it a deserved and honourable retirement. Its place will be taken by more effective instruments that require less time, are user-friendly and free of charge, can be applied to all individuals, and yield more equitable outcomes.
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Affiliation(s)
- C Carnero-Pardo
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España; FIDYAN Neurocenter, Granada, España.
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Gallagher R, Sullivan A, Burke R, Hales S, Gillies G, Cameron J, Saliba B, Tofler G. Mild Cognitive Impairment, Screening, and Patient Perceptions in Heart Failure Patients. J Card Fail 2013; 19:641-6. [DOI: 10.1016/j.cardfail.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/25/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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