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Kiper P, Richard M, Stefanutti F, Pierson-Poinsignon R, Cacciante L, Perin C, Mazzucchelli M, Viganò B, Meroni R. Combined Motor and Cognitive Rehabilitation: The Impact on Motor Performance in Patients with Mild Cognitive Impairment. Systematic Review and Meta-Analysis. J Pers Med 2022; 12:276. [PMID: 35207764 PMCID: PMC8874573 DOI: 10.3390/jpm12020276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
Mild cognitive impairment (MCI), a neurodegenerative disease leading to Alzheimer's disease or dementia, is often associated with physical complaints. Combined physical and cognitive training (PCT) has been investigated to see the effects on cognitive function, but its impact on motor functions and activities of daily living has not been explored yet. The combination of physical and cognitive training may be a valuable non-pharmacological intervention that could preserve motor function and quality of life (QoL). We aimed, therefore, to analyze if combined PCT is effective at improving motor performance in patients with an MCI. A systematic electronic literature search and a meta-analysis were conducted. The following criteria were compulsory for inclusion in the study: (1) randomized controlled trial design; (2) combined PCT compared to motor training alone or no intervention; (3) motor outcomes as a study's end point. Nine articles met the inclusion criteria. Results showed that PCT significantly enhances balance compared to motor training alone (SMD 0.56; 95% CI 0.07 to 1.06; I2 = 59%; 160 participants), whereas a significant improvement was found for mobility in the PCT group when compared to no intervention (MD -1.80; 95% CI -2.70 to -0.90; I2 = 0%; 81 participants). However, there is no evidence that people with MCI experience an increase in gait speed and QoL at the end of their practice sessions. Further investigation with larger samples and a longer period of monitoring after intervention should be undertaken.
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Affiliation(s)
- Pawel Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy
| | - Michelle Richard
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (M.R.); (F.S.); (R.P.-P.); (R.M.)
| | - Françoise Stefanutti
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (M.R.); (F.S.); (R.P.-P.); (R.M.)
| | - Romain Pierson-Poinsignon
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (M.R.); (F.S.); (R.P.-P.); (R.M.)
| | - Luisa Cacciante
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy;
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (C.P.); (M.M.)
- GDS Foundation, 20841 Carate Brianza, Italy;
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (C.P.); (M.M.)
- GDS Foundation, 20841 Carate Brianza, Italy;
| | | | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (M.R.); (F.S.); (R.P.-P.); (R.M.)
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., L-4671 Differdange, Luxembourg
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102
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Many Changes in Speech through Aging Are Actually a Consequence of Cognitive Changes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042137. [PMID: 35206323 PMCID: PMC8871602 DOI: 10.3390/ijerph19042137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
Background: During aging, changes in human speech may arise because of the neurophysiological deterioration associated with age, or as the result of an impairment in the cognitive processes underlying speech production. Some speech parameters show specific alterations under the presence of dementia. The objective of our study is to identify which of these parameters change because of age, cognitive state, or the interaction of both. Methods: The sample includes 400 people over 55 years old, who were divided into four groups, according to their age. The cognitive state of the participants was assessed through the MMSE test and three ranks were stablished. Gender was also considered in the analysis. Results: Certain temporal, fluency, rhythm, amplitude and voice quality parameters were found to be related to the cognitive state, while disturbance parameters changed due to age. Frequency parameters were exclusively influenced by gender. Conclusions: Understanding how speech parameters are specifically affected by age, cognitive state, or the interaction of both, is determinant to advance in the use of speech as a clinical marker for the detection of cognitive impairments.
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103
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Liu Q, Vaci N, Koychev I, Kormilitzin A, Li Z, Cipriani A, Nevado-Holgado A. Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model. BMC Med 2022; 20:45. [PMID: 35101059 PMCID: PMC8805393 DOI: 10.1186/s12916-022-02250-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Donepezil, galantamine, rivastigmine and memantine are potentially effective interventions for cognitive impairment in dementia, but the use of these drugs has not been personalised to individual patients yet. We examined whether artificial intelligence-based recommendations can identify the best treatment using routinely collected patient-level information. METHODS Six thousand eight hundred four patients aged 59-102 years with a diagnosis of dementia from two National Health Service (NHS) Foundation Trusts in the UK were used for model training/internal validation and external validation, respectively. A personalised prescription model based on the Recurrent Neural Network machine learning architecture was developed to predict the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores post-drug initiation. The drug that resulted in the smallest decline in cognitive scores between prescription and the next visit was selected as the treatment of choice. Change of cognitive scores up to 2 years after treatment initiation was compared for model evaluation. RESULTS Overall, 1343 patients with MMSE scores were identified for internal validation and 285 [21.22%] took the drug recommended. After 2 years, the reduction of mean [standard deviation] MMSE score in this group was significantly smaller than the remaining 1058 [78.78%] patients (0.60 [0.26] vs 2.80 [0.28]; P = 0.02). In the external validation cohort (N = 1772), 222 [12.53%] patients took the drug recommended and reported a smaller MMSE reduction compared to the 1550 [87.47%] patients who did not (1.01 [0.49] vs 4.23 [0.60]; P = 0.01). A similar performance gap was seen when testing the model on patients prescribed with AChEIs only. CONCLUSIONS It was possible to identify the most effective drug for the real-world treatment of cognitive impairment in dementia at an individual patient level. Routine care patients whose prescribed medications were the best fit according to the model had better cognitive performance after 2 years.
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Affiliation(s)
- Qiang Liu
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Nemanja Vaci
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrey Kormilitzin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Institute of Mathematics, University of Oxford, Oxford, UK
| | - Zhenpeng Li
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alejo Nevado-Holgado
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Akrivia Health, Oxford, UK
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104
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Abstract
This study aims to explore the effects of healthy aging and Parkinson’s disease on speech motor performance. One area of speech production which requires fine speech motor control is prominence marking. Therefore, strategies of prominence marking of three speaker groups with four speakers each were investigated: younger speakers, older speakers, and speakers with Parkinson’s disease (PD). Acoustic and articulatory data were collected. Speech data were analyzed focusing on prominence-related adjustments of vowel production and tongue body movements in the temporal and spatial domain. Longer durations, varying initiation of the tongue movements and smaller vowel sizes in older speakers and in speakers with PD were found compared to younger speakers. The data indicate further that all speaker groups mark prominence by changing relevant parameters in the vowel articulation; however, strategies seem to differ between the groups: (i) in the temporal domain, articulatory movement durations increase with age and are further prolonged in speakers with PD; (ii) in the spatial domain, the articulation space is resized by the older speakers in a non-symmetrical way, while no systematic vocalic modulations were found for speakers with PD. To conclude, the speech system seems to be affected by age and disease, but speakers develop compensatory strategies to counteract influences in the spatial domain.
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105
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Gan J, Wang XD, Shi Z, Yuan J, Zhang M, Liu S, Wang F, You Y, Jia P, Feng L, Xu J, Zhang J, Hu W, Chen Z, Ji Y. The Impact of Rotating Night Shift Work and Daytime Recharge on Cognitive Performance Among Retired Nurses. Front Aging Neurosci 2022; 13:827772. [PMID: 35145395 PMCID: PMC8821912 DOI: 10.3389/fnagi.2021.827772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe exact relationship between long-term shift work (SW) and cognitive impairment (CI) has been poorly understood. The effects of the long-term rotating night SW (RNSW) combining daytime recharge (DTR) on cognitive function were investigated.MethodsA total 920 retired nurses and 656 retired female teachers aged ≥50 years were analyzed. Participants who worked at least once per week for 8 hat night for more than 1 year were defined as the SW group, and those without a regular nighttime shift were defined as the control group. The associations among duration, frequency, and DTR of RNSW, and neuropsychological assessments were ascertained by regression models.ResultsParticipants with RNSW had a significantly higher proportion of mild CI (MCI), both amnestic MCI (aMCI) (14.4% in 11–20 years, p < 0.05, and 17.8% in > 20 years, p < 0.001) and non-amnestic MCI (naMCI) (8.1% in 11–20 years, p < 0.05), as well as dementia (1.5% in 1–10 years, and 11.7% in > 20 years, p < 0.05) compared to controls (8.4% with aMCI, 4.4% with naMCI, and 7.0% with dementia, respectively). There were significant negative relationships between general times of night SW and scores of Mini-Mental State Examination (MMSE) (R squared = 0.01, p = 0.0014) and Montreal Cognitive Assessment (MoCA) (R squared = 0.01, p = 0.0054). Participants with ≥1 h of DTR and ≥ 11 years of RNSW were about 2-fold more likely to experience MCI compared with the subjects in the control group, especially with 3–5 h (odds ratio [OR]: 2.35; 95% confidence interval: 1.49–3.68, p < 0.001).ConclusionThe long-term RNSW was associated with a higher risk of CI, especially aMCI and dementia, and the problem cannot be improved by DTR.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute, Tianjin, China
| | - Zhihong Shi
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute, Tianjin, China
| | - Junliang Yuan
- NHC Key Laboratory of Mental Health (Peking University), Department of Neurology, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Meiyun Zhang
- Department of Neurology, Tianjin People’s Hospital, Tianjin, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute, Tianjin, China
| | - Fei Wang
- Department of Neurology, Yuncheng Central Hospital of Shanxi Province, Yuncheng, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Peifei Jia
- Department of Neurology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Lisha Feng
- Department of Encephalopathy, Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junying Xu
- Department of Neurology, Tianjin Baodi People’s Hospital, Tianjin, China
| | - Jinhong Zhang
- Department of Neurology, Cangzhou People’s Hospital, Cangzhou, China
| | - Wenzheng Hu
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhichao Chen
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Ji
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Dementia Institute, Tianjin, China
- *Correspondence: Yong Ji,
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106
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Schippinger W. Comprehensive geriatric assessment. Wien Med Wochenschr 2022; 172:122-125. [PMID: 35041103 DOI: 10.1007/s10354-021-00905-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
Geriatric assessment is a multidimensional and interdisciplinarily deployed diagnostic process to evaluate functional capacities and impairments in geriatric patients. The results of geriatric assessment are the basis for planning of therapeutic interventions in the multidisciplinary geriatrics team. Geriatric assessment adds essential information to the state-of-the-art diagnostic tests, such as physical examination, laboratory tests, or imaging techniques, to acquire a holistic picture about health and functional problems and needs of geriatric patients. Studies have demonstrated that geriatric assessment and the following geriatric treatment improves prognosis and increases the chance of older patients remaining in their own home after discharge from hospital after admission for an acute disease.
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Affiliation(s)
- Walter Schippinger
- Medical Director and Head of the Department of Internal Medicine, Albert Schweitzer Hospital, Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020, Graz, Austria.
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107
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Schaffert J, LoBue C, Hynan LS, Hart J, Rossetti H, Carlew AR, Lacritz L, White CL, Cullum CM. Predictors of Life Expectancy in Autopsy-Confirmed Alzheimer's Disease. J Alzheimers Dis 2022; 86:271-281. [PMID: 35034898 PMCID: PMC8966055 DOI: 10.3233/jad-215200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Life expectancy (LE) following Alzheimer's disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. OBJECTIVE No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. METHODS Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer's Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. RESULTS Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE variance in 764 total participants. Mini-Mental State Examination (MMSE) score was the strongest predictor of LE, followed by sex, age, race/ethnicity, neuropsychiatric symptoms, abnormal neurological exam results, and functional impairment ratings. Post-hoc analyses revealed correlations of LE were strongest with MMSE ≤12. CONCLUSION Global cognitive functioning was the strongest predictor of LE following diagnosis, and AD patients with severe impairment had the shortest LE. AD patients who are older, male, white, and have more motor symptoms, functional impairment, and neuropsychiatric symptoms were also more likely have shorter LE. While this model cannot provide individual prognoses, additional studies may focus on these variables to enhance predictions of LE in patients with AD.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Department of Neurological Surgery, University of Texas
Southwestern Medical Center, Dallas, TX, USA
| | - Linda S. Hynan
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Department of Population and Data Sciences, University of
Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Callier Center, School of Behavioral and Brain Sciences, UT
Dallas, Dallas, TX, USA,Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Heidi Rossetti
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Anne R. Carlew
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Laura Lacritz
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Charles L. White
- Department of Pathology, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - C. Munro Cullum
- Department of Psychiatry, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Department of Neurological Surgery, University of Texas
Southwestern Medical Center, Dallas, TX, USA,Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, TX, USA,Correspondence to: C. Munro Cullum, ABPP/CN,
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., MC9044,
Dallas, TX 75390, USA. Tel.: +1 214 648 5277;
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108
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Song P, Zhao Y, Chen X, Zhang H, Han P, Xie F, Guo Q. Association between Sleep Duration and Mild Cognitive Impairment at Different Levels of Metabolic Disease in Community-Dwelling Older Chinese Adults. J Nutr Health Aging 2022; 26:139-146. [PMID: 35166305 DOI: 10.1007/s12603-022-1734-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the relationship between metabolic syndrome (MetS), sleep duration and mild cognitive impairment (MCI) in community-dwelling older Chinese adults. METHODS The study comprised of 1367 community-dwelling Chinese participants (563 men; mean age: 71.0 years) recruited from Tianjin and Shanghai, China who were invited to participate in a comprehensive geriatric assessment. The International Diabetes Federation metabolic syndrome guidelines were used to define MetS. The Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were used for the initial classification of patients with MCI. We divided sleep duration into five groups (≤6 h, 6-8 h which was used as the reference, 8-9 h, 9-10 h, and >10 h). Nutritional status was assessed by Mini Nutrition Assessment Short Form. RESULTS The overall incidence of metabolic syndrome was 46.7%, the overall incidence of mild cognitive impairment was 17.4%. In logistic regression analysis model, after adjusting for multiple confounding factors such as nutritional status and physical activity level, there was a significant positive association between long sleep duration (> 10h) and mild cognitive impairment in general population and metabolic syndrome population (p<0.05), but the association was not significant in non-metabolic syndrome group. In addition, in the long sleep duration group, the components of metabolic syndrome, elevated blood glucose were significantly associated with mild cognitive impairment (p<0.05). CONCLUSIONS Long sleep duration was significantly associated with increased risk of MCI in older adults with MetS, but not in those without MetS. The prevention of MCI may be more effective in the population of MetS with long sleep duration.
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Affiliation(s)
- P Song
- Qi Guo, Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 1500 Zhouyuan Road, Pudong New District, Shanghai, 201318, China, Phone: 86-22-8333-6977, FAX: 86-22-8333-6977, E-mail: ; Fandi Xie, M.D. Jiangwan hospital, Hongkou District, Shanghai, 1878 Sichuan North Road, Hongkou District, Shanghai, 200080, China, Phone: 65422593-2002, E-mail:
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109
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Vu T, Smith JA. An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery. Front Psychiatry 2022; 13:884907. [PMID: 35782418 PMCID: PMC9240195 DOI: 10.3389/fpsyt.2022.884907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/23/2022] [Indexed: 12/14/2022] Open
Abstract
Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015-present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.
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Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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110
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Strutt PA, Barnier AJ, Savage G, Picard G, Kochan NA, Sachdev P, Draper B, Brodaty H. Hearing loss, cognition, and risk of neurocognitive disorder: evidence from a longitudinal cohort study of older adult Australians. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:121-138. [PMID: 33371769 DOI: 10.1080/13825585.2020.1857328] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Addressing midlife hearing loss could prevent up to 9% of new cases of dementia, the highest of any potentially modifiable risk factor identified in the 2017 commissioned report in The Lancet. In Australia, hearing loss is the second-most common chronic health condition in older people, affecting 74% of people aged over 70. Estimates indicate that people with severe hearing loss are up to 5-times more likely to develop dementia, but these estimates vary between studies due to methodological limitations. Using data from the Sydney Memory and Aging Study, in which 1,037 Australian men and women aged between 70 and 90 years were enrolled and completed biennial assessments from 2005-2017, investigations between hearing loss and baseline cognitive performance as well as longitudinal risk of neurocognitive disorder were undertaken. Individuals who reported moderate-to-severe hearing difficulties had poorer cognitive performances in the domains of Attention/Processing Speed and Visuospatial Ability, and on an overall index of Global Cognition, and had a 1.5-times greater risk for the neurocognitive disorder during 6-years' follow-up. Hearing loss independently predicted risk for MCI but not dementia. The presence of hearing loss is an important consideration for neuropsychological case formulation in older adults with cognitive impairment. Hearing loss may increase cognitive load, resulting in observable cognitive impairment on neuropsychological testing. Individuals with hearing loss who demonstrate impairment in non-amnestic domains may experience benefits from the provision of hearing devices; This study provides support for a randomized control trial of hearing devices for improvement of cognitive function in this group.
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Affiliation(s)
- Paul A Strutt
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia
| | - Amanda J Barnier
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia
| | - Greg Savage
- Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Gabrielle Picard
- Centre for Ageing, Cognition, and Wellbeing, Macquarie University, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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111
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Wei Y, Liu S, Cai J, Tang X, Zhang J, Xu M, Liu Q, Wei C, Mo X, Huang S, Lin Y, Mai T, Tan D, Luo T, Gou R, Lu H, Qin J, Zhang Z. Associations of TFEB Gene Polymorphisms With Cognitive Function in Rural Chinese Population. Front Aging Neurosci 2022; 13:757992. [PMID: 34970136 PMCID: PMC8713571 DOI: 10.3389/fnagi.2021.757992] [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: 08/13/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The study aimed to investigate the relationship between transcription factor EB (TFEB) gene polymorphisms, including their haplotypes, and the cognitive functions of a selected population in Gongcheng County, Guangxi. Methods: A case-control study approach was used. The case group comprised 339 individuals with cognitive impairment, as assessed by their Mini-Mental State Examination scores; the control population also comprised 339 individuals who were matched by sex and age (± 5 years) in a 1:1 ratio. TFEB gene polymorphisms were genotyped in 678 participants (190 men and 488 women, aged 30-91 years) by using the Sequenom MassARRAY platform. Results: Multifactorial logistic regression analysis showed that in the dominant model, the risk of developing cognitive impairment was 1.547 times higher in cases with the TFEB rs14063A allele (AG + AA) than in those with the GG genotype (adjusted odds ratio [OR] = 1.547, Bonferroni correction confidence interval = 1.021-2.345). Meanwhile, the presence of the TFEB rs1062966T allele (CT + TT) was associated with a lower risk of cognitive impairment in comparison with the presence of the CC genotype (adjusted OR = 0.636, Bonferroni correction confidence interval = 0.405-0.998). In the co-dominant model, the risk of developing cognitive impairment was 1.553 times higher in carriers of the TFEB rs14063AG genotype than in carriers of the GG genotype (adjusted OR = 1.553, Bonferroni correction confidence interval = 1.007-2.397). After the Bonferroni correction and adjustment for confounding factors, the association of TFEB rs1062966 with cognitive function persisted in the analyses stratified by education level. Ethnically stratified analysis showed a significant association between TFEB rs1062966 and cognitive function in the Yao population. The multilocus linkage disequilibrium analysis indicated that the identified single nucleotide polymorphisms were not inherited independently. The haplotype analysis suggested that the rs14063A-rs1062966C-rs2278068C-rs1015149T haplotype of the TFEB gene increased the risk of cognitive impairment (P < 0.05) and that the rs14063G-rs1062966T-rs2278068C-rs1015149C haplotype was associated with a reduced risk of cognitive impairment (P < 0.05). Conclusion: TFEB rs1062966 polymorphisms and their rs14063A-rs1062966C-rs2278068C-rs1015149T and rs14063G-rs1062966T-rs2278068C-rs1015149C haplotypes are genetic factors that may affect cognitive function among the rural Chinese population.
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Affiliation(s)
- Yanfei Wei
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Shuzhen Liu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Jiansheng Cai
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
| | - Xu Tang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Junling Zhang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Min Xu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Qiumei Liu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Chunmei Wei
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Xiaoting Mo
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Shenxiang Huang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Yinxia Lin
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Tingyu Mai
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Dechan Tan
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Tingyu Luo
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Ruoyu Gou
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Huaxiang Lu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Jian Qin
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Key Laboratory of Longevity and Aging-Related Diseases of Chinese Ministry of Education, Nanning, China
| | - Zhiyong Zhang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guangxi, China
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Locquet M, Sanchez-Rodriguez D, Bruyère O, Geerinck A, Lengelé L, Reginster JY, Beaudart C. Intrinsic Capacity Defined Using Four Domains and Mortality Risk: A 5-Year Follow-Up of the SarcoPhAge Cohort. J Nutr Health Aging 2022; 26:23-29. [PMID: 35067699 DOI: 10.1007/s12603-021-1702-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The concept of 'intrinsic capacity' (IC) offers a new way to approach another concept, that of 'healthy aging'. The first objective of the present study was to assess the ability of the construct of 'intrinsic capacity' to predict death. The second objective was to assess whether deteriorations in intrinsic capacity, measured over 1 and 2 years, are predictive of death. DESIGN The present analysis was based on a prospective cohort study. SETTING Community-dwelling participants. PARTICIPANTS The study recruited older adults aged 65 years and older. MEASUREMENTS Intrinsic capacity (IC) encompasses five domains: sensorial (not evaluated here), cognition (Mini-Mental State Examination), nutrition (Mini-Nutritional Assessment), mobility (Short Physical Performance Battery), and psychological (Geriatric Depression Scale). Each domain was considered satisfactory when its assessment, for an individual, was above the threshold defined by the initial validation of the domain assessment tool. To explore the relationship between IC and mortality risk, a Cox model was applied. The predictive value of the dynamic aspects (i.e., changes over 1 year and 2 years) was investigated using the following categorization of IC: stable, deteriorated, improved. RESULTS The sample was composed of 481 volunteers aged 73.4±6.12 years (60.1% women). Two satisfactory IC domains appeared to be significantly associated with reduced mortality risk: the satisfactory mobility domain (adjusted HR=0.45 [0.26-0.79]) and the satisfactory psychological domain (adjusted HR = 0.56 [1.04-3.09]). When considering intrinsic capacity as a whole construct, using a composite Z-score, we noticed that the risk of death was decreased by 49% for an increase of 1 standard deviation in IC. Changes in intrinsic capacity in the mobility and psychological domains led to an increased risk of death (from 2.74 to 4.18-fold). CONCLUSION The concept of intrinsic capacity seems highly relevant in order to assess older adults' health and well-being. This concept should be considered for integration into clinical practice.
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Affiliation(s)
- M Locquet
- Médéa Locquet, M.Sc., PhD, CHU de Liège, Avenue Hippocrate 13, 4000 Liège, Belgium, 003243662519,
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Luan S, Cheng W, Wang C, Gong J, Zhou J. Impact of glucagon-like peptide 1 analogs on cognitive function among patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1047883. [PMID: 36387915 PMCID: PMC9650490 DOI: 10.3389/fendo.2022.1047883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes is an independent risk factor for cognitive impairment. However, little is known about the neuroprotective effects of glucagon-like peptide 1 (GLP-1) analogs on type 2 diabetes mellitus (T2DM). Herein, we assessed the impact of GLP-1 analogs on the general cognitive functioning among patients with T2DM. METHODS Relevant studies were retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases from their inception till June 30, 2022, without any language restrictions. For continuous variables, the mean and standard deviation (SD) were extracted. Considering the heterogeneity in general cognitive functioning assessments among the pooled studies, the standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs), were calculated. RESULTS Five studies including 7,732 individuals with T2DM were selected for the meta-analysis. The use of GLP-1 analogs exerted no significant effects on the general cognitive functioning in self-controlled studies (SMD 0.33, 95% CI -0.03 to 0.69). Subgroup analyses among the self-controlled studies based on age and history of cardio-cerebrovascular disease showed that GLP-1 analogs significantly improved the general cognitive functioning in T2DM patients younger than 65 years (SMD 0.69, 95% CI 0.31 to 1.08) or those without cardio-cerebrovascular diseases (SMD 0.69, 95% CI 0.31 to 1.08). Similarly, differences in the general cognitive functioning for GLP-1 analogs between treated and non-treated patients with T2DM were significant in subgroups with patients younger than 65 years (SMD 1.04, 95% CI 0.61 to 1.47) or those with no history of cardio-cerebrovascular diseases (SMD 1.04, 95% CI 0.61 to 1.47). CONCLUSION Limited evidence suggests that the use of GLP-1 analogs exerts no significant effects on general cognitive functioning but may be beneficial for patients with T2DM younger than 65 years or those without a history of cardio-cerebrovascular diseases. Further prospective clinical studies with large sample sizes are needed to validate these findings. SYSTEMATIC REVIEW REGISTRATION www.inplasy.com, identifier 202260015.
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Affiliation(s)
- Sisi Luan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wenke Cheng
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Chenglong Wang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianhong Gong
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianbo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jianbo Zhou,
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Detecting Cognitive Impairment Status Using Keystroke Patterns and Physical Activity Data among the Older Adults: A Machine Learning Approach. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1302989. [PMID: 34966518 PMCID: PMC8712156 DOI: 10.1155/2021/1302989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022]
Abstract
Cognitive impairment has a significantly negative impact on global healthcare and the community. Holding a person's cognition and mental retention among older adults is improbable with aging. Early detection of cognitive impairment will decline the most significant impact of extended disease to permanent mental damage. This paper aims to develop a machine learning model to detect and differentiate cognitive impairment categories like severe, moderate, mild, and normal by analyzing neurophysical and physical data. Keystroke and smartwatch have been used to extract individuals' neurophysical and physical data, respectively. An advanced ensemble learning algorithm named Gradient Boosting Machine (GBM) is proposed to classify the cognitive severity level (absence, mild, moderate, and severe) based on the Standardised Mini-Mental State Examination (SMMSE) questionnaire scores. The statistical method "Pearson's correlation" and the wrapper feature selection technique have been used to analyze and select the best features. Then, we have conducted our proposed algorithm GBM on those features. And the result has shown an accuracy of more than 94%. This paper has added a new dimension to the state-of-the-art to predict cognitive impairment by implementing neurophysical data and physical data together.
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115
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Zhang F, Petersen M, Johnson L, Hall J, O’Bryant SE. Accelerating Hyperparameter Tuning in Machine Learning for Alzheimer's Disease With High Performance Computing. Front Artif Intell 2021; 4:798962. [PMID: 34957393 PMCID: PMC8692864 DOI: 10.3389/frai.2021.798962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
Driven by massive datasets that comprise biomarkers from both blood and magnetic resonance imaging (MRI), the need for advanced learning algorithms and accelerator architectures, such as GPUs and FPGAs has increased. Machine learning (ML) methods have delivered remarkable prediction for the early diagnosis of Alzheimer's disease (AD). Although ML has improved accuracy of AD prediction, the requirement for the complexity of algorithms in ML increases, for example, hyperparameters tuning, which in turn, increases its computational complexity. Thus, accelerating high performance ML for AD is an important research challenge facing these fields. This work reports a multicore high performance support vector machine (SVM) hyperparameter tuning workflow with 100 times repeated 5-fold cross-validation for speeding up ML for AD. For demonstration and evaluation purposes, the high performance hyperparameter tuning model was applied to public MRI data for AD and included demographic factors such as age, sex and education. Results showed that computational efficiency increased by 96%, which helped to shed light on future diagnostic AD biomarker applications. The high performance hyperparameter tuning model can also be applied to other ML algorithms such as random forest, logistic regression, xgboost, etc.
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Affiliation(s)
- Fan Zhang
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Melissa Petersen
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Leigh Johnson
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - James Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Sid E. O’Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
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Honarmand Tamizkar K, Gorji P, Gholipour M, Hussen BM, Mazdeh M, Eslami S, Taheri M, Ghafouri-Fard S. Parkinson's Disease Is Associated With Dysregulation of Circulatory Levels of lncRNAs. Front Immunol 2021; 12:763323. [PMID: 34868009 PMCID: PMC8632636 DOI: 10.3389/fimmu.2021.763323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) have been recently reported to be involved in the pathoetiology of Parkinson’s disease (PD). Circulatory levels of lncRNAs might be used as markers for PD. In the present work, we measured expression levels of HULC, PVT1, MEG3, SPRY4-IT1, LINC-ROR and DSCAM-AS1 lncRNAs in the circulation of patients with PD versus healthy controls. Expression of HULC was lower in total patients compared with total controls (Expression ratio (ER)=0.19, adjusted P value<0.0001) as well as in female patients compared with female controls (ER=0.071, adjusted P value=0.0004). Expression of PVT1 was lower in total patients compared with total controls (ER=0.55, adjusted P value=0.0124). Expression of DSCAM-AS1 was higher in total patients compared with total controls (ER=5.67, P value=0.0029) and in male patients compared with male controls (ER=9.526, adjusted P value=0.0024). Expression of SPRY4-IT was higher in total patients compared with total controls (ER=2.64, adjusted P value<0.02) and in male patients compared with male controls (ER=3.43, P value<0.03). Expression of LINC-ROR was higher in total patients compared with total controls (ER=10.36, adjusted P value<0.0001) and in both male and female patients compared with sex-matched controls (ER=4.57, adjusted P value=0.03 and ER=23.47, adjusted P value=0.0019, respectively). Finally, expression of MEG3 was higher in total patients compared with total controls (ER=13.94, adjusted P value<0.0001) and in both male and female patients compared with sex-matched controls (ER=8.60, adjusted P value<0.004 and ER=22.58, adjusted P value<0.0085, respectively). ROC curve analysis revealed that MEG3 and LINC-ROR have diagnostic power of 0.77 and 0.73, respectively. Other lncRNAs had AUC values less than 0.7. Expression of none of lncRNAs was correlated with age of patients, disease duration, disease stage, MMSE or UPDRS. The current study provides further evidence for dysregulation of lncRNAs in the circulation of PD patients.
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Affiliation(s)
| | - Pooneh Gorji
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Gholipour
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bashdar Mahmud Hussen
- Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Mehrdokht Mazdeh
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Solat Eslami
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Medical Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Taheri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Behehsti University of Medical Sciences, Tehran, Iran.,Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Behehsti University of Medical Sciences, Tehran, Iran
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Liu CS, Herrmann N, Song BX, Ba J, Gallagher D, Oh PI, Marzolini S, Rajji TK, Charles J, Papneja P, Rapoport MJ, Andreazza AC, Vieira D, Kiss A, Lanctôt KL. Exercise priming with transcranial direct current stimulation: a study protocol for a randomized, parallel-design, sham-controlled trial in mild cognitive impairment and Alzheimer's disease. BMC Geriatr 2021; 21:677. [PMID: 34863115 PMCID: PMC8645072 DOI: 10.1186/s12877-021-02636-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive type of brain stimulation that uses electrical currents to modulate neuronal activity. A small number of studies have investigated the effects of tDCS on cognition in patients with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and have demonstrated variable effects. Emerging evidence suggests that tDCS is most effective when applied to active brain circuits. Aerobic exercise is known to increase cortical excitability and improve brain network connectivity. Exercise may therefore be an effective, yet previously unexplored primer for tDCS to improve cognition in MCI and mild AD. Methods Participants with MCI or AD will be randomized to receive 10 sessions over 2 weeks of either exercise primed tDCS, exercise primed sham tDCS, or tDCS alone in a blinded, parallel-design trial. Those randomized to an exercise intervention will receive individualized 30-min aerobic exercise prescriptions to achieve a moderate-intensity dosage, equivalent to the ventilatory anaerobic threshold determined by cardiopulmonary assessment, to sufficiently increase cortical excitability. The tDCS protocol consists of 20 min sessions at 2 mA, 5 times per week for 2 weeks applied through 35 cm2 bitemporal electrodes. Our primary aim is to assess the efficacy of exercise primed tDCS for improving global cognition using the Montreal Cognitive Assessment (MoCA). Our secondary aims are to evaluate the efficacy of exercise primed tDCS for improving specific cognitive domains using various cognitive tests (n-back, Word Recall and Word Recognition Tasks from the Alzheimer’s Disease Assessment Scale-Cognitive subscale) and neuropsychiatric symptoms (Neuropsychiatric Inventory). We will also explore whether exercise primed tDCS is associated with an increase in markers of neurogenesis, oxidative stress and angiogenesis, and if changes in these markers are correlated with cognitive improvement. Discussion We describe a novel clinical trial to investigate the effects of exercise priming before tDCS in patients with MCI or mild AD. This proof-of-concept study may identify a previously unexplored, non-invasive, non-pharmacological combination intervention that improves cognitive symptoms in patients. Findings from this study may also identify potential mechanistic actions of tDCS in MCI and mild AD. Trial registration Clinicaltrials.gov, NCT03670615. Registered on September 13, 2018.
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Affiliation(s)
- Celina S Liu
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 3K1, Canada.,Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Bing Xin Song
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 3K1, Canada.,Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Joycelyn Ba
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Biology, Faculty of Science, The University of Western Ontario, London, ON, Canada
| | - Damien Gallagher
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Paul I Oh
- Cardiovascular Prevention and Rehabilitation Program, KITE - Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON, M5G 1R7, Canada
| | - Susan Marzolini
- Cardiovascular Prevention and Rehabilitation Program, KITE - Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON, M5G 1R7, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction & Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.,Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Charles
- Family & Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Purti Papneja
- Family & Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Mark J Rapoport
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 3K1, Canada
| | - Danielle Vieira
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Alex Kiss
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 3K1, Canada. .,Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. .,Cardiovascular Prevention and Rehabilitation Program, KITE - Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON, M5G 1R7, Canada.
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118
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Yan M, Yin H, Meng Q, Wang S, Ding Y, Li G, Wang C, Chen L. A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study. JMIR Serious Games 2021; 9:e30919. [PMID: 34870610 PMCID: PMC8686451 DOI: 10.2196/30919] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/29/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI. Objective The objectives of this study are to validate a VR game–based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels. Methods Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively. Results A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048). Conclusions The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary. Trial Registration Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639
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Affiliation(s)
- Mingli Yan
- School of Nursing, Jilin University, Changchun, China
| | - Huiru Yin
- School of Nursing, Jilin University, Changchun, China
| | - Qiuyan Meng
- School of Nursing, Jilin University, Changchun, China
| | - Shuo Wang
- School of Nursing, Jilin University, Changchun, China
| | - Yiwen Ding
- School of Nursing, Jilin University, Changchun, China
| | - Guichen Li
- School of Nursing, Jilin University, Changchun, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China
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Nejtek VA, James RN, Salvatore MF, Alphonso HM, Boehm GW. Premature cognitive decline in specific domains found in young veterans with mTBI coincide with elder normative scores and advanced-age subjects with early-stage Parkinson's disease. PLoS One 2021; 16:e0258851. [PMID: 34788310 PMCID: PMC8598036 DOI: 10.1371/journal.pone.0258851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Importance Epidemiologists report a 56% increased risk of veterans with (+) mild traumatic brain injury (mTBI) developing Parkinson’s disease (PD) within 12-years post-injury. The most relevant contributors to this high risk of PD in veterans (+) mTBI is unknown. As cognitive problems often precede PD diagnosis, identifying specific domains most involved with mTBI-related PD onset is critical. Objectives To discern which cognitive domains underlie the mTBI-PD risk relationship proposed in epidemiology studies. Design and setting This exploratory match-controlled, cross-sectional study was conducted in a medical school laboratory from 2017–2020. Participants Age- and IQ-matched veterans with (+) and without mTBI, non-veteran healthy controls, and IQ-matched non-demented early-stage PD were compared. Chronic neurological, unremitted/debilitating diseases, disorders, dementia, and substance use among others were excluded. Exposure Veterans were or were not exposed to non-penetrating combat-related mTBI occurring within the past 7-years. No other groups had recent military service or mTBI. Main outcomes / measures Cognitive flexibility, attention, memory, visuospatial ability, and verbal fluency were examined with well-known standardized neuropsychological assessments. Results Out of 200 volunteers, 114 provided evaluable data. Groups significantly differed on cognitive tests [F (21,299) = 3.09, p<0.0001]. Post hoc tests showed veterans (+) mTBI performed significantly worse than matched-control groups on four out of eight cognitive tests (range: p = .009 to .049), and more often than not performed comparably to early-stage PD (range: p = .749 to .140). Conclusions and relevance We found subtle, premature cognitive decline occurring in very specific cognitive domains in veterans (+) mTBI that would typically be overlooked in a clinic setting, This result potentially puts them at-risk for continual cognitive decline that may portend to the eventual onset of PD or some other neurodegenerative disease.
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Affiliation(s)
- Vicki A Nejtek
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Rachael N James
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Michael F Salvatore
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Helene M Alphonso
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America.,John Peter Smith Health Network, Fort Worth, Texas, United States of America
| | - Gary W Boehm
- Texas Christian University, Fort Worth, Texas, United States of America
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The patient-caregiver dyad: the impact of cognitive and functional impairment. Neurol Sci 2021; 43:2481-2490. [PMID: 34773209 DOI: 10.1007/s10072-021-05712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
This study evaluates the cognitive impairment impact on the caregiver's burden and quality of life.Patient-caregiver dyads admitted to dementia Diagnostic-Therapeutic Care Pathway underwent a psychological and neuropsychological assessment. Overall, 30 caregivers (age 58.97 ± 14.68) of patients with dementia and 28 caregivers (age 58.57 ± 12.22) of patients with MCI were recruited. Caregiver's burden is positively correlated to the number (r = .37, p = .003) and severity (r = .37, p = .003) of neuropsychiatric patient's symptoms and with the caregiver's distress (r = .36, p = .004). It is also negatively related to good quality of life perception (r = - .52, p = < .0001), to lower cognitive impairment (r = - .26, p = .05), to higher patient's residual functional abilities in daily living (r = - .32, p = .010) and to positive perception of the physician's communication (r = - .28, p = .026). Moreover, the caregiver's burden is significantly predicted by the patient's low level of instrumental activity of daily living (β = - .74; p = .043) and by the number of neuropsychiatric symptoms (β = .74; p = .029). Thus, this study suggests that the autonomy and neuropsychiatric symptoms may determine the caregiver's burden.
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Wasef S, Laksono I, Kapoor P, Tang-Wei D, Gold D, Saripella A, Riazi S, Islam S, Englesakis M, Wong J, Chung F. Screening for subjective cognitive decline in the elderly via subjective cognitive complaints and informant-reported questionnaires: a systematic review. BMC Anesthesiol 2021; 21:277. [PMID: 34753428 PMCID: PMC8579566 DOI: 10.1186/s12871-021-01493-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subjective cognitive decline may represent at-risk persons progressing to mild cognitive impairment (MCI), which can be exacerbated by effects of anesthesia and surgery. The objective of this systematic review is to identify the most common questions in subjective cognitive complaint and informant-reported questionnaires used in assessing cognitive impairment of elderly patients that are correlated with standardized tests for cognitive impairment screening. METHODS We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials.Gov, and ICTRP between September 20, 2005 to August 31, 2020. We included studies that evaluated subjective cognitive complaints and informant-reported questions in elderly patients. RESULTS AND CONCLUSION A total of 28,407 patients were included from 22 studies that assessed 21 subjective complaint questionnaires and nine informant-reported questionnaires. The most common subjective cognitive complaints were those assessing anterograde memory, closely followed by perceptual-motor function and executive function. The most common informant-reported questions were those assessing executive function, temporal orientation, and anterograde memory. Questions assessing learning and memory were most associated with results from standardized tests assessing cognitive impairment. Assessing learning and memory plays a key role in evaluating subjective cognitive decline in elderly patients. Delivering subjective cognitive complaints questions to elderly patient preoperatively may aid in screening for those exhibiting cognitive signs, and in turn are at risk of postoperative complications. Thus, the results from this review contribute to knowledge for healthcare professionals regarding the use of subjective cognitive complaints and informant-reported complaints in preoperative settings.
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Affiliation(s)
- Sara Wasef
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Isabelle Laksono
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Tang-Wei
- Department of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Gold
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sheila Riazi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
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Evaluation of Available Cognitive Tools Used to Measure Mild Cognitive Decline: A Scoping Review. Nutrients 2021; 13:nu13113974. [PMID: 34836228 PMCID: PMC8623828 DOI: 10.3390/nu13113974] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Cognitive decline is a broad syndrome ranging from non-pathological/age-associated cognitive decline to pathological dementia. Mild cognitive impairment MCI) is defined as the stage of cognition that falls between normal ageing and dementia. Studies have found that early lifestyle interventions for MCI may delay its pathological progression. Hence, this review aims to determine the most efficient cognitive tools to discriminate mild cognitive decline in its early stages. After a systematic search of five online databases, a total of 52 different cognitive tools were identified. The performance of each tool was assessed by its psychometric properties, administration time and delivery method. The Montreal Cognitive Assessment (MoCA, n = 15), the Mini-Mental State Examination (MMSE, n = 14) and the Clock Drawing Test (CDT, n = 4) were most frequently cited in the literature. The preferable tools with all-round performance are the Six-item Cognitive Impairment Test (6CIT), MoCA (with the cut-offs of ≤24/22/19/15.5), MMSE (with the cut-off of ≤26) and the Hong Kong Brief Cognitive Test (HKBC). In addition, SAGE is recommended for a self-completed survey setting whilst a 4-point CDT is quick and easy to be added into other cognitive assessments. However, most tools were affected by age and education levels. Furthermore, optimal cut-off points need to be cautiously chosen while screening for MCI among different populations.
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Davis JRC, Knight SP, Donoghue OA, Hernández B, Rizzo R, Kenny RA, Romero-Ortuno R. Comparison of Gait Speed Reserve, Usual Gait Speed, and Maximum Gait Speed of Adults Aged 50+ in Ireland Using Explainable Machine Learning. FRONTIERS IN NETWORK PHYSIOLOGY 2021; 1:754477. [PMID: 36925580 PMCID: PMC10013005 DOI: 10.3389/fnetp.2021.754477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
Gait speed is a measure of general fitness. Changing from usual (UGS) to maximum (MGS) gait speed requires coordinated action of many body systems. Gait speed reserve (GSR) is defined as MGS-UGS. From a shortlist of 88 features across five categories including sociodemographic, cognitive, and physiological, we aimed to find and compare the sets of predictors that best describe UGS, MGS, and GSR. For this, we leveraged data from 3,925 adults aged 50+ from Wave 3 of The Irish Longitudinal Study on Ageing (TILDA). Features were selected by a histogram gradient boosting regression-based stepwise feature selection pipeline. Each model's feature importance and input-output relationships were explored using TreeExplainer from the Shapely Additive Explanations explainable machine learning package. The meanR a d j 2 (SD) from fivefold cross-validation on training data and theR a d j 2 score on test data were 0.38 (0.04) and 0.41 for UGS, 0.45 (0.04) and 0.46 for MGS, and 0.19 (0.02) and 0.21 for GSR. Each model selected features across all categories. Features common to all models were age, grip strength, chair stands time, mean motor reaction time, and height. Exclusive to UGS and MGS were educational attainment, fear of falling, Montreal cognitive assessment errors, and orthostatic intolerance. Exclusive to MGS and GSR were body mass index (BMI), and number of medications. No features were selected exclusively for UGS and GSR. Features unique to UGS were resting-state pulse interval, Center for Epidemiologic Studies Depression Scale (CESD) depression, sit-to-stand difference in diastolic blood pressure, and left visual acuity. Unique to MGS were standard deviation in sustained attention to response task times, resting-state heart rate, smoking status, total heartbeat power during paced breathing, and visual acuity. Unique to GSR were accuracy proportion in a sound-induced flash illusion test, Mini-mental State Examination errors, and number of cardiovascular conditions. No interactions were present in the GSR model. The four features that overall gave the most impactful interactions in the UGS and MGS models were age, chair stands time, grip strength, and BMI. These findings may help provide new insights into the multisystem predictors of gait speed and gait speed reserve in older adults and support a network physiology approach to their study.
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Affiliation(s)
- James R. C Davis
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Silvin P. Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orna A. Donoghue
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rossella Rizzo
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
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Engedal K, Gjøra L, Bredholt T, Thingstad P, Tangen GG, Ernstsen L, Selbæk G. Sex Differences on Montreal Cognitive Assessment and Mini-Mental State Examination Scores and the Value of Self-Report of Memory Problems among Community Dwelling People 70 Years and above: The HUNT Study. Dement Geriatr Cogn Disord 2021; 50:74-84. [PMID: 34038905 DOI: 10.1159/000516341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aims were to examine if the total and item scores on the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) and self-reported memory problems differed between older women and men, and if self-reported memory problems were associated with scores on the 2 tests. METHODS We included 309 home-dwelling people aged 70 years and older, 155 women, mean age 75.6 (SD 4.1) years, and 154 men, mean age 76.0 (SD 4.6) years. They were examined with MoCA and MMSE, and they answered 2 questions: "have you experienced any memory problems" and "have you experienced significant memory problems the last 5 years?" RESULTS The participants scored significantly higher on the MMSE (women 28.0 [1.8], men 28.4 [1.4]) than on MoCA (women 24.6 [3.3], men 24.3 [3.1]). Spearman's rho was 0.36 between the tests. Women scored significantly higher than men on delayed recall of MoCA (3.0 [1.6] vs. 2.4 [1.6]), whereas men scored significantly higher on visuoconstruction (3.8 [1.2] vs. 3.5 [1.0]) and serial subtraction on MoCA (2.7 [0.6] vs. 2.5 [0.8]) and serial sevens on MMSE (4.5 [0.8] vs. 4.1 [1.1]). Multivariate linear regression analyses revealed that female sex, younger age, and higher education were associated with a higher score on MoCA, whereas age and education were associated with a higher score on MMSE. About half of the participants (no sex difference) had experienced significant memory problems the last 5 years, and they had significantly lower scores on both tests. CONCLUSIONS The MoCA score was associated with sex, age, and education, whereas sex did not influence the MMSE score. The question "have you experienced significant memory problems the last 5 years?" may be useful to evaluate older people's cognition.
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Affiliation(s)
- Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Gjøra
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Thea Bredholt
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health and Social Services, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Ernstsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Bernaerts S, De Witte NAJ, Van der Auwera V, Bonroy B, Muraru L, Bamidis P, Frantzidis C, Kourtidou-Papadeli C, Azevedo N, Garatea J, Muñoz I, Almeida R, Losada R, Fung J, Kehayia E, Lamontagne A, de Guise E, Duclos C, Higgins J, Nadeau S, Beaudry L, Konstantinidis E. Rehabilitation supported by technology: Protocol for an international co-creation and user experience study (Preprint). JMIR Res Protoc 2021; 11:e34537. [PMID: 35266874 PMCID: PMC8949709 DOI: 10.2196/34537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. Objective With this joint research activity, this study primarily aims to gain insight into each living lab’s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. Methods This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. Results Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. Conclusions The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. International Registered Report Identifier (IRRID) PRR1-10.2196/34537
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Affiliation(s)
- Sylvie Bernaerts
- LiCalab, Thomas More University of Applied Sciences, Geel, Belgium
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerpen, Belgium
| | - Nele A J De Witte
- LiCalab, Thomas More University of Applied Sciences, Geel, Belgium
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerpen, Belgium
| | | | - Bert Bonroy
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Luiza Muraru
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Panagiotis Bamidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Frantzidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysoula Kourtidou-Papadeli
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Aerospace Medical Association and Space Research, Thessaloniki, Greece
| | - Nancy Azevedo
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
| | - Jokin Garatea
- GAIA, Asociación de Industrias de Conocimiento y Tecnologías Aplicadas, San Sebastian, Spain
| | - Idoia Muñoz
- GAIA, Asociación de Industrias de Conocimiento y Tecnologías Aplicadas, San Sebastian, Spain
| | - Rosa Almeida
- Fundación INTRAS, Research, Development and Innovation Department, Valladolid, Spain
| | - Raquel Losada
- Fundación INTRAS, Research, Development and Innovation Department, Valladolid, Spain
| | - Joyce Fung
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Eva Kehayia
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Anouk Lamontagne
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Elaine de Guise
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Université de Montreal, Montreal, QC, Canada
| | - Cyril Duclos
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Université de Montreal, Montreal, QC, Canada
| | - Johanne Higgins
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Université de Montreal, Montreal, QC, Canada
| | - Sylvie Nadeau
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Université de Montreal, Montreal, QC, Canada
| | - Lucie Beaudry
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Institut Universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Dance Department, Université du Québec à Montréal, Montreal, QC, Canada
| | - Evdokimos Konstantinidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- European Network of Living Labs, Brussels, Belgium
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Mei X, Qiu C, Zhou Q, Chen Z, Chen Y, Xu Z, Zou C. Changes in retinal multilayer thickness and vascular network of patients with Alzheimer's disease. Biomed Eng Online 2021; 20:97. [PMID: 34602087 PMCID: PMC8489058 DOI: 10.1186/s12938-021-00931-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Retinal biomarkers of Alzheimer's disease (AD) have been extensively investigated in recent decades. Retinal nervous and vascular parameters can reflect brain conditions, and they can facilitate early diagnosis of AD. OBJECTIVE Our study aimed to evaluate the difference in retinal neuro-layer thickness and vascular parameters of patients with AD and healthy controls (HCs). METHODS Non-invasive optical coherence tomography angiography (OCTA) was used to determine the combined thickness of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), as well as the full retinal thickness (FRT). The vascular branching (VB), vascular curvature (VC), and vascular density (VD) for AD and HC groups were also obtained. The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive performance of all the participants. After obtaining all the parameters, two-way analysis of variance (ANOVA) was used to compare the mean values of all the retinal parameters of the patients with AD and the HCs. Pearson's correlation was used to test the association between retinal parameters, MMSE scores, and vascular parameters. RESULTS Seventy-eight eyes from 39 participants (19 AD and 20 HC; male, 52.6% in AD and 45.0% in HC; mean [standard deviation] age of 73.79 [7.22] years in AD and 74.35 [6.07] years in HC) were included for the analysis. The average RNFL + GCL thickness (106.32 ± 7.34 μm), FRTs of the four quadrants (290.35 ± 13.05 μm of inferior quadrant, 294.68 ± 9.37 μm of superior quadrant, 302.97 ± 6.52 μm of nasal quadrant, 286.02 ± 13.74 μm of temporal quadrant), and retinal VD (0.0148 ± 0.003) of patients with AD, compared with the HCs, were significantly reduced (p < 0.05). Retinal thickness was significantly correlated with the MMSE scores (p < 0.05). Meanwhile, retinal VD was significantly correlated with the average RNFL + GCL thickness (r2 = 0.2146, p < 0.01). When the vascular parameters were considered, the sensitivity of the AD diagnosis was increased from 0.874 to 0.892. CONCLUSION Our study suggested that the patients with AD, compared with age-matched HCs, had significantly reduced RNFL + GCL thickness and vascular density. These reductions correlated with the cognitive performance of the participants. By combining nerve and vessel parameters, the diagnosis of AD can be improved using OCTA technology. Trail registration Name of the registry: Chinese Clinical Trail Registry, Trial registration number: ChiCTR2000035243, Date of registration: Aug. 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Xi Mei
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China.
| | - Conglong Qiu
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China
| | - Qi Zhou
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China
| | - Zhongming Chen
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China
| | - Yang Chen
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China
- Ningbo University, Ningbo, Zhejiang, China
| | - Zemin Xu
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China
| | - Chenjun Zou
- Kangning Hospital of Ningbo, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Ningbo, Zhejiang, China.
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Effect of transcranial magnetic stimulation as an enhancer of cognitive stimulation sessions on mild cognitive impairment: Preliminary results. Psychiatry Res 2021; 304:114151. [PMID: 34392162 DOI: 10.1016/j.psychres.2021.114151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022]
Abstract
Mild cognitive impairment (MCI) is a state between normal cognition and dementia. Currently, there is little evidence of repetitive Transcranial Magnetic Stimulation (rTMS) as an enhancing tool for Cognitive Stimulation (CS) on MCI. The importance of this study consists in its assessment of the enhancing effect of rTMS on CS in 22 MCI patients randomized and divided into two group: active (AG) and sham (SG). Diagnoses and assessments were determined during 30 sessions over a 10-week period by Montreal Cognitive Assessment (MoCA) and Neuropsí test. Results were statistically significant in the intergroup analysis with MoCA and intragroup only for AG.
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128
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Vislapuu M, Angeles RC, Berge LI, Kjerstad E, Gedde MH, Husebo BS. The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study. BMC Health Serv Res 2021; 21:1003. [PMID: 34551783 PMCID: PMC8457031 DOI: 10.1186/s12913-021-07041-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background COVID-19 isolated home-dwelling people with dementia (PwD) from home care services, respite care, and daytime activities. We aimed to investigate the consequences of these restrictions on informal (family, friends) and formal (homecare staff) resource utilization among co-residing (e.g., spouses) and visiting caregivers (e.g., children). Methods 105 PwD (≥65 years old) and their caregivers were included in the prospective PANdemic in DEMentia (PAN.DEM) study, which was initiated when the ongoing stepped-wedge, cluster randomized LIVE@Home.Path trial (N = 438) was temporarily halted due to the pandemic. Primary outcome was change in resource utilization assessed by the Resource Utilization in Dementia Care (RUD) instrument in pre- (12 Dec. 2019 to 11 Mar. 2020) and during the lockdown periods (20 April 2020 to 15 May 2020). Degree of cognitive impairment was assessed by Mini-Mental Status Examination (MMSE), and physical functioning and independent living skills by Physical Self-Maintenance Scale and Lawton Instrumental Activities of Daily Living Scale. Associations between informal and formal care utilization, socio-demographics, and clinical variables were assessed by descriptive statistics and Ordinary Least Squares models (OLS). Results Mean age for PwD was 81.8 years; 61% were female; 45.6% lived alone, and the mean MMSE score was 20.8 (SD ± 3.7). PwD with co-residents (44%) were younger (78.4 years) than those who were living alone (84.5 years; P < 0.001). During the first 2 months of lockdown, PwD missed on average 20.5 h of formal care in a month (P < 0.001) leading to an approximately 100% increase in informal care, which was particularly pronounced in personal hygiene (6.9 vs. 11.4 days in a month, P < 0.001) and supervision (9.2 vs. 17.6 days in a month; P < 0.001). Visiting caregivers increased by 1.9 days (SD ± 11.5), but co-residing caregivers increased their number of days providing ADL by approximately 7 days per month (β = 6.9; CI, 0.39–13.1, P < 0.05) after adjusting for PwD and caregiver demographics and clinical variables. Decrease in home nursing care was particularly visible for PwD living alone (− 6.1 vs. -1.3 h per month, P = 0.005). Higher cognitive function (β = − 0.64, CI, − 1.26 – 0.02, P = 0.044) was associated with reduction in home nursing service during the lockdown. Conclusion The care situation for PwD changed dramatically in the early phase of the COVID-19 pandemic, especially for those living alone who received less support from homecare services and visiting caregivers. For future crises and the forthcoming post-pandemic period, health authorities must plan better and identify and prioritize those in greatest need. Trial registration ClinicalTrials.gov; NCT04043364.
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Affiliation(s)
- Maarja Vislapuu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.
| | | | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Erdal, Norway
| | | | - Marie H Gedde
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
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129
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Limpawattana P, Manjavong M. The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid Cognitive Screening Tools with Comparable Performance in Detecting Mild NCD in Older Patients. Geriatrics (Basel) 2021; 6:91. [PMID: 34562992 PMCID: PMC8482262 DOI: 10.3390/geriatrics6030091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. METHODS This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools' accuracy. RESULTS A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). CONCLUSIONS All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice.
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Affiliation(s)
| | - Manchumad Manjavong
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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130
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Bloch L, Friedrich CM. Data analysis with Shapley values for automatic subject selection in Alzheimer's disease data sets using interpretable machine learning. Alzheimers Res Ther 2021; 13:155. [PMID: 34526114 PMCID: PMC8444618 DOI: 10.1186/s13195-021-00879-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND For the recruitment and monitoring of subjects for therapy studies, it is important to predict whether mild cognitive impaired (MCI) subjects will prospectively develop Alzheimer's disease (AD). Machine learning (ML) is suitable to improve early AD prediction. The etiology of AD is heterogeneous, which leads to high variability in disease patterns. Further variability originates from multicentric study designs, varying acquisition protocols, and errors in the preprocessing of magnetic resonance imaging (MRI) scans. The high variability makes the differentiation between signal and noise difficult and may lead to overfitting. This article examines whether an automatic and fair data valuation method based on Shapley values can identify the most informative subjects to improve ML classification. METHODS An ML workflow was developed and trained for a subset of the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. The validation was executed for an independent ADNI test set and for the Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing (AIBL) cohort. The workflow included volumetric MRI feature extraction, feature selection, sample selection using Data Shapley, random forest (RF), and eXtreme Gradient Boosting (XGBoost) for model training as well as Kernel SHapley Additive exPlanations (SHAP) values for model interpretation. RESULTS The RF models, which excluded 134 of the 467 training subjects based on their RF Data Shapley values, outperformed the base models that reached a mean accuracy of 62.64% by 5.76% (3.61 percentage points) for the independent ADNI test set. The XGBoost base models reached a mean accuracy of 60.00% for the AIBL data set. The exclusion of those 133 subjects with the smallest RF Data Shapley values could improve the classification accuracy by 2.98% (1.79 percentage points). The cutoff values were calculated using an independent validation set. CONCLUSION The Data Shapley method was able to improve the mean accuracies for the test sets. The most informative subjects were associated with the number of ApolipoproteinE ε4 (ApoE ε4) alleles, cognitive test results, and volumetric MRI measurements.
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Affiliation(s)
- Louise Bloch
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, Dortmund, 44227 Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, 45122 Germany
| | - Christoph M. Friedrich
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, Dortmund, 44227 Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, 45122 Germany
| | - for the Alzheimer’s Disease Neuroimaging Initiative
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, Dortmund, 44227 Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, 45122 Germany
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131
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Puaschitz NG, Jacobsen FF, Mannseth J, Angeles RC, Berge LI, Gedde MH, Husebo BS. Factors associated with access to assistive technology and telecare in home-dwelling people with dementia: baseline data from the LIVE@Home.Path trial. BMC Med Inform Decis Mak 2021; 21:264. [PMID: 34525979 PMCID: PMC8442311 DOI: 10.1186/s12911-021-01627-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is a knowledge gap regarding factors that may influence the access to different devices for home-dwelling people with dementia (PwD). The aim of this study was to identify different assistive technology and telecare (ATT) devices installed in the home and key factors associated with access to such technology. Methods The baseline data came from the LIVE@Home.Path trial, a 24-month multi-component intervention including PwDs and their informal caregivers (dyads) and were collected through semi-quantitative questionnaires in three Norwegian municipalities between May and November of 2019. Regression models were applied to detect demographic and clinical factors associated with access to ATT. Results Of 438 screened dyads, 276 were included at baseline. The mean ages of the PwDs and caregivers were 82 ± 7.0 and 66 ± 12 years, respectively, and 62.8% of the PwD were female and 73.5% had access to any type of ATT. The majority had traditional equipment such as stove guards (43.3%) and social alarms (39.5%) or everyday technology, e.g. calendar support and door locks (45.3%). Multivariate regression analyses revealed that access to a social alarm was more often available for females than males, at increased age, and when the PwD lived alone, while tracking devices (14.9%) were more often accessible at lower age. Everyday technology was more often available for females, at increased age of the PwD and the caregiver, higher comorbidity, and poor IADL (instrumental activities of daily living) function. For PwDs with severe dementia, access to ATT was significantly associated with poor IADL function, having their children as the main caregiver (61.3%), and having caregivers who contributed 81–100% to their care (49.5%). Conclusions Home-dwelling PwDs mainly had access to traditional and obligated devices, followed by everyday technology. There is unmet potential for communication, tracking, and sensing technology, especially for devices not offered by the municipalities. Gender, ages of the PwD and caregiver, cohabitation status, and physical function were the main associated factors for access to ATT. Trial registration: ClinicalTrials.gov NCT04043364. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01627-2.
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Affiliation(s)
- Nathalie Genevieve Puaschitz
- Centre of Care Research (West), Western Norway University of Applied Sciences (HVL), 5009, Bergen, Norway. .,Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Frode Fadnes Jacobsen
- Centre of Care Research (West), Western Norway University of Applied Sciences (HVL), 5009, Bergen, Norway.,VID Specialized University, Stavanger, Norway
| | - Janne Mannseth
- Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Renira Corinne Angeles
- Centre of Care Research (West), Western Norway University of Applied Sciences (HVL), 5009, Bergen, Norway.,NORCE Norwegian Research Centre, Department of Social Science and Health Research, Health Services and Health Economics Research Group, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
| | - Marie Hidle Gedde
- Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Haraldsplass Deaconness Hospital, Bergen, Norway
| | - Bettina Sandgathe Husebo
- Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
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Hassenstab J, Nicosia J, LaRose M, Aschenbrenner AJ, Gordon BA, Benzinger TLS, Xiong C, Morris JC. Is comprehensiveness critical? Comparing short and long format cognitive assessments in preclinical Alzheimer disease. Alzheimers Res Ther 2021; 13:153. [PMID: 34517889 PMCID: PMC8436865 DOI: 10.1186/s13195-021-00894-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Comprehensive testing of cognitive functioning is standard practice in studies of Alzheimer disease (AD). Short-form tests like the Montreal Cognitive Assessment (MoCA) use a "sampling" of measures, administering key items in a shortened format to efficiently assess cognition while reducing time requirements, participant burden, and administrative costs. We compared the MoCA to a commonly used long-form cognitive battery in predicting AD symptom onset and sensitivity to AD neuroimaging biomarkers. METHODS Survival, area under the receiver operating characteristic (ROC) curve (AUC), and multiple regression analyses compared the MoCA and long-form measures in predicting time to symptom onset in cognitively normal older adults (n = 6230) from the National Alzheimer's Coordinating Center (NACC) cohort who had, on average, 2.3 ± 1.2 annual assessments. Multiple regression models in a separate sample (n = 416) from the Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight ADRC) compared the sensitivity of the MoCA and long-form measures to neuroimaging biomarkers including amyloid PET, tau PET, and cortical thickness. RESULTS Hazard ratios suggested that both the MoCA and the long-form measures are similarly and modestly efficacious in predicting symptomatic conversion, although model comparison analyses indicated that the long-form measures slightly outperformed the MoCA (HRs > 1.57). AUC analyses indicated no difference between the measures in predicting conversion (DeLong's test, Z = 1.48, p = 0.13). Sensitivity to AD neuroimaging biomarkers was similar for the two measures though there were only modest associations with tau PET (rs = - 0.13, ps < 0.02) and cortical thickness in cognitively normal participants (rs = 0.15-0.16, ps < 0.007). CONCLUSIONS Both test formats showed weak associations with symptom onset, AUC analyses indicated low diagnostic accuracy, and biomarker correlations were modest in cognitively normal participants. Alternative assessment approaches are needed to improve how clinicians and researchers monitor cognitive changes and disease progression prior to symptom onset.
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Affiliation(s)
- Jason Hassenstab
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jessica Nicosia
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Megan LaRose
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew J Aschenbrenner
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Gordon
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L S Benzinger
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Chengjie Xiong
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Ge XY, Cui K, Liu L, Qin Y, Cui J, Han HJ, Luo YH, Yu HM. Screening and predicting progression from high-risk mild cognitive impairment to Alzheimer's disease. Sci Rep 2021; 11:17558. [PMID: 34475445 PMCID: PMC8413294 DOI: 10.1038/s41598-021-96914-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/18/2021] [Indexed: 11/09/2022] Open
Abstract
Individuals with mild cognitive impairment (MCI) are clinically heterogeneous, with different risks of progression to Alzheimer's disease. Regular follow-up and examination may be time-consuming and costly, especially for MRI and PET. Therefore, it is necessary to identify a more precise MRI population. In this study, a two-stage screening frame was proposed for evaluating the predictive utility of additional MRI measurements among high-risk MCI subjects. In the first stage, the K-means cluster was performed for trajectory-template based on two clinical assessments. In the second stage, high-risk individuals were filtered out and imputed into prognosis models with varying strategies. As a result, the ADAS-13 was more sensitive for filtering out high-risk individuals among patients with MCI. The optimal model included a change rate of clinical assessments and three neuroimaging measurements and was significantly associated with a net reclassification improvement (NRI) of 0.246 (95% CI 0.021, 0.848) and integrated discrimination improvement (IDI) of 0.090 (95% CI - 0.062, 0.170). The ADAS-13 longitudinal models had the best discrimination performance (Optimism-corrected concordance index = 0.830), as validated by the bootstrap method. Considering the limited medical and financial resources, our findings recommend follow-up MRI examination 1 year after identification for high-risk individuals, while regular clinical assessments for low-risk individuals.
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Affiliation(s)
- Xiao-Yan Ge
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China
- Department of Health Statistics, School of Public Health, Jinzhou Medical University, 40 SongPo Road, Jinzhou, China
| | - Kai Cui
- Department of Health Statistics, School of Public Health, Jinzhou Medical University, 40 SongPo Road, Jinzhou, China
| | - Long Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China
| | - Yao Qin
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China
| | - Hong-Juan Han
- Department of Mathematics, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Yan-Hong Luo
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China
| | - Hong-Mei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 XinJian South Road, Taiyuan, China.
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 XinJian South Road, Taiyuan, China.
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Boo YY, Jutila OE, Cupp MA, Manikam L, Cho SI. The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA). Aging Clin Exp Res 2021; 33:2573-2586. [PMID: 33538990 PMCID: PMC8429388 DOI: 10.1007/s40520-020-01783-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/25/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life. METHODS A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables. RESULTS The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05-1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12-1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81-7.66), living with diabetes (aHR 2.30, 1.22-4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09-3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46-0.99), higher educational attainment (aHR 0.36, 0.26-0.56), and regular exercise (aHR 0.37, 0.26-0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01-1.03) and CESD-10 (aHR 1.17, 1.14-1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94-0.98), higher educational attainment (aHR 0.33, 0.26-0.43), and regular exercise (aHR 0.83, 0.74-0.92). CONCLUSION In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.
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Affiliation(s)
- Yebeen Ysabelle Boo
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK.
| | - Otto-Emil Jutila
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Meghan A Cupp
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Logan Manikam
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Quinn TJ, Richard E, Teuschl Y, Gattringer T, Hafdi M, O’Brien JT, Merriman N, Gillebert C, Huyglier H, Verdelho A, Schmidt R, Ghaziani E, Forchammer H, Pendlebury ST, Bruffaerts R, Mijajlovic M, Drozdowska BA, Ball E, Markus HS. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur Stroke J 2021; 6:I-XXXVIII. [PMID: 34746430 PMCID: PMC8564156 DOI: 10.1177/23969873211042192] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023] Open
Abstract
The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.
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Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, UK
| | - Edo Richard
- Department of Neurology, Donders
Institute for Brain, Behaviour and Cognition, Radboud University Medical
Centre, Nijmegen, The Netherlands
| | - Yvonne Teuschl
- Department for Clinical
Neurosciences and Preventive Medicine, Danube University Krems, der Donau, Austria
| | - Thomas Gattringer
- Department of Neurology and
Division of Neuroradiology, Vascular and Interventional Radiology, Department of
Radiology, Medical University of
Graz, Graz, Austria
| | - Melanie Hafdi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of
Clinical Medicine, Cambridge, UK
| | - Niamh Merriman
- Deptartment of Health Psychology,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin, Ireland
| | - Celine Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational
Psychological Research (TRACE), KU Leuven – Hospital
East-Limbourgh, Genk, Belgium
| | - Hanne Huyglier
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational
Psychological Research (TRACE), KU Leuven – Hospital
East-Limbourgh, Genk, Belgium
| | - Ana Verdelho
- Department of Neurosciences and
Mental Health, Hospital de Santa Maria, Lisbon, Portugal
| | - Reinhold Schmidt
- Department of Neurology, Medical University of
Graz, Graz, Austria
| | - Emma Ghaziani
- Department of Physical and
Occupational Therapy, Bispebjerg and Frederiksberg
Hospital, Copenhagen, Denmark
| | | | - Sarah T Pendlebury
- Departments of Medicine and
Geratology and NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
| | - Rose Bruffaerts
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Milija Mijajlovic
- Neurosonology Unit, Neurology
Clinic, University Clinical Center of Serbia
and Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Bogna A Drozdowska
- Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily Ball
- Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Hugh S Markus
- Stroke Research Group, Department
of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Cogo-Moreira H, Krance SH, Black SE, Herrmann N, Lanctôt KL, MacIntosh BJ, Eid M, Swardfager W. Questioning the Meaning of a Change on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): Noncomparable Scores and Item-Specific Effects Over Time. Assessment 2021; 28:1708-1722. [PMID: 32406251 PMCID: PMC8392777 DOI: 10.1177/1073191120915273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Longitudinal invariance indicates that a construct is measured over time in the same way, and this fundamental scale property is a sine qua non to track change over time using ordinary mean comparisons. The Alzheimer's Disease Assessment Scale-cognitive (ADAS-Cog) and its subscale scores are often used to monitor the progression of Alzheimer's disease, but longitudinal invariance has not been formally evaluated. A configural invariance model was used to evaluate ADAS-Cog data as a three correlated factors structure for two visits over 6 months, and four visits over 2 years (baseline, 6, 12, and 24 months) among 341 participants with Alzheimer's disease. We also attempted to model ADAS-Cog subscales individually, and furthermore added item-specific latent variables. Neither the three-correlated factors ADAS-Cog model, nor its subscales viewed unidimensionally, achieved longitudinal configural invariance under a traditional modeling approach. No subscale achieved scalar invariance when considered unidimensional across 6 months or 2 years of assessment. In models accounting for item-specific effects, configural and metric invariance were achieved for language and memory subscales. Although some of the ADAS-Cog individual items were reliable, comparisons of summed ADAS-Cog scores and subscale scores over time may not be meaningful due to a lack of longitudinal invariance.
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Affiliation(s)
- Hugo Cogo-Moreira
- Freie Universität Berlin, Berlin, Germany
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Saffire H. Krance
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Sandra E. Black
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Krista L. Lanctôt
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Bradley J. MacIntosh
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Walter Swardfager
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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137
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Yeh TP, Chen HC, Ma WF. A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8901. [PMID: 34501495 PMCID: PMC8430645 DOI: 10.3390/ijerph18178901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.
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Affiliation(s)
- Tzu-Pei Yeh
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Nursing Department, China Medical University Hospital, Taichung 406404, Taiwan
| | - Hsing-Chia Chen
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan;
| | - Wei-Fen Ma
- Nursing Department, China Medical University Hospital, Taichung 406404, Taiwan
- Ph.D. Program for Health Science and Industry, College of Health Care, China Medical University, Taichung 406040, Taiwan
- School of Nursing, China Medical University Hospital, Taichung 406040, Taiwan
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138
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Elsherif M, Esmael A. Hippocampal atrophy and quantitative EEG markers in mild cognitive impairment in temporal lobe epilepsy versus extra-temporal lobe epilepsy. Neurol Sci 2021; 43:1975-1986. [PMID: 34406537 DOI: 10.1007/s10072-021-05540-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cognitive impairment in temporal lobe epilepsy is widely acknowledged as one of the most well-known comorbidities. This study aimed to explore cognitive impairment and to determine the potential clinical, radiological, and quantitative electroencephalography markers for cognitive impairment in temporal lobe epilepsy patients versus extra-temporal lobe epilepsy. METHODS Forty-five patients with temporal lobe epilepsy and forty-five patients with extra-temporal lobe epilepsy were recruited for an administered digit span test, verbal fluency test, mini-mental state examination, digital symbol test, and Montreal cognitive assessment. Also, they were subjected to magnetic resonance imaging assessment for hippocampal atrophy and a quantitative electroencephalography assessment for electroencephalography markers (median frequency, peak frequency, and the alpha-to-theta ratio). RESULTS Patients with extra-temporal lobe epilepsy showed non-significant higher epilepsy durations and a higher frequency of seizures. Temporal lobe epilepsy patients showed a more statistically significant family history of epilepsy (37.7%), more history of febrile convulsions (13.3%), higher hippocampal atrophy (17.8%), and lower cognitive scales, especially mini-mental state examination and Montreal cognitive assessment; lower digital symbol test, verbal fluency test, and backward memory of digit span test. Also, temporal lobe epilepsy patients had a strong negative correlation with electroencephalography markers: median frequency, peak frequency, and the alpha-to-theta ratio (r = - 0.68, P < 0.005 and r = - 0.64, P < 0.005 and r = - 0.66, P < 0.005 respectively). CONCLUSION Cognitive impairment in patients with temporal lobe epilepsy was correlated with hippocampal atrophy and quantitative electroencephalography abnormalities, especially peak frequency, median frequency, and alpha-to-theta ratio that could be used alone for the identification of early cognitive impairment. TRIAL REGISTRATION Clinicaltrials.gov: NCT04376671.
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Affiliation(s)
- Mohammed Elsherif
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Dakahlia, Egypt.
| | - Ahmed Esmael
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Dakahlia, Egypt
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139
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Xie L, Pu M, Liu Y. The effect of individual nursing on improving the living ability and blood sugar control of Alzheimer disease patients with diabetes mellitus. Am J Transl Res 2021; 13:9324-9331. [PMID: 34540049 PMCID: PMC8430077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effect of individual nursing on Alzheimer disease (AD) patients with diabetes mellitus. METHODS A total of 119 patients with AD complicated with diabetes admitted to our hospital from January 2017 to January 2019 were selected for prospective analysis, and 64 patients received individual nursing mode, which were regarded as the personality group (PG). Another 55 patients received routine nursing mode and were regarded as the regular group (RG). The curative effect of AD, blood glucose, living ability, cognitive function, self-care ability and nursing satisfaction of the two groups were investigated. RESULTS There was no difference between the two groups in AD curative effect and cognitive function (P > 0.05), and the blood sugar control, living ability, self-care ability and nursing satisfaction of the PG were higher than those of the RG (P < 0.05). CONCLUSION Individual nursing can effectively improve the ability of blood sugar control and daily life of AD patients with diabetes mellitus, and greatly enhance the patients' trust, dependence, and satisfaction with medical staff, which is worth popularizing in clinical practice.
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Affiliation(s)
- Lanlan Xie
- Department of Neurology, Xingtai People's Hospital Xingtai 054000, Hebei Province, China
| | - Mengmeng Pu
- Department of Neurology, Xingtai People's Hospital Xingtai 054000, Hebei Province, China
| | - Yalin Liu
- Department of Neurology, Xingtai People's Hospital Xingtai 054000, Hebei Province, China
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140
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Liss JL, Seleri Assunção S, Cummings J, Atri A, Geldmacher DS, Candela SF, Devanand DP, Fillit HM, Susman J, Mintzer J, Bittner T, Brunton SA, Kerwin DR, Jackson WC, Small GW, Grossberg GT, Clevenger CK, Cotter V, Stefanacci R, Wise‐Brown A, Sabbagh MN. Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis. J Intern Med 2021; 290:310-334. [PMID: 33458891 PMCID: PMC8359937 DOI: 10.1111/joim.13244] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
The critical role of primary care clinicians (PCCs) in Alzheimer's disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: no longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stems from a focus on preventive interventions in midlife and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (i.e. MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (i.e. biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment and the role of biomarkers in the clinic.
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Affiliation(s)
| | - S. Seleri Assunção
- US Medical Affairs – Neuroscience, Genentech, A Member of the Roche GroupSouth San FranciscoCAUSA
| | - J. Cummings
- Chambers‐Grundy Center for Transformative NeuroscienceDepartment of Brain HealthSchool of Integrated Health SciencesUniversity of NevadaLas VegasNVUSA
- Lou Ruvo Center for Brain Health – Cleveland Clinic NevadaLas VegasNVUSA
| | - A. Atri
- Banner Sun Health Research InstituteSun CityAZUSA
- Center for Brain/Mind MedicineDepartment of NeurologyBrigham and Women’s HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - D. S. Geldmacher
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - S. F. Candela
- Health & Wellness Partners, LLCUpper Saddle RiverNJUSA
| | - D. P. Devanand
- Division of Geriatric PsychiatryNew York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNYUSA
| | - H. M. Fillit
- Departments of Geriatric Medicine, Medicine, and NeuroscienceIcahn School of Medicine and Mt. SinaiNew YorkNYUSA
- Alzheimer’s Drug Discovery FoundationNew YorkNYUSA
| | - J. Susman
- Department of Family and Community MedicineNortheast Ohio Medical UniversityRootstownOHUSA
| | - J. Mintzer
- Roper St Francis HealthcareCharlestonSCUSA
- Ralph H. Johnson VA Medical CenterCharlestonSCUSA
| | | | - S. A. Brunton
- Department of Family MedicineTouro UniversityVallejoCAUSA
| | - D. R. Kerwin
- Kerwin Medical CenterDallasTXUSA
- Department of Neurology and NeurotherapeuticsUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - W. C. Jackson
- Departments of Family Medicine and PsychiatryUniversity of Tennessee College of MedicineMemphisTNUSA
| | - G. W. Small
- Division of Geriatric PsychiatryUCLA Longevity CenterSemel Institute for Neuroscience & Human BehaviorUniversity of California – Los AngelesLos AngelesCAUSA
| | - G. T. Grossberg
- Division of Geriatric PsychiatrySt Louis University School of MedicineSt LouisMOUSA
| | - C. K. Clevenger
- Department of NeurologyNell Hodgson Woodruff School of NursingEmory UniversityAtlantaGAUSA
| | - V. Cotter
- Johns Hopkins School of NursingBaltimoreMDUSA
| | - R. Stefanacci
- Jefferson College of Population HealthThomas Jefferson UniversityPhiladelphiaPAUSA
| | - A. Wise‐Brown
- US Medical Affairs – Neuroscience, Genentech, A Member of the Roche GroupSouth San FranciscoCAUSA
| | - M. N. Sabbagh
- Lou Ruvo Center for Brain Health – Cleveland Clinic NevadaLas VegasNVUSA
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Amini A, Vaezmousavi M, Shirvani H. The effectiveness of cognitive-motor training on reconstructing cognitive health components in older male adults, recovered from the COVID-19. Neurol Sci 2021; 43:1395-1403. [PMID: 34328579 PMCID: PMC8322109 DOI: 10.1007/s10072-021-05502-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/22/2021] [Indexed: 11/09/2022]
Abstract
Objective The incidence of COVID-19 disease in the elderly can accelerate normal degenerative process of cognitive functions. Interactive cognitive-motor training (CMT) is an intervention that integrates cognitive and motor tasks to promote individuals’ physical and psychological health. The present study aimed to examine the effect of CMT on reconstructing cognitive health components in older men, who have recently recovered from COVID-19. Materials and methods This study is a quasi-experimental repeated measure (without control group). Participants were 42 elderly men (65–80 years) who recovered from the COVID-19 disease that individually participated in a 4-week CMT program twice a week. The cognitive health components of the participants were assessed by the General Health Questionnaire (GHQ-2) and the Mini-Mental State Examination (MMSE) at 3 stages before the beginning of the intervention (baseline assessment); 2 weeks after the intervention (short-term follow-up); and 3 months after the intervention (long-term follow-up). Results The results showed that the scores of depression, anxiety, physical symptoms, and social performance components and the overall GHQ score improved significantly in short-term follow-up (P < 0.05) and also in long-term follow-up compared to baseline assessment (P < 0.05). It was also found that attention and calculation, recall, lingual skill, and action performance components and the overall score of MMSE were also improved at three stages of assessments. Other components did not differ among stages. Conclusions This study adds to the research on the effectiveness of using CMT for reconstructing cognitive health components in older adults, recovered from the COVID-19, and supports CMT as a viable intervention practice.
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Affiliation(s)
- Amin Amini
- Department of Knowledge and Cognitive Intelligence, Imam Hossein University, Tehran, Iran
| | - Mohammad Vaezmousavi
- Department of Knowledge and Cognitive Intelligence, Imam Hossein University, Tehran, Iran
| | - Hossein Shirvani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Warren SL, Moustafa AA, Alashwal H. Harnessing forgetfulness: can episodic-memory tests predict early Alzheimer's disease? Exp Brain Res 2021; 239:2925-2937. [PMID: 34313791 DOI: 10.1007/s00221-021-06182-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/16/2021] [Indexed: 01/04/2023]
Abstract
A rapid increase in the number of patients with Alzheimer's disease (AD) is expected over the next decades. Accordingly, there is a critical need for early-stage AD detection methods that can enable effective treatment strategies. In this study, we consider the ability of episodic-memory measures to predict mild cognitive impairment (MCI) to AD conversion and thus, detect early-stage AD. For our analysis, we studied 307 participants with MCI across four years using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Using a binary logistic regression, we compared episodic-memory tests to each other and to prominent neuroimaging methods in MCI converter (MCI participants who developed AD) and MCI non-converter groups (MCI participants who did not develop AD). We also combined variables to test the accuracy of mixed-predictor models. Our results indicated that the best predictors of MCI to AD conversion were the following: a combined episodic-memory and neuroimaging model in year one (59.8%), the Rey Auditory Verbal Learning Test in year two (71.7%), a mixed episodic-memory predictor model in year three (77.7%) and the Logical Memory Test in year four (77.2%) of ADNI. Overall, we found that individual episodic-memory measure and mixed models performed similarly when predicting MCI to AD conversion. Comparatively, individual neuroimaging measures predicted MCI conversion worse than chance. Accordingly, our results indicate that episodic-memory tests could be instrumental in detecting early-stage AD and enabling effective treatment.
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Affiliation(s)
- Samuel L Warren
- School of Psychology, Western Sydney University, Sydney, Australia.
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, Australia.,MARCS Institute for Brain and Behaviour, Western Sydney University, Sydney, Australia
| | - Hany Alashwal
- College of Information Technology, United Arab Emirates University, Al-Ain, 15551, United Arab Emirates
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Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2021; 7:CD010783. [PMID: 34313331 PMCID: PMC8406467 DOI: 10.1002/14651858.cd010783.pub3] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. OBJECTIVES To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment SEARCH METHODS: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. SELECTION CRITERIA We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. DATA COLLECTION AND ANALYSIS We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. MAIN RESULTS In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. AUTHORS' CONCLUSIONS Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.
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Affiliation(s)
- Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Erick Sanchez-Perez
- Neurosciences, Hospital Infantil Universitario de San José-FUCS, Bogotá, Colombia
| | - Antri Giannakou
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Olga L Pedraza
- Neurosciences, Hospital Infantil Universitario de San José-FUCS, Bogotá, Colombia
| | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Carotenuto A, Traini E, Fasanaro AM, Battineni G, Amenta F. Tele-Neuropsychological Assessment of Alzheimer's Disease. J Pers Med 2021; 11:jpm11080688. [PMID: 34442332 PMCID: PMC8398333 DOI: 10.3390/jpm11080688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Because of the new pandemic caused by the novel coronavirus disease (COVID-19), the demand for telemedicine and telemonitoring solutions has been exponentially raised. Because of its special advantage to treat patients in an emergency without physical presence at a hospital via video conferencing, telemedicine has been used to overcome distance barriers and to improve access to special domains like neurology. In these pandemic times, telemedicine has been also employed as a support for the diagnosis and treatment of adult-onset dementia disorders including Alzheimer’s disease. Objective: In this study, we carried out a systematic literature analysis to clarify if the neuropsychological tests traditionally employed in face-to-face (FTF) contexts are reliable via telemedicine. Methods: A systematic literature search for the past 20 years (2001–2020) was carried out through the medical databases PubMed (Medline) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The quality assessment was conducted by adopting the Newcastle Ottawa Scale (NOS) and only studies with a NOS ≥ 7 were included in this review. Results: The Mini-Mental State Examination (MMSE) results do not differ when tests are administered in the traditional FTF modality or by videoconference, and only negligible minor changes in the scoring system were noticeable. Other neuropsychological tests used to support the diagnosis of AD and dementia such as the Token Test, the Comprehension of Words and Phrases (ACWP), the Controlled Oral Word Association Test showed high reliability between the two modalities considered. No differences in the reliability concerning the living setting or education of the subjects were reported. Conclusions: The MMSE, which is the main screening test for dementia, can be administered via telemedicine with minor adaptation in the scoring system. Telemedicine use for other neuropsychological tests also resulted in general reliability and enough accuracy. Cognitive assessment by videoconference is accepted and appreciated and therefore can be used for dementia diagnosis in case of difficulties to performing FTF assessments. This approach can be useful given a personalized medicine approach for the treatment of adult-onset dementia disorders.
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Affiliation(s)
- Anna Carotenuto
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Enea Traini
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Angiola Maria Fasanaro
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Gopi Battineni
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
- Correspondence: ; Tel.: +39-333-172-8206
| | - Francesco Amenta
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
- Research Department, International Radio Medical Centre (C.I.R.M.), Via dell’Architettura 41, 00144 Roma, Italy
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Cunnane SC, Sieber CC, Swerdlow RH, Cruz-Jentoft AJ. Mild cognitive impairment: when nutrition helps brain energy rescue-a report from the EuGMS 2020 Congress. Eur Geriatr Med 2021; 12:1285-1292. [PMID: 34227053 PMCID: PMC8626370 DOI: 10.1007/s41999-021-00534-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is characterized by a decline in cognition and mainly affects older individuals above the age of 60. The global incidence of MCI varies, but it is often underdiagnosed and untreated. There is a distinct lack of approved pharmacologic options to treat MCI. There is, however, evidence to support the efficacy of nutritional interventions, such as ketogenic supplements/diets, which offer ketones as an alternative energy source to brain cells. This article explores the effect of ketones on metabolic activity in the brain and the mechanisms by which ketogenic medium-chain triglycerides (kMCTs) induce ketosis in patients with MCI. KEY TAKEAWAYS This article reviews the effect of ketogenic supplements/diets on brain metabolism, including evidence supporting the efficacy of ketones as an efficient fuel for the brain. It discusses the use of oral nutritional ketogenic supplements, with particular reference to the 6-month randomized controlled BENEFIC trial, which showed that consumption of a kMCT drink, BrainXpert Energy Complex, improved cognitive performance in individuals with MCI compared with placebo. CONCLUSION While there is a need for more long-term studies, results from the BENEFIC trial revealed the benefits of a brain-specific ketogenic supplement, as a nutritional intervention, on cognitive performance in individuals with MCI.
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Affiliation(s)
- Stephen C Cunnane
- Research Center on Aging and Department of Medicine, Université de Sherbrooke, Québec, Canada
| | - Cornel C Sieber
- Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Center, KUMC Neurodegenerative Disorders Program, University of Kansas School of Medicine, Lawrence, KS, USA
| | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra. Colmenar km 9.1, Madrid, 28034, Spain.
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146
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Past, present and future role of retinal imaging in neurodegenerative disease. Prog Retin Eye Res 2021; 83:100938. [PMID: 33460813 PMCID: PMC8280255 DOI: 10.1016/j.preteyeres.2020.100938] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.
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147
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The Association between Tau Protein Level in Cerebrospinal Fluid and Cognitive Status: A Large-Scale Analysis of GAAIN Database. Brain Sci 2021; 11:brainsci11070861. [PMID: 34209512 PMCID: PMC8301769 DOI: 10.3390/brainsci11070861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/26/2022] Open
Abstract
Alzheimer’s disease (AD) and the associated neurodegenerative dementia have become of increasing concern in healthcare. The tau protein has been considered a key hallmark of progressive neurodegeneration. In this paper, a large-scale analysis of five datasets (more than 2500 people) from the Global Alzheimer’s Association Interactive Network (GAAIN) databases was performed to investigate the association between the level of tau protein, including total tau and phosphorylated tau (p-tau), in cerebrospinal fluid (CSF) and cognitive status. Statistically significant (or marginally significant) high total tau or p-tau concentrations in CSF were observed in dementia patients compared with healthy people in all datasets. There is also a statistically significant (or marginally significant) negative correlation between p-tau concentrations in CSF and Folstein Mini-Mental State Examination (MMSE) scores. In addition, transcriptomic data derived from mouse microglial cells showed multiple genes upregulated in Toll-like receptor signaling and Alzheimer’s disease pathways, including TNF, TLR2, IL-1β, and COX subunits, suggesting that the mechanism of action that relates p-tau and MMSE scores may be through overactivation of pro-inflammatory microglial activity by Aβ peptides, TNF-mediated hyperphosphorylation of tau, and the infectious spread of pathological tau across healthy neurons. Our results not only confirmed the association between tau protein level and cognitive status in a large population but also provided useful information for the understanding of the role of tau in neurodegeneration and the development of dementia.
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148
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Chen J, Ying X, Yang D. Propofol combined with remifentanil reduces the adverse reactions of patients undergoing laparoscopic cholecystectomies. Am J Transl Res 2021; 13:6560-6567. [PMID: 34306397 PMCID: PMC8290765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effectiveness of using isoflurane and propofol combined with remifentanil in laparoscopic cholecystectomies (LC). METHODS A total of 118 patients undergoing LC in our hospital from April 2018 to January 2019 were recruited as the study cohort. 56 of the patients were anesthetized with isoflurane combined with remifentanil during their operations (the IR group), and the other 62 patients were anesthetized with propofol combined with remifentanil during their operations (the PR group). The effects of the two anesthesia methods on the hemodynamics and stress responses were compared, and the postoperative recoveries, adverse reactions, analgesia, and cognitive functions were recorded. RESULTS Compared with the IR group, the average arterial pressure, heart rate, norepinephrine, and cortisol decreased in the PR group. Compared with the IR group, the total postoperative adverse reaction rate was lower in the PR group. Compared with the IR group, the spontaneous respiration recovery times, the times to opening eyes, and the extubation times were significantly shortened in the PR group. There was no significant difference in the postoperative pain levels between the two groups. Compared with the IR group, the postoperative cognitive function assessment was better in the PR group. CONCLUSION Compared with isoflurane combined with remifentanil, propofol combined with remifentanil has a smaller impact on the hemodynamics and cognitive functions of patients undergoing LC, and it causes a more significant reduction in the stress response. In addition, its postoperative adverse reactions are lower, so it is worthy of promoting in clinical practice.
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Affiliation(s)
- Juhui Chen
- Department of Anesthesiology, College of Medicine, Zhejiang University, Sir Run Run Shaw Hospital Hangzhou 310015, Zhejiang Province, China
| | - Xiaogang Ying
- Department of Anesthesiology, College of Medicine, Zhejiang University, Sir Run Run Shaw Hospital Hangzhou 310015, Zhejiang Province, China
| | - Danfeng Yang
- Department of Anesthesiology, College of Medicine, Zhejiang University, Sir Run Run Shaw Hospital Hangzhou 310015, Zhejiang Province, China
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149
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Riello M, Rusconi E, Treccani B. The Role of Brief Global Cognitive Tests and Neuropsychological Expertise in the Detection and Differential Diagnosis of Dementia. Front Aging Neurosci 2021; 13:648310. [PMID: 34177551 PMCID: PMC8222681 DOI: 10.3389/fnagi.2021.648310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential.
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Affiliation(s)
- Marianna Riello
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Elena Rusconi
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Barbara Treccani
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
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150
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Khazaal W, Taliani M, Boutros C, Abou-Abbas L, Hosseini H, Salameh P, Sadier NS. Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon. Front Psychol 2021; 12:663267. [PMID: 34177717 PMCID: PMC8222528 DOI: 10.3389/fpsyg.2021.663267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: Stroke continues to be a common and debilitating medical condition which has a significant effect on public health as the second primary source of mortality and the third major root of disability worldwide. A wide range of complications affecting the survivor's life and interfering with the recovery process usually follows stroke; anxiety and depression are considered one of the major complications post-stroke. This study sought to investigate the short-term psychological consequences of stroke among Lebanese survivors and to identify their correlates. Methods: This study is a prospective observational epidemiological study. 143 stroke patients admitted to hospitals in Mount Lebanon and Beirut between February and May 2018.were included in this study. Assessments of complications were carried out at 3 months post-stroke by completing a 30-min face-to-face interview questionnaire. The survey included the socio-demographic -characteristics of the patients, their lifestyle, health indicators, the severity of stroke, and the post-stroke consequences disturbing their quality of life. Results: Complications were recorded for 117 stroke survivors (mean age, 72.46 years; 60.7% male). The analysis of results 3 months post stroke showed that 29 survivors suffered from neuropathic pain (24.8%), 110 (94%) suffered from fatigue, and 81 (69.2%) from cognitive impairment. High rates of anxiety (51.3%), and depression (76.1%) were recorded as well. Multivariate logistic regression confirmed that there is a significant association between depression and the following variables: anxiety (OR = 4.814, p-value = 0.017), pain (OR = 6.868, p-value = 0.002), and physical activity, which acts as a protective factor against depression (OR = 0.261; p-value = 0.029). However, the results of the multivariate logistic regression analysis for anxiety indicated that immobility-related complications increase the risk of anxiety by 8.457 in sedentary duration longer than 12 h (ORa = 8.457, p-value = 0.01). Furthermore, patients with neuropathic pain (24.8%) are 3.858 times more likely to have anxiety compared to patients without neuropathic pain (ORa = 3.858, p-value = 0.019). Conclusion: Using a patient-centered structure more interventions should take place to evaluate stroke survivors' outcomes, and organize rehabilitation services that deal with stroke consequences, particularly high anxiety and depression levels, which are prevalent and persistent among the Lebanese stroke survivors.
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Affiliation(s)
- Walaa Khazaal
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Celina Boutros
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.,Institut National de Sante Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,University of Nicosia Medical school, Nicosia, Cyprus
| | - Najwane Said Sadier
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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