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Hahn L, Kessler J. A new scoring system for increasing the sensitivity of the MMSE. Z Gerontol Geriatr 2019; 53:156-162. [PMID: 30805664 DOI: 10.1007/s00391-019-01516-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The mini mental state examination (MMSE) has been criticized for its lack of sensitivity, especially in mild cases of dementia. There have been several attempts to increase the sensitivity by adding or deleting items, which never became accepted in clinical practice. OBJECTIVE In the current study a new scoring system for improving the sensitivity of the MMSE is proposed, which preserves the original items and the total score of 30 points. Instead of changing the number of items or the total score of 30 points, the weighting of the different items in the total score of 30 points was changed. MATERIAL AND METHODS Neuropsychological test data of 765 patients were retrospectively included in the study to determine the difficulty of each MMSE item. Multiple scoring systems for the MMSE were developed by inclusion of the item difficulty and clinical relevance. The sensitivity of the new scoring system was compared to the original scoring system by using the DemTect as an established measure. RESULTS The results showed that an increase of 24.3% in sensitivity was statistically significant. Within the mild cognitive impairment subgroup, the sensitivity of the new scoring system was twice as high in comparison to the original MMSE and within the dementia group the sensitivity was increased by 8.2%. CONCLUSION A new scoring system with a higher sensitivity than the original MMSE was developed, which can easily be administered in clinical practice because it preserves all items and the total score of 30 points.
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Affiliation(s)
- Lisa Hahn
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Josef Kessler
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Kan KC, Subramaniam P, Shahrizaila N, Kamaruzzaman SB, Razali R, Ghazali SE. Validation of the Malay Version of Addenbrooke's Cognitive Examination III in Detecting Mild Cognitive Impairment and Dementia. Dement Geriatr Cogn Dis Extra 2019; 9:66-76. [PMID: 31043965 PMCID: PMC6477467 DOI: 10.1159/000495107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Aims This study aimed to investigate the validity and reliability of the Malay version of Addenbrooke's Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and dementia. Methods A total of 152 participants (dementia = 53, MCI = 38, controls = 61) were recruited from two teaching hospitals. The Malay version of ACE-III was translated following the standard guidelines for cross-cultural adaptation of measure. All the participants were assessed with the Malay version of ACE-III and Mini-Mental State Examination (MMSE). Results The reliability of the Malay version of ACE-III was good with Cronbach's α coefficient of 0.829 and intraclass correlation coefficient of 0.959. There was a strong positive correlation between the Malay version of ACE-III and MMSE (r = 0.806). Age (r = -0.335) and years of education (r = 0.536) exerted a significant correlation with total score performance. The cutoff score to discriminate dementia from healthy controls was 74/75 (sensitivity = 90.6%, specificity = 82.0%) whereas to discriminate MCI, the cutoff score was 77/78 (sensitivity = 63.2%, specificity = 63.9%). The diagnostic accuracy of ACE-III was higher than that of MMSE in the detection of dementia (area under the curve: ACE-III = 0.929 vs. MMSE = 0.915). Conclusions The Malay version of ACE-III demonstrated to be a reliable and valid screening tool for dementia.
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Affiliation(s)
- Kwai Ching Kan
- Health Psychology Programme, School of Healthcare Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme, School of Healthcare Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Geriatric Mental Health Sciences, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatric, Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rosdinom Razali
- Department of Psychiatry, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shazli Ezzat Ghazali
- Health Psychology Programme, School of Healthcare Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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253
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Thomas R, Sims R, Beller E, Scott AM, Doust J, Le Couteur D, Pond D, Loy C, Forlini C, Glasziou P. An Australian community jury to consider case-finding for dementia: Differences between informed community preferences and general practice guidelines. Health Expect 2019; 22:475-484. [PMID: 30714290 PMCID: PMC6543153 DOI: 10.1111/hex.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 01/13/2023] Open
Abstract
Background Case‐finding for dementia is practised by general practitioners (GPs) in Australia but without an awareness of community preferences. We explored the values and preferences of informed community members around case‐finding for dementia in Australian general practice. Design, setting and participants A before and after, mixed‐methods study in Gold Coast, Australia, with ten community members aged 50‐70. Intervention A 2‐day citizen/community jury. Participants were informed by experts about dementia, the potential harms and benefits of case‐finding, and ethical considerations. Primary and secondary outcomes We asked participants, “Should the health system encourage GPs to practice ‘case‐finding’ of dementia in people older than 50?” Case‐finding was defined as a GP initiating testing for dementia when the patient is unaware of symptoms. We also assessed changes in participant comprehension/knowledge, attitudes towards dementia and participants’ own intentions to undergo case‐finding for dementia if it were suggested. Results Participants voted unanimously against case‐finding for dementia, citing a lack of effective treatments, potential for harm to patients and potential financial incentives. However, they recognized that case‐finding was currently practised by Australian GPs and recommended specific changes to the guidelines. Participants increased their comprehension/knowledge of dementia, their attitude towards case‐finding became less positive, and their intentions to be tested themselves decreased. Conclusion Once informed, community jury participants did not agree case‐finding for dementia should be conducted by GPs. Yet their personal intentions to accept case‐finding varied. If case‐finding for dementia is recommended in the guidelines, then shared decision making is essential.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - David Le Couteur
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimity Pond
- School of Medicine and Public Health, The University of Newcastle, Sydney, New South Wales, Australia
| | - Clement Loy
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Cynthia Forlini
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
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Validation of MoCA-MMSE Conversion Scales in Korean Patients with Cognitive Impairments. Dement Neurocogn Disord 2019; 17:148-155. [PMID: 30906404 PMCID: PMC6425884 DOI: 10.12779/dnd.2018.17.4.148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Two conversion scales between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) have been validated for Korean patients with Parkinson's disease. The aim of the present study was to validate these conversion scales for all patients with cognitive impairments regardless of dementia subtype. Methods Medical records of 323 subjects who completed both MMSE and MoCA on the same day were retrospectively reviewed. Mean, median, and root mean squared error (RMSE) of the difference between true and equivalent MMSE scores were calculated. Intraclass correlation coefficients (ICCs) between true and equivalent MMSE scores were also calculated. The validity of MoCA-MMSE conversion scales was evaluated according to educational level (low educated: ≤6 years; high educated: ≥7 years) and subtypes of cognitive impairment. Results The difference between true and equivalent MMSE scores had a median value of 0, a mean value of 0.19 according to the van Steenoven scale, a mean value of 0.57 according to the Lawton scale, RMSE value of 2.2 according to the van Steenoven scale, and RMSE value of 0.42 according to the Lawton scale. Additionally, ICCs between true and equivalent MMSE scores were 0.92 and 0.90 on van Steenovan and Lawton conversion scales, respectively. These results were maintained in subgroup analyses. Conclusions Findings of the present study suggest that both van Steenovan and Lawton MoCA-MMSE conversion scales are applicable to transforming MoCA scores into MMSE scores in patients with cognitive impairments regardless of dementia subtype or educational level.
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255
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Meguro K, Dodge HH. Vascular Mild Cognitive Impairment: Identifying Disease in Community-Dwelling Older Adults, Reducing Risk Factors, and Providing Support. The Osaki-Tajiri and Kurihara Projects. J Alzheimers Dis 2019; 70:S293-S302. [PMID: 30909215 PMCID: PMC6699913 DOI: 10.3233/jad-180899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/15/2023]
Abstract
Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or "hidden" in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI.
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Affiliation(s)
- Kenichi Meguro
- Geriatric Behavioral Neurology Project, New Industry Creation Hatchery Center (NICHe), Tohoku University, Sendai, Japan
- The Osaki-Tajiri SKIP Center, Osaki, Japan
| | - Hiroko H. Dodge
- Department of Neurology, Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health and Science University, Portland, OR, USA
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256
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Samaei A, Nobahar M, Hydarinia-Naieni Z, Ebrahimian AA, Tammadon MR, Ghorbani R, Vafaei AA. Effect of valerian on cognitive disorders and electroencephalography in hemodialysis patients: a randomized, cross over, double-blind clinical trial. BMC Nephrol 2018; 19:379. [PMID: 30591031 PMCID: PMC6309073 DOI: 10.1186/s12882-018-1134-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/12/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prevalence of cognitive disorders in hemodialysis patients is twice as high as the general population, while these disorders often are undiagnosed. Timely prevention and treatment can improve their personal and social functions. Aim of study was determined the effect of Valerian on cognitive disorders and electroencephalography (EGG) in hemodialysis patients. METHODS This crossover, double-blind clinical trial was conducted on 39 hemodialysis patients. The patients were randomly divided into two groups. Group A (n = 19) took Valerian capsules and Group B (n = 20) received placebo capsules 60 min before bedtime for one month. The type of treatment was replaced between the two groups after a one-month wash-out. The Mini Mental State Examination (MMSE) questionnaire was completed and EGG was performed before and after intervention in both periods. RESULTS The cognitive scores of the Group valerian were increased significantly in the first (p = 0.003) and the second (p = 0.005) periods. In addition, the mean increase in the cognitive scores in the Group valerian was significant in the first (p = 0.028) and the second periods (p = 0.030). However, the changes in EGG showed no significant difference before and after intervention in two groups. CONCLUSION The findings of this study indicated that valerian could be effective and significantly improve patients' cognitive status; however, no significant changes were observed in the electroencephalography of the hemodialysis patients. TRIAL REGISTRATION IRCT201606076318N7 -2016-06-17.
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Affiliation(s)
- Afshin Samaei
- Research Center and Department of Physiology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center and Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, 3513138111 Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Abbas Ali Ebrahimian
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Raheb Ghorbani
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ali Vafaei
- Rehabilitation Research Center, Neurology Department, Kowsar Hospital, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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257
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Black CM, Ritchie CW, Khandker RK, Wood R, Jones E, Hu X, Ambegaonkar BM. Non-professional caregiver burden is associated with the severity of patients' cognitive impairment. PLoS One 2018; 13:e0204110. [PMID: 30521532 PMCID: PMC6283568 DOI: 10.1371/journal.pone.0204110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives To analyse the relationship between caregiver burden and severity of patients’ cognitive impairment. Design Data were drawn from the cross-sectional 2015/2016 Adelphi Real World Dementia Disease-Specific Programme. Setting This research was multi-national and studied physicians and their consulting patients with cognitive impairment. Participants 1,201 caregivers completed self-assessment forms. Measurements Validated instruments of caregiver wellbeing and burden (EQ-5D-3L questionnaire, EQ-VAS, Zarit Burden Interview, and Work Productivity and Activity Impairment questionnaire) and number of caregiver hours were analysed by severity of patients’ cognitive impairment, categorised according to the Mini-Mental State Examination. Data were analysed using Spearman’s rank correlation coefficients and ordinary least squares regression models, to compare outcomes between caregivers of patients with prodromal, mild, moderate, and severe dementia. Results The majority of caregivers were female (69.1%), lived with the patient they cared for (75.8%), and only approximately one third (28.3%) were in part- or full-time employment. There were statistically significant (p<0.001) increases in caregiver time (36.9 versus 108.6 hours per week for prodromal versus severe dementia, respectively) and measures of caregiver burden and health status (EQ-5D-3L, EQ-VAS, and Zarit Burden Interview) and increases in measures of work productivity and activity impairment with increasing severity of patients’ disease. Conclusion This study of real-world data confirmed an association between increased caregiver burden and severity of patients’ cognitive impairment by analysis of a wide range of validated measures of caregiver burden. These findings suggest that maintaining patients in the earliest stages of their disease for as long as possible may potentially help to protect caregiver wellbeing, although further research is required to confirm this hypothesis.
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Affiliation(s)
- Christopher M. Black
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Craig W. Ritchie
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rezaul K. Khandker
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Robert Wood
- Adelphi Real World, Macclesfield, United Kingdom
| | - Eddie Jones
- Adelphi Real World, Macclesfield, United Kingdom
- * E-mail:
| | - Xiaohan Hu
- University of Southern California, Los Angeles, California, United States of America
| | - Baishali M. Ambegaonkar
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
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258
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Straubmeier M, Behrndt EM, Seidl H, Özbe D, Luttenberger K, Graessel E. Non-Pharmacological Treatment in People With Cognitive Impairment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:815-821. [PMID: 29249224 DOI: 10.3238/arztebl.2017.0815] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/11/2017] [Accepted: 09/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A number of non-pharmacological methods are available to help elderly people with cognitive impairment. Unstructured and non-evidencebased interventions are commonly used. The multicomponent therapy MAKS (a German acronym for Motor, Activities of daily living, Cognitive, Social) has already been evaluated in nursing homes; in this study, we investigated its use in day care centers (DCCs). METHODS A cluster-randomized, controlled, single-blinded trial involving a 6-month intervention phase was performed. 362 cognitively impaired persons in 32 DCCs took part in the trial. Multiple regression analyses were used to determine whether MAKS therapy led to any statistically significant and clinically relevant improvement over time (compared to membership in the control group) in these persons' cognitive abilities and activities of daily living (ADL) abilities, as assessed, respectively, with the Mini-Mental State Examination (MMSE) and the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). A primary per-protocol analysis was supplemented by an intention-to-treat analysis. Two secondary outcomes (social behavior and neuropsychiatric symptoms) were analyzed exploratively as well. Study registration: ISRCTN16412551. RESULTS In the primary per-protocol analysis at 6 months, the intervention group had significantly better MMSE and ETAM scores than the control group (Cohen's d, 0.26 and 0.21, respectively; p = 0.012 for both). The same was found in the ITT analysis at 6 months (Cohen's d = 0.21, p = 0.033; and Cohen's d = 0.20, p = 0.019, respectively). Neuropsychiatric symptoms, one of the secondary outcomes, also evolved more favorably in the intervention group (Cohen's d = 0.23, p = 0.055). CONCLUSION MAKS therapy is effective for persons with cognitive impairment ranging from mild cognitive impairment (MCI) to moderate dementia who live at home and regularly visit a day care center. The fact that 32 day care facilities from all over Germany participated in this study gives its findings high external validity.
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Affiliation(s)
- Melanie Straubmeier
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg; Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Neuherberg; Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich
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259
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Alexopoulos P, Thierjung N, Grimmer T, Ortner M, Economou P, Assimakopoulos K, Gourzis P, Politis A, Perneczky R. Cerebrospinal Fluid BACE1 Activity and sAβPPβ as Biomarker Candidates of Alzheimer's Disease. Dement Geriatr Cogn Disord 2018; 45:152-161. [PMID: 29788013 DOI: 10.1159/000488481] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/11/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS The utility of β-site amyloid-β precursor protein (AβPP) cleaving enzyme 1 (BACE1) activity and soluble AβPP β (sAβPPβ) levels in cerebrospinal fluid (CSF) in detecting Alzheimer's disease (AD) is still elusive. METHODS BACE1 activity and sAβPPβ concentration were measured in patients with AD dementia (n = 56) and mild cognitive impairment (MCI) due to AD (n = 76) with abnormal routine AD CSF markers, in patients with MCI with normal CSF markers (n = 39), and in controls without preclinical AD (n = 48). In a subsample with available 18F-fluorodeoxyglucose positron emission tomography (FDG PET) data, ordinal regression models were employed to compare the contribution of BACE1 and sAβPPβ to correct diagnostic classification to that of FDG PET. RESULTS BACE1 activity was significantly higher in patients with MCI due to AD compared to both controls and patients with MCI with normal CSF markers. sAβPPβ did not differ between any of the studied groups. Interestingly, BACE1 activity was not found to be inferior to FDG PET as predictive covariate in differentiating between the diagnostic groups. CONCLUSIONS Further studies using biomarker-underpinned diagnoses are warranted to shed more light on the potential diagnostic utility of BACE1 activity as AD biomarker candidate in MCI.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, University Hospital of Rion, University of Patras, Patras, Greece.,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nathalie Thierjung
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marion Ortner
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), University of Patras, Patras, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Rion, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, John's Hopkins Medical School, Baltimore, Maryland, USA
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, United Kingdom.,West London Mental Health NHS Trust, London, United Kingdom.,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
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260
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Wu C, Guo S, Hong Y, Xiao B, Wu Y, Zhang Q. Discrimination and conversion prediction of mild cognitive impairment using convolutional neural networks. Quant Imaging Med Surg 2018; 8:992-1003. [PMID: 30598877 DOI: 10.21037/qims.2018.10.17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Recently, studies have demonstrated that machine learning techniques, particularly cutting-edge deep learning technology, have achieved significant progression on the classification of Alzheimer's disease (AD) and its prodromal phase, mild cognitive impairment (MCI). Moreover, accurate prediction of the progress and the conversion risk from MCI to probable AD has been of great importance in clinical application. Methods In this study, the baseline MR images and follow-up information during 3 years of 150 normal controls (NC), 150 patients with stable MCI (sMCI) and 157 converted MCI (cMCI) were collected from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The deep convolutional neural networks (CNNs) were adopted to distinguish different stages of MCI from the NC group, and predict the conversion time from MCI to AD. Two CNN architectures including GoogleNet and CaffeNet were explored and evaluated in multiple classifications and estimations of conversion risk using transfer learning from pre-trained ImageNet (via fine-tuning) and five-fold cross-validation. A novel data augmentation approach using random views aggregation was applied to generate abundant image patches from the original MR scans. Results The GoogleNet acquired accuracies with 97.58%, 67.33% and 84.71% in three-way discrimination among the NC, sMCI and cMCI groups respectively, whereas the CaffeNet obtained promising accuracies of 98.71%, 72.04% and 92.35% in the NC, sMCI and cMCI classifications. Furthermore, the accuracy measures of conversion risk of patients with cMCI ranged from 71.25% to 83.25% in different time points using GoogleNet, whereas the CaffeNet achieved remarkable accuracy measures from 95.42% to 97.01% in conversion risk prediction. Conclusions The experimental results demonstrated that the proposed methods had prominent capability in classification among the 3 groups such as sMCI, cMCI and NC, and exhibited significant ability in conversion risk prediction of patients with MCI.
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Affiliation(s)
- Congling Wu
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
| | - Shengwen Guo
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
| | - Yanjia Hong
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
| | - Benheng Xiao
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
| | - Yupeng Wu
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
| | - Qin Zhang
- Department of Biomedical Engineering, South China University of Technology, Guangzhou 510006, China
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261
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Sadeq NA, Molinari V. Personality and its Relationship to Depression and Cognition in Older Adults: Implications for Practice. Clin Gerontol 2018; 41:385-398. [PMID: 29279022 DOI: 10.1080/07317115.2017.1407981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Personality is an important contributor to an individual's mental health and is consistently linked to the two most prevalent mental health conditions among older adults: dementia and depression. This review summarizes the current findings on personality and its association with cognitive decline and depression, as well as treatment outcomes and possible intervention strategies. METHODS Literature searches were conducted in Web of Science, PubMed, and PsycINFO. Search terms included 'personality traits,' 'depression,' 'treatment,' and 'older adults.' RESULTS Cognitive decline and depressive disorders are both associated with a common personality profile: high neuroticism, and low conscientiousness, extraversion, openness, and agreeableness. Across studies, the most consistent predictor of late-life depression, its course, and treatment outcomes is higher neuroticism. CONCLUSIONS Personality traits are associated with cognitive decline, as well as the diagnosis and course of late-life depression in older adults. However, formal personality assessment is not typically incorporated in clients' treatment plans, even though personality traits may influence treatment efficacy and outcomes. CLINICAL IMPLICATIONS Formal assessment of personality traits may be beneficial in terms of treatment adherence and outcomes for older adults. Tailored interventions that specifically target the client's strengths are likely to be well received by both clients and clinicians.
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Affiliation(s)
- Nasreen A Sadeq
- a School of Aging Studies , University of South Florida , Tampa , Florida , USA
| | - Victor Molinari
- a School of Aging Studies , University of South Florida , Tampa , Florida , USA
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Qiu S, Chang GH, Panagia M, Gopal DM, Au R, Kolachalama VB. Fusion of deep learning models of MRI scans, Mini-Mental State Examination, and logical memory test enhances diagnosis of mild cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2018; 10:737-749. [PMID: 30480079 PMCID: PMC6240705 DOI: 10.1016/j.dadm.2018.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Our aim was to investigate if the accuracy of diagnosing mild cognitive impairment (MCI) using the Mini-Mental State Examination (MMSE) and logical memory (LM) test could be enhanced by adding MRI data. METHODS Data of individuals with normal cognition and MCI were obtained from the National Alzheimer Coordinating Center database (n = 386). Deep learning models trained on MRI slices were combined to generate a fused MRI model using different voting techniques to predict normal cognition versus MCI. Two multilayer perceptron (MLP) models were developed with MMSE and LM test results. Finally, the fused MRI model and the MLP models were combined using majority voting. RESULTS The fusion model was superior to the individual models alone and achieved an overall accuracy of 90.9%. DISCUSSION This study is a proof of principle that multimodal fusion of models developed using MRI scans, MMSE, and LM test data is feasible and can better predict MCI.
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Affiliation(s)
- Shangran Qiu
- Department of Physics, College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Gary H. Chang
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Marcello Panagia
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Deepa M. Gopal
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Boston University Alzheimer's Disease Center and Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
- Hariri Institute for Computing and Computational Science and Engineering, Boston University, Boston, MA, USA
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Book S, Luttenberger K, Stemmler M, Meyer S, Graessel E. The Erlangen test of activities of daily living in persons with mild dementia or mild cognitive impairment (ETAM) - an extended validation. BMC Psychiatry 2018; 18:308. [PMID: 30249231 PMCID: PMC6154426 DOI: 10.1186/s12888-018-1886-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia. METHODS We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months. RESULTS The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1. CONCLUSIONS The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia. TRIAL REGISTRATION Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
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Affiliation(s)
- Stephanie Book
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katharina Luttenberger
- 0000 0001 2107 3311grid.5330.5Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Mark Stemmler
- 0000 0001 2107 3311grid.5330.5Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 49c, 91052 Erlangen, Germany
| | - Sebastian Meyer
- 0000 0001 2107 3311grid.5330.5Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany
| | - Elmar Graessel
- 0000 0001 2107 3311grid.5330.5Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Toyoshima K, Araki A, Tamura Y, Iritani O, Ogawa S, Kozaki K, Ebihara S, Hanyu H, Arai H, Kuzuya M, Iijima K, Sakurai T, Suzuki T, Toba K, Arai H, Akishita M, Rakugi H, Yokote K, Ito H, Awata S. Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions. Geriatr Gerontol Int 2018; 18:1458-1462. [DOI: 10.1111/ggi.13512] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/01/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kenji Toyoshima
- Department of Diabetes, Metabolism and Endocrinology; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Osamu Iritani
- Department of Geriatric Medicine; Kanazawa Medical University; Ishikawa Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine; The University of Tokyo; Tokyo Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine; Kyorin University School of Medicine; Tokyo Japan
| | - Satoru Ebihara
- Departments of Rehabilitation Medicine; Toho University Graduate School of Medicine; Tokyo Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine; Tokyo Medical University; Tokyo Japan
| | - Hiroyuki Arai
- Department of Geriatric Medicine and Neuroimaging; Tohoku University Hospital; Miyagi Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Katsuya Iijima
- Institute of Gerontology; The University of Tokyo; Tokyo Japan
| | | | - Takao Suzuki
- Institute of Gerontology, J.F. Oberlin University; Tokyo Japan
| | - Kenji Toba
- National Center for Geriatrics and Gerontology; Aichi Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology; Aichi Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine; The University of Tokyo; Tokyo Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Koutaro Yokote
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology; Chiba University Hospital; Chiba Japan
| | - Hideki Ito
- Department of Diabetes, Metabolism and Endocrinology; Tokyo Metropolitan Geriatric Hospital; Tokyo Japan
| | - Shuichi Awata
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology; Tokyo Japan
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265
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Vanoh D, Ishak IH, Shahar S, Manaf ZA, Ali NM, Noah SAM. Development and assessment of a web-based intervention for educating older people on strategies promoting healthy cognition. Clin Interv Aging 2018; 13:1787-1798. [PMID: 30271134 PMCID: PMC6152600 DOI: 10.2147/cia.s157324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The increase in the population of aging people has increased the occurrence of cognitive decline leading to predemented stage of dementia, ie, mild cognitive impairment (MCI). The cognitive tools that are web-based have been proven to be useful in decreasing the risk of MCI. Thus, in the present study, an education tool that is web-based, called WESIHAT 2.0©, had been created to educate elderly people about precautionary strategies against MCI. Methodology WESIHAT 2.0 was devised in a senior-friendly style, which includes touch screen, greater font size, larger icons, and employed multimedia components of text, images, and videos. The components employed in WESIHAT 2.0 were a screening tool called TUA-WELLNESS, 10 guides for memory improvement, health diary, and guide for a healthy menu. This application assessed a group of 73 candidates consisting of elderly people, health professionals, caregivers, and information technology (IT) professionals for 1 month. Results All the elderly people, caregivers, and 75% of IT and health professionals were satisfied with the subject matter of WESIHAT 2.0. About more than half of the elderly people, caregivers, and IT and health professionals had given a consensus on the comprehensive ease of the terminologies, sentences, images, table, and advice related to diet included in the web application. Proposals for improvements of the web portal included suggestions such as using smaller sentences, using greater font size, adding more images, and avoiding the use of unfamiliar terminologies. Conclusion WESIHAT 2.0 is a suitable tool for educating older people about the lifestyle modification strategies to slower progression to cognitive impairment, with regard to the significance of expert advice.
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Affiliation(s)
- Divya Vanoh
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, .,Dietetics Programme, School of Health Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Intan Hafizah Ishak
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Zahara Abdul Manaf
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Nazlena Mohamad Ali
- Institute of Visual Informatics (IVI), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Shahrul Azman Mohd Noah
- School of Information Technology, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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266
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Kong D, Bai J, Ma S, Li C, Yang L, Kong X. Effects of dexmedetomidine hydrochloride on hemodynamics, postoperative analgesia and cognition in cesarean section. Exp Ther Med 2018; 16:1778-1783. [PMID: 30186401 PMCID: PMC6122377 DOI: 10.3892/etm.2018.6363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/22/2018] [Indexed: 12/17/2022] Open
Abstract
The present study aims to investigate the effects of dexmedetomidine hydrochloride (Dex) on hemodynamics, postoperative analgesia and cognition in cesarean section. One hundred and two pregnant women who underwent cesarean section were selected from August 2016 to July 2017 in People's Hospital of Zhangqiu District and randomly divided into control group and observation group. Control group was anesthetized with bupivacaine hydrochloride, and morphine + ropivacaine hydrochloride were given postoperatively. Observation group received intraoperative anesthesia with bupivacaine hydrochloride and Dex, and Dex + ropivacaine hydrochloride were given for postoperative analgesia. Hemodynamic factors were compared between the two groups. Postoperative Ramsay sedation score, the incidence of adverse reactions and the incidence of transient neurological syndrome (TNS) were compared between the two groups. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scoring were performed to evaluate the cognitive function of the two groups. The mean arterial pressure (MAP) and visual analogue scale (VAS) scores of the observation group after anesthesia were significantly lower than those of control group (P<0.05). The Ramsay sedation score of the observation group was significantly better than that of control group at different time-points after surgery (P<0.05). Incidence of postoperative agitation in observation group was significantly lower than that in control group (P<0.05). Incidence of TNS in observation group was significantly lower than that in control group during 1 week after surgery (P<0.05). MoCA and MMSE scores of the observation group were better than that of control group at 1 day after operation (P<0.05). The use of Dex anesthesia in cesarean section can achieve more stable hemodynamic conditions during perioperative period and more obvious analgesic effect after operation. It also reduced the incidence of postoperative TNS and cognitive dysfunction, and had important clinical significance.
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Affiliation(s)
- Dehua Kong
- Department of Obstetrics, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Jianhua Bai
- Department of Obstetrics, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Suqiao Ma
- Department of Oral and Maxillofacial Surgery, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Cong Li
- Department of Otorhinolaryngology, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Lina Yang
- Department of Endocrinology, People's Hospital of Zhangqiu District, Jinan, Shandong 250200, P.R. China
| | - Xiangang Kong
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
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267
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Adlimoghaddam A, Neuendorff M, Roy B, Albensi BC. A review of clinical treatment considerations of donepezil in severe Alzheimer's disease. CNS Neurosci Ther 2018; 24:876-888. [PMID: 30058285 DOI: 10.1111/cns.13035] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disorder that affects over 45 million people worldwide. Patients with severe AD require help with daily activities and show severe memory impairment. Currently, donepezil is one of two drugs approved by FDA and Health Canada for the treatment of severe AD (MMSE score <10). It is prescribed as 5 or 10 mg/d and an FDA-approved 23-mg/d dose. METHOD This review will discuss risks and benefits of donepezil at these doses in severe AD. Articles were identified using PubMed using the MeSH terms "donepezil" AND "Alzheimer Disease" AND "severe." Three double-blind, placebo-controlled, randomized studies, one post hoc analysis, and one subgroup analysis were selected. RESULTS Donepezil was found to benefit patients in cognition and global functioning. The most consistent improvement was in severe impairment battery (SIB) scores. However, more patients treated with high dosage of donepezil discontinued their treatment due to various adverse events (AEs). CONCLUSION Clinicians must weigh benefits against adverse events when determining the course of therapy, as recommendations for cholinesterase inhibitors in advanced AD remain unclear and vary with different guidelines.
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Affiliation(s)
- Aida Adlimoghaddam
- Division of Neurodegenerative Disorders, St. Boniface Hospital Research, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
| | - Melanie Neuendorff
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Banibrata Roy
- Department of Community Health Sciences, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Institutional Research and Assessment, Community College of Aurora, Denver, Colorado
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St. Boniface Hospital Research, Winnipeg, MB, Canada.,Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada
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268
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Cognitive Assessment Test: Validation of a Short Cognitive Test for the Detection of Mild Cognitive Disorder. Int J Alzheimers Dis 2018; 2018:3280621. [PMID: 30057805 PMCID: PMC6051079 DOI: 10.1155/2018/3280621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Cognitive disorders are a clinical and research challenge; in particular, the mild cognitive disorder (MiCD) requires diagnostic suspicion and tools with adequate performance for its detection. The objective of this study was the validation of a short cognitive test (CATest) for the detection of MiCD in population of 50 years or more. Methods A diagnostic accuracy study was assembled and performed in a prospective cohort. A consecutive sample of 200 Colombian subjects who represented the whole spectrum of the condition of interest allowed us to reach the objective. Validity was determined by concurrent criteria. The cut points were determined by the ROC curves considering the best overall performance and accuracy of the test. Results CATest was validated to detection of MiCD at a cut-off point of 18. As a result, scores lower than 18 classified the participants as MiCD. At this cut-off point, CATest showed sensitivity of 84.3% (CI 76 to 90.16), specificity of 71.4% (CI 95% 61.8 to 79.43), positive predictive value of 75% ( 95% CI 66.79 to 82.42), and area under curve AUC 0.8518 (standard error SE 0.0265). Discussion CATest has an adequate performance as a short cognitive test for the detection of MiCD. Its performance is superior to MiniMental and similar to Montreal Cognitive test (MoCA) according to the data reported in the literature. The advantages over other tests are the evaluation of all cognitive domains, time of application, and easy interpretation of results. CATest is a free use alternative for MiCD detection.
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269
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Göthlin M, Eckerström M, Rolstad S, Wallin A, Nordlund A. Prognostic Accuracy of Mild Cognitive Impairment Subtypes at Different Cut-Off Levels. Dement Geriatr Cogn Disord 2018; 43:330-341. [PMID: 28591751 DOI: 10.1159/000477341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The prognostic accuracy of mild cognitive impairment (MCI) in clinical settings is debated, variable across criteria, cut-offs, subtypes, and follow-up time. We aimed to estimate the prognostic accuracy of MCI and the MCI subtypes for dementia using three different cut-off levels. METHODS Memory clinic patients were followed for 2 (n = 317, age 63.7 ± 7.8) and 4-6 (n = 168, age 62.6 ± 7.4) years. We used 2.0, 1.5, and 1.0 standard deviations (SD) below the mean of normal controls (n = 120, age 64.1 ± 6.6) to categorize MCI and the MCI subtypes. Prognostic accuracy for dementia syndrome at follow-up was estimated. RESULTS Amnestic multi-domain MCI (aMCI-md) significantly predicted dementia under all conditions, most markedly when speed/attention, language, or executive function was impaired alongside memory. For aMCI-md, sensitivity increased and specificity decreased when the cut-off was lowered from 2.0 to 1.5 and 1.0 SD. Non-subtyped MCI had a high sensitivity and a low specificity. CONCLUSION Our results suggest that aMCI-md is the only viable subtype for predicting dementia for both follow-up times. Lowering the cut-off decreases the positive predictive value and increases the negative predictive value of aMCI-md. The results are important for understanding the clinical prognostic utility of MCI, and MCI as a non-progressive disorder.
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Affiliation(s)
- Mattias Göthlin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
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270
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Murray MM, Eardley AF, Edginton T, Oyekan R, Smyth E, Matusz PJ. Sensory dominance and multisensory integration as screening tools in aging. Sci Rep 2018; 8:8901. [PMID: 29891964 PMCID: PMC5995929 DOI: 10.1038/s41598-018-27288-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/31/2018] [Indexed: 02/07/2023] Open
Abstract
Multisensory information typically confers neural and behavioural advantages over unisensory information. We used a simple audio-visual detection task to compare healthy young (HY), healthy older (HO) and mild-cognitive impairment (MCI) individuals. Neuropsychological tests assessed individuals' learning and memory impairments. First, we provide much-needed clarification regarding the presence of enhanced multisensory benefits in both healthily and abnormally aging individuals. The pattern of sensory dominance shifted with healthy and abnormal aging to favour a propensity of auditory-dominant behaviour (i.e., detecting sounds faster than flashes). Notably, multisensory benefits were larger only in healthy older than younger individuals who were also visually-dominant. Second, we demonstrate that the multisensory detection task offers benefits as a time- and resource-economic MCI screening tool. Receiver operating characteristic (ROC) analysis demonstrated that MCI diagnosis could be reliably achieved based on the combination of indices of multisensory integration together with indices of sensory dominance. Our findings showcase the importance of sensory profiles in determining multisensory benefits in healthy and abnormal aging. Crucially, our findings open an exciting possibility for multisensory detection tasks to be used as a cost-effective screening tool. These findings clarify relationships between multisensory and memory functions in aging, while offering new avenues for improved dementia diagnostics.
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Affiliation(s)
- Micah M Murray
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Department of Ophthalmology, Fondation Asile des Aveugles and University of Lausanne, Lausanne, Switzerland.
- EEG Brain Mapping Core, Center for Biomedical Imaging (CIBM), Lausanne, Switzerland.
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.
| | | | - Trudi Edginton
- Department of Psychology, City, University of London, London, UK
| | - Rebecca Oyekan
- Department of Psychology, University of Westminster, London, UK
| | - Emily Smyth
- Department of Psychology, University of Westminster, London, UK
| | - Pawel J Matusz
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland
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271
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Risk Factors for the Progression of Mild Cognitive Impairment in Different Types of Neurodegenerative Disorders. Behav Neurol 2018; 2018:6929732. [PMID: 29971138 PMCID: PMC6008817 DOI: 10.1155/2018/6929732] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/24/2018] [Accepted: 04/05/2018] [Indexed: 12/24/2022] Open
Abstract
Objective Mild cognitive impairment (MCI) is a transitional state between normal aging and early dementia. It has a heterogeneous etiology and clinical course. This study aimed to examine the factors associated with the progression of MCI in different types of dementia disorders. Method A retrospective, longitudinal, observational study of outpatients with MCI was conducted at a medical center in northern Taiwan. Patient medical records were reviewed, and risk factors were analyzed by multivariate analysis. Results Among 279 patients with MCI, 163 (58.4%), 68 (24.4%), and 48 (17.2%) were diagnosed with Alzheimer's disease, vascular cognitive impairment, and Lewy body diseases, respectively. During the observation period, 37.2% of patients progressed to dementia. Older age and a higher Clinical Dementia Rating Scale-Sum of Boxes were associated with the risk of progression. Hyperlipidemia was associated with a decreased risk. Converters were more likely to receive an antidementia prescription. Conclusion Our study suggests the importance of comprehensive clinical profiling, risk factor assessment, and detailed drug history evaluations in improving our understanding and management of dementia subtypes.
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272
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Fernández T, Martínez-Serrano A, Cussó L, Desco M, Ramos-Gómez M. Functionalization and Characterization of Magnetic Nanoparticles for the Detection of Ferritin Accumulation in Alzheimer's Disease. ACS Chem Neurosci 2018; 9:912-924. [PMID: 29298040 DOI: 10.1021/acschemneuro.7b00260] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Early diagnosis in Alzheimer's disease (AD), prior to the appearance of marked clinical symptoms, is critical to prevent irreversible neuronal damage and neural malfunction that lead to dementia and death. Therefore, there is an urgent need to generate new contrast agents which reveal by a noninvasive method the presence of some of the pathological signs of AD. In the present study, we demonstrate for the first time a new nanoconjugate composed of magnetic nanoparticles bound to an antiferritin antibody, which has been developed based on the existence of iron deposits and high levels of the ferritin protein present in areas with a high accumulation of amyloid plaques (particularly the subiculum in the hippocampal area) in the brain of a transgenic mouse model with five familial AD mutations. Both in vitro and after intravenous injection, functionalized magnetic nanoparticles were able to recognize and bind specifically to the ferritin protein accumulated in the subiculum area of the AD transgenic mice.
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Affiliation(s)
- Tamara Fernández
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, 28223 Madrid, Spain
| | - Alberto Martínez-Serrano
- Department of Molecular Biology
and Centre for Molecular Biology “Severo Ochoa” (CBMSO),
Universidad Autónoma de Madrid and Consejo Superior de Investigaciones
Científicas, 28049 Madrid, Spain
| | - Lorena Cussó
- Departamento de Ingeniería Biomédica e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación
Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Manuel Desco
- Departamento de Ingeniería Biomédica e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Leganés, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación
Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Milagros Ramos-Gómez
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, 28223 Madrid, Spain
- CIBER de Bioingeniería,
Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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273
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Carotenuto A, Rea R, Traini E, Ricci G, Fasanaro AM, Amenta F. Cognitive Assessment of Patients With Alzheimer's Disease by Telemedicine: Pilot Study. JMIR Ment Health 2018; 5:e31. [PMID: 29752254 PMCID: PMC5970283 DOI: 10.2196/mental.8097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/29/2017] [Accepted: 02/26/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Approximately 46.8 million people are living with dementia worldwide and their number will grow in the next years. Any potential treatment should be administered as early as possible because it is important to provide an early cognitive assessment and to regularly monitor the mental function of patients. Information and communication technologies can be helpful to reach and follow patients without displacing them, but there may be doubts about the reliability of cognitive tests performed by telemedicine. OBJECTIVE The purpose of this study was to evaluate the reliability of the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) tests administered in hospital by videoconference to patients with mild to moderate Alzheimer's disease. METHODS The tests were administered to 28 Alzheimer's disease outpatients (8 male, mean age 73.88, SD 7.45 years; 20 female mean age 76.00, SD 5.40 years) recruited and followed in the Alzheimer's Unit of the A Cardarelli National Hospital (Naples, Italy) at baseline and after 6, 12, 18, and 24 months of observation. Patients were evaluated first face-to-face by a psychologist and then, after 2 weeks, by another psychologist via videoconference in hospital. RESULTS This study showed no differences in the MMSE and ADAS-cog scores when the tests were administered face-to-face or by videoconference, except in patients with more pronounced cognitive deficits (MMSE<17), in which the assessment via videoconference overestimated the cognitive impairment (face to face, MMSE mean 13.9, SD 4.9 and ADAS-cog mean 9.0, SD 3.8; videoconference, MMSE mean 42.8, SD 12.5 and ADAS-cog mean 56.9, SD 5.5). CONCLUSIONS We found that videoconferencing is a reliable approach to document cognitive stability or decline, and to measure treatment effects in patients with mild to moderate dementia. A more extended study is needed to confirm these results.
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Affiliation(s)
- Anna Carotenuto
- Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Raffaele Rea
- Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Enea Traini
- Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Bioethics and Legal Medicine Centre, School of Law, University of Camerino, Camerino, Italy
| | | | - Francesco Amenta
- Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Camerino, Italy
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274
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Lawrence E, Vegvari C, Ower A, Hadjichrysanthou C, De Wolf F, Anderson RM. A Systematic Review of Longitudinal Studies Which Measure Alzheimer's Disease Biomarkers. J Alzheimers Dis 2018; 59:1359-1379. [PMID: 28759968 PMCID: PMC5611893 DOI: 10.3233/jad-170261] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Alzheimer’s disease (AD) is a progressive and fatal neurodegenerative disease, with no effective treatment or cure. A gold standard therapy would be treatment to slow or halt disease progression; however, knowledge of causation in the early stages of AD is very limited. In order to determine effective endpoints for possible therapies, a number of quantitative surrogate markers of disease progression have been suggested, including biochemical and imaging biomarkers. The dynamics of these various surrogate markers over time, particularly in relation to disease development, are, however, not well characterized. We reviewed the literature for studies that measured cerebrospinal fluid or plasma amyloid-β and tau, or took magnetic resonance image or fluorodeoxyglucose/Pittsburgh compound B-positron electron tomography scans, in longitudinal cohort studies. We summarized the properties of the major cohort studies in various countries, commonly used diagnosis methods and study designs. We have concluded that additional studies with repeat measures over time in a representative population cohort are needed to address the gap in knowledge of AD progression. Based on our analysis, we suggest directions in which research could move in order to advance our understanding of this complex disease, including repeat biomarker measurements, standardization and increased sample sizes.
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Affiliation(s)
- Emma Lawrence
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Carolin Vegvari
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Alison Ower
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Frank De Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Janssen Prevention Center, Leiden, The Netherlands
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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275
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The Effect of Cognitive Intervention on Cognitive Improvement in Patients with Dementia. Dement Neurocogn Disord 2018; 17:23-31. [PMID: 30906388 PMCID: PMC6427996 DOI: 10.12779/dnd.2018.17.1.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose The effect of cognitive intervention in patients with dementia is inconsistent. This study sought to find out the effect of cognitive intervention by measuring interval change between before and after intervention. Methods We evaluated cognitive changes according to clinical diagnostic group across Gangwon province for 940 patients with dementia diagnosed at hospital clinics and 2,975 subjects without dementia. All subjects were treated with cognitive intervention. They underwent a cognitive and mood assessment before and after intervention. We used interval change of Mini-Mental State Examination (MMSE) scores as a primary measure of interventional outcome. Results Changes in mean MMSE score were significantly different between the non-dementia group and the dementia group (p=0.016), with changes of 0.7±2.4 and 1.0±3.7 points (±standard deviation), respectively. Cognitive improvement regarding completion of session was significantly higher in the dementia group (p=0.001), with changes of 0.41±4.51 for uncompleted group and 1.30±3.22 points for completed ones. Lower initial MMSE scores, lower age, and type of intervention were found to be independent predictive factors of subsequent cognitive changes as indicated by mean MMSE scores. Conclusions These findings suggest that cognitive intervention might be useful for patients with dementia. Their response to treatment might be related to the type of intervention.
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276
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O'Caoimh R, Gao Y, Svendovski A, Gallagher P, Eustace J, Molloy DW. Comparing Approaches to Optimize Cut-off Scores for Short Cognitive Screening Instruments in Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2018; 57:123-133. [PMID: 28222528 PMCID: PMC5345649 DOI: 10.3233/jad-161204] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although required to improve the usability of cognitive screening instruments (CSIs), the use of cut-off scores is controversial yet poorly researched. OBJECTIVE To explore cut-off scores for two short CSIs: the Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) screen, describing adjustments in scores for diagnosis (MCI or dementia), age (≤, >75 years), and education (<, ≥12 years), comparing two methods: the maximal accuracy approach, derived from receiver operating characteristic curves, and Youden's Index. METHODS Pooled analysis of assessments from patients attending memory clinics in Canada between 1999-2010 : 766 with mild cognitive impairment (MCI) and 1,746 with dementia, and 875 normal controls. RESULTS The Qmci was more accurate than the SMMSE in differentiating controls from MCI or cognitive impairment (MCI and dementia). Employing the maximal accuracy approach, the optimal SMMSE cut-off for cognitive impairment was <28/30 (AUC 0.86, sensitivity 74%, specificity 88%) versus <63/100 for the Qmci (AUC 0.93, sensitivity 85%, specificity 85%). Using Youden's Index, the optimal SMMSE cut-off remained <28/30 but fell slightly to <62/100 for the Qmci (sensitivity 83%, specificity 87%). The optimal cut-off for MCI was <29/30 for the SMMSE and <67/100 for the Qmci, irrespective of technique. The maximal accuracy approach generally produced higher Qmci cut-offs than Youden's Index, both requiring adjustment for age and education. There were no clinically meaningful differences in SMMSE cut-off scores by age and education or method employed. CONCLUSION Caution should be exercised selecting cut-offs as these differ by age, education, and method of derivation, with the extent of adjustment varying between CSIs.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland.,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
| | | | - Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland
| | - Joseph Eustace
- Health Research Board, Clinical Research Facility Cork, Mercy Univeristy Hospital, Cork City, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
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277
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Ren L, Zheng Y, Wu L, Gu Y, He Y, Jiang B, Zhang J, Zhang L, Li J. Investigation of the prevalence of Cognitive Impairment and its risk factors within the elderly population in Shanghai, China. Sci Rep 2018; 8:3575. [PMID: 29476112 PMCID: PMC5824836 DOI: 10.1038/s41598-018-21983-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
To investigate the prevalence of cognitive impairment and its risk factors among Chinese elders aged over 80 years, a community-based, cross-sectional study was conducted from May to June 2016 in Shanghai, China. Cognitive function was measured by using Mini-Mental Status Examination. Multiple logistic regression assessed associations between risk factors and cognitive impairment. Of 480 participants, 30% were diagnosed with cognitive impairment. Women [adjusted odds ratio (AOR): 1.71, 95% confidence interval (CI): 1.03-2.83], solitary life (AOR: 3.15, 1.89-5.26), monthly income less than 2000 Chinese yuan (AOR: 3.47, 1.18-10.23) were significantly associated with increased risk of cognitive impairment, compared with men, non-solitary life, and monthly income greater than 4000 Chinese yuan, respectively. Overweight (AOR: 0.59, 0.36-0.97), being physically active at least 60 minutes per day (AOR: 0.59, 0.35-0.95), antihypertensive drugs users (AOR: 0.45, 0.28-0.72), and lipid lowering drugs users (AOR: 0.21, 0.06-0.76) significantly lowered the risk of cognitive impairment, compared with normal weight, inadequate outdoor activity, and non-medication users, respectively. Accordingly, this study found that women, solitary life, lower income was associated with increased risk of cognitive impairment, while overweight, being physically active, and antihypertensive and lipid lowering drugs usage might lower the risk.
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Affiliation(s)
- Longbing Ren
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China
| | - Yongtao Zheng
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China
| | - Lezhou Wu
- Department of Data Science, Children's Hospital of Philadelphia, Philadelphia, PA, 19147, USA
| | - Yijun Gu
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China
| | - Yusheng He
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Bo Jiang
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China
| | - Jie Zhang
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China
| | - Lijuan Zhang
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China.
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China.
| | - Jue Li
- Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China.
- Institute of Clinical Epidemiology and Evidence-based medicine, Tongji University School of Medicine, Shanghai, 200092, P.R. China.
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278
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Kabbara A, Eid H, El Falou W, Khalil M, Wendling F, Hassan M. Reduced integration and improved segregation of functional brain networks in Alzheimer’s disease. J Neural Eng 2018; 15:026023. [DOI: 10.1088/1741-2552/aaaa76] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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279
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Yuan J, Sun Y, Sang S, Pham JH, Kong WJ. The risk of cognitive impairment associated with hearing function in older adults: a pooled analysis of data from eleven studies. Sci Rep 2018; 8:2137. [PMID: 29391476 PMCID: PMC5794920 DOI: 10.1038/s41598-018-20496-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/09/2018] [Indexed: 01/03/2023] Open
Abstract
Impaired hearing and cognition are disabling conditions among older adults. Research has presented inconsistent conclusions regarding hearing impairment posing a risk for cognitive impairment. We aimed to assess this from published evidence via searching PubMed and Embase, from the inception of the databases indexed to December 2, 2016. For those high-quality studies retrieved, relative risk (RR) and 95% confidence intervals (CIs) were combined to estimate the risk of cognitive impairment. Eleven cohort studies were included in the present study. Pooled results found that elderly people with disabled peripheral and central hearing function had a higher risk of cognitive impairment (for moderate/severe peripheral hearing impairment: RR = 1.29, 95% CI: 1.04-1.59 during a follow-up ≤6 years. RR = 1.57, 95% CI: 1.13-2.20 during a follow-up >6 years; for severe central hearing impairment, RR = 3.21, 95% CI: 1.19-8.69) compared to those with normal hearing function. We also recorded a dose-response trend for cognitive impairment as hearing thresholds rose. No evident bias from potential confounding factors was found with one exception: the length for clinical follow-up. Although results are preliminary because qualifying studies were few, statistical findings were consistent with older people identified as having greater levels of hearing loss, having a corresponding higher risk of cognitive impairment.
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Affiliation(s)
- Jing Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Shuping Sang
- School of Medicine, Yunnan University, Kunming, Yunan, 650031, PR China
| | - Jessica Huynh Pham
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106, United States
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China.
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280
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Mezzarobba S, Grassi M, Pellegrini L, Catalan M, Kruger B, Furlanis G, Manganotti P, Bernardis P. Action Observation Plus Sonification. A Novel Therapeutic Protocol for Parkinson's Patient with Freezing of Gait. Front Neurol 2018; 8:723. [PMID: 29354092 PMCID: PMC5758544 DOI: 10.3389/fneur.2017.00723] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/13/2017] [Indexed: 11/25/2022] Open
Abstract
Freezing of gait (FoG) is a disabling symptom associated with falls, with little or no responsiveness to pharmacological treatment. Current protocols used for rehabilitation are based on the use of external sensory cues. However, cued strategies might generate an important dependence on the environment. Teaching motor strategies without cues [i.e., action observation (AO) plus Sonification] could represent an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. We aimed to test the effects of a novel experimental protocol to treat patients with Parkinson’s disease (PD) and FoG, using functional, and clinical scales. The experimental protocol was based on AO plus Sonification. 12 patients were treated with 8 motor gestures. They watched eight videos showing an actor performing the same eight gestures, and then tried to repeat each gesture. Each video was composed by images and sounds of the gestures. By means of the Sonification technique, the sounds of gestures were obtained by transforming kinematic data (velocity) recorded during gesture execution, into pitch variations. The same 8 motor gestures were also used in a second group of 10 patients; which were treated with a standard protocol based on a common sensory stimulation method. All patients were tested with functional and clinical scales before, after, at 1 month, and 3 months after the treatment. Data showed that the experimental protocol have positive effects on functional and clinical tests. In comparison with the baseline evaluations, significant performance improvements were seen in the NFOG questionnaire, and the UPDRS (parts II and III). Importantly, all these improvements were consistently observed at the end, 1 month, and 3 months after treatment. No improvement effects were found in the group of patients treated with the standard protocol. These data suggest that a multisensory approach based on AO plus Sonification, with the two stimuli semantically related, could help PD patients with FoG to relearn gait movements, to reduce freezing episodes, and that these effects could be prolonged over time.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Life Sciences, University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Lorella Pellegrini
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Mauro Catalan
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Bjorn Kruger
- Gokhale Method Institute, Palo Alto, CA, United States
| | - Giovanni Furlanis
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Paolo Manganotti
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Bernardis
- Department of Life Sciences, University of Trieste, Trieste, Italy
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281
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Fantoni ER, Chalkidou A, O’ Brien JT, Farrar G, Hammers A. A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease. J Alzheimers Dis 2018; 63:783-796. [PMID: 29689725 PMCID: PMC5929301 DOI: 10.3233/jad-171093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.
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Affiliation(s)
| | - Anastasia Chalkidou
- King’s Technology Evaluation Centre (KiTEC), London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | | | | | - Alexander Hammers
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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282
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Martínez G, Vernooij RWM, Fuentes Padilla P, Zamora J, Bonfill Cosp X, Flicker L. 18F PET with florbetapir for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2017; 11:CD012216. [PMID: 29164603 PMCID: PMC6486090 DOI: 10.1002/14651858.cd012216.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND 18F-florbetapir uptake by brain tissue measured by positron emission tomography (PET) is accepted by regulatory agencies like the Food and Drug Administration (FDA) and the European Medicine Agencies (EMA) for assessing amyloid load in people with dementia. Its added value is mainly demonstrated by excluding Alzheimer's pathology in an established dementia diagnosis. However, the National Institute on Aging and Alzheimer's Association (NIA-AA) revised the diagnostic criteria for Alzheimer's disease and confidence in the diagnosis of mild cognitive impairment (MCI) due to Alzheimer's disease may be increased when using amyloid biomarkers tests like 18F-florbetapir. These tests, added to the MCI core clinical criteria, might increase the diagnostic test accuracy (DTA) of a testing strategy. However, the DTA of 18F-florbetapir to predict the progression from MCI to Alzheimer's disease dementia (ADD) or other dementias has not yet been systematically evaluated. OBJECTIVES To determine the DTA of the 18F-florbetapir PET scan for detecting people with MCI at time of performing the test who will clinically progress to ADD, other forms of dementia (non-ADD), or any form of dementia at follow-up. SEARCH METHODS This review is current to May 2017. We searched MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), BIOSIS Citation Index (Thomson Reuters Web of Science), Web of Science Core Collection, including the Science Citation Index (Thomson Reuters Web of Science) and the Conference Proceedings Citation Index (Thomson Reuters Web of Science), LILACS (BIREME), CINAHL (EBSCOhost), ClinicalTrials.gov (https://clinicaltrials.gov), and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (http://www.who.int/ictrp/search/en/). We also searched ALOIS, the Cochrane Dementia & Cognitive Improvement Group's specialised register of dementia studies (http://www.medicine.ox.ac.uk/alois/). We checked the reference lists of any relevant studies and systematic reviews, and performed citation tracking using the Science Citation Index to identify any additional relevant studies. No language or date restrictions were applied to the electronic searches. SELECTION CRITERIA We included studies that had prospectively defined cohorts with any accepted definition of MCI at time of performing the test and the use of 18F-florbetapir scan to evaluate the DTA of the progression from MCI to ADD or other forms of dementia. In addition, we only selected studies that applied a reference standard for Alzheimer's dementia diagnosis, for example, National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) or Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. DATA COLLECTION AND ANALYSIS We screened all titles and abstracts identified in electronic-database searches. Two review authors independently selected studies for inclusion and extracted data to create two-by-two tables, showing the binary test results cross-classified with the binary reference standard. We used these data to calculate sensitivities, specificities, and their 95% confidence intervals. Two independent assessors performed quality assessment using the QUADAS-2 tool plus some additional items to assess the methodological quality of the included studies. MAIN RESULTS We included three studies, two of which evaluated the progression from MCI to ADD, and one evaluated the progression from MCI to any form of dementia.Progression from MCI to ADD was evaluated in 448 participants. The studies reported data on 401 participants with 1.6 years of follow-up and in 47 participants with three years of follow-up. Sixty-one (15.2%) participants converted at 1.6 years follow-up; nine (19.1%) participants converted at three years of follow-up.Progression from MCI to any form of dementia was evaluated in five participants with 1.5 years of follow-up, with three (60%) participants converting to any form of dementia.There were concerns regarding applicability in the reference standard in all three studies. Regarding the domain of flow and timing, two studies were considered at high risk of bias. MCI to ADD;Progression from MCI to ADD in those with a follow-up between two to less than four years had a sensitivity of 67% (95% CI 30 to 93) and a specificity of 71% (95% CI 54 to 85) by visual assessment (n = 47, 1 study).Progression from MCI to ADD in those with a follow-up between one to less than two years had a sensitivity of 89% (95% CI 78 to 95) and a specificity of 58% (95% CI 53 to 64) by visual assessment, and a sensitivity of 87% (95% CI 76 to 94) and a specificity of 51% (95% CI 45 to 56) by quantitative assessment by the standardised uptake value ratio (SUVR)(n = 401, 1 study). MCI to any form of dementia;Progression from MCI to any form of dementia in those with a follow-up between one to less than two years had a sensitivity of 67% (95% CI 9 to 99) and a specificity of 50% (95% CI 1 to 99) by visual assessment (n = 5, 1 study). MCI to any other forms of dementia (non-ADD);There was no information regarding the progression from MCI to any other form of dementia (non-ADD). AUTHORS' CONCLUSIONS Although sensitivity was good in one included study, considering the poor specificity and the limited data available in the literature, we cannot recommend routine use of 18F-florbetapir PET in clinical practice to predict the progression from MCI to ADD.Because of the poor sensitivity and specificity, limited number of included participants, and the limited data available in the literature, we cannot recommend its routine use in clinical practice to predict the progression from MCI to any form of dementia.Because of the high financial costs of 18F-florbetapir, clearly demonstrating the DTA and standardising the process of this modality are important prior to its wider use.
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Affiliation(s)
- Gabriel Martínez
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
- Institut Català de Neurociències AplicadesAlzheimer Research Center and Memory Clinic of Fundació ACEBarcelonaSpain
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
| | - Paulina Fuentes Padilla
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
| | - Javier Zamora
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid (Spain) and Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of LondonClinical Biostatistics UnitLondonMadridUK
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
- Universitat Autònoma de BarcelonaSant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaCatalunyaSpain08025
| | - Leon Flicker
- University of Western AustraliaWestern Australian Centre for Health & Ageing ‐ WACHACrawleyPerthWestern AustraliaAustralia6014
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Martínez G, Vernooij RWM, Fuentes Padilla P, Zamora J, Flicker L, Bonfill Cosp X. 18F PET with flutemetamol for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2017; 11:CD012884. [PMID: 29164602 PMCID: PMC6486287 DOI: 10.1002/14651858.cd012884] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND 18F-flutemetamol uptake by brain tissue, measured by positron emission tomography (PET), is accepted by regulatory agencies like the Food and Drug Administration (FDA) and the European Medicine Agencies (EMA) for assessing amyloid load in people with dementia. Its added value is mainly demonstrated by excluding Alzheimer's pathology in an established dementia diagnosis. However, the National Institute on Aging and Alzheimer's Association (NIA-AA) revised the diagnostic criteria for Alzheimer's disease and the confidence in the diagnosis of mild cognitive impairment (MCI) due to Alzheimer's disease may be increased when using some amyloid biomarkers tests like 18F-flutemetamol. These tests, added to the MCI core clinical criteria, might increase the diagnostic test accuracy (DTA) of a testing strategy. However, the DTA of 18F-flutemetamol to predict the progression from MCI to Alzheimer's disease dementia (ADD) or other dementias has not yet been systematically evaluated. OBJECTIVES To determine the DTA of the 18F-flutemetamol PET scan for detecting people with MCI at time of performing the test who will clinically progress to ADD, other forms of dementia (non-ADD) or any form of dementia at follow-up. SEARCH METHODS The most recent search for this review was performed in May 2017. We searched MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), BIOSIS Citation Index (Thomson Reuters Web of Science), Web of Science Core Collection, including the Science Citation Index (Thomson Reuters Web of Science) and the Conference Proceedings Citation Index (Thomson Reuters Web of Science), LILACS (BIREME), CINAHL (EBSCOhost), ClinicalTrials.gov (https://clinicaltrials.gov), and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (http://www.who.int/ictrp/search/en/). We also searched ALOIS, the Cochrane Dementia & Cognitive Improvement Group's specialised register of dementia studies (http://www.medicine.ox.ac.uk/alois/). We checked the reference lists of any relevant studies and systematic reviews, and performed citation tracking using the Science Citation Index to identify any additional relevant studies. No language or date restrictions were applied to the electronic searches. SELECTION CRITERIA We included studies that had prospectively defined cohorts with any accepted definition of MCI at time of performing the test and the use of 18F-flutemetamol scan to evaluate the DTA of the progression from MCI to ADD or other forms of dementia. In addition, we only selected studies that applied a reference standard for Alzheimer's dementia diagnosis, for example, National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) or Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. DATA COLLECTION AND ANALYSIS We screened all titles and abstracts identified in electronic-database searches. Two review authors independently selected studies for inclusion and extracted data to create two-by-two tables, showing the binary test results cross-classified with the binary reference standard. We used these data to calculate sensitivities, specificities, and their 95% confidence intervals. Two independent assessors performed quality assessment using the QUADAS-2 tool plus some additional items to assess the methodological quality of the included studies. MAIN RESULTS Progression from MCI to ADD was evaluated in 243 participants from two studies. The studies reported data on 19 participants with two years of follow-up and on 224 participants with three years of follow-up. Nine (47.4%) participants converted at two years follow-up and 81 (36.2%) converted at three years of follow-up.There were concerns about participant selection and sampling in both studies. The index test domain in one study was considered unclear and in the second study it was considered at low risk of bias. For the reference standard domain, one study was considered at low risk and the second study was considered to have an unclear risk of bias. Regarding the domains of flow and timing, both studies were considered at high risk of bias. MCI to ADD;Progression from MCI to ADD at two years of follow-up had a sensitivity of 89% (95% CI 52 to 100) and a specificity of 80% (95% CI 44 to 97) by quantitative assessment by SUVR (n = 19, 1 study).Progression from MCI to ADD at three years of follow-up had a sensitivity of 64% (95% CI 53 to 75) and a specificity of 69% (95% CI 60 to 76) by visual assessment (n = 224, 1 study).There was no information regarding the other two objectives in this systematic review (SR): progression from MCI to other forms of dementia and progression to any form of dementia at follow-up. AUTHORS' CONCLUSIONS Due to the varying sensitivity and specificity for predicting the progression from MCI to ADD and the limited data available, we cannot recommend routine use of 18F-flutemetamol in clinical practice. 18F-flutemetamol has high financial costs; therefore, clearly demonstrating its DTA and standardising the process of the 18F-flutemetamol modality is important prior to its wider use.
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Affiliation(s)
- Gabriel Martínez
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
- Institut Català de Neurociències AplicadesAlzheimer Research Center and Memory Clinic of Fundació ACEBarcelonaSpain
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
| | - Paulina Fuentes Padilla
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
| | - Javier Zamora
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid (Spain) and Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of LondonClinical Biostatistics UnitLondonMadridUK
| | - Leon Flicker
- University of Western AustraliaWestern Australian Centre for Health & Ageing ‐ WACHACrawleyPerthWestern AustraliaAustralia6014
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
- Universitat Autònoma de BarcelonaSant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaCatalunyaSpain08025
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Martínez G, Vernooij RWM, Fuentes Padilla P, Zamora J, Flicker L, Bonfill Cosp X. 18F PET with florbetaben for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2017; 11:CD012883. [PMID: 29164600 PMCID: PMC6485979 DOI: 10.1002/14651858.cd012883] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND 18F-florbetaben uptake by brain tissue, measured by positron emission tomography (PET), is accepted by regulatory agencies like the Food and Drug Administration (FDA) and the European Medicine Agencies (EMA) for assessing amyloid load in people with dementia. Its added value is mainly demonstrated by excluding Alzheimer's pathology in an established dementia diagnosis. However, the National Institute on Aging and Alzheimer's Association (NIA-AA) revised the diagnostic criteria for Alzheimer's disease and confidence in the diagnosis of mild cognitive impairment (MCI) due to Alzheimer's disease may be increased when using some amyloid biomarkers tests like 18F-florbetaben. These tests, added to the MCI core clinical criteria, might increase the diagnostic test accuracy (DTA) of a testing strategy. However, the DTA of 18F-florbetaben to predict the progression from MCI to Alzheimer's disease dementia (ADD) or other dementias has not yet been systematically evaluated. OBJECTIVES To determine the DTA of the 18F-florbetaben PET scan for detecting people with MCI at time of performing the test who will clinically progress to ADD, other forms of dementia (non-ADD), or any form of dementia at follow-up. SEARCH METHODS The most recent search for this review was performed in May 2017. We searched MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), BIOSIS Citation Index (Thomson Reuters Web of Science), Web of Science Core Collection, including the Science Citation Index (Thomson Reuters Web of Science) and the Conference Proceedings Citation Index (Thomson Reuters Web of Science), LILACS (BIREME), CINAHL (EBSCOhost), ClinicalTrials.gov (https://clinicaltrials.gov), and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (http://www.who.int/ictrp/search/en/). We also searched ALOIS, the Cochrane Dementia & Cognitive Improvement Group's specialised register of dementia studies (http://www.medicine.ox.ac.uk/alois/). We checked the reference lists of any relevant studies and systematic reviews, and performed citation tracking using the Science Citation Index to identify any additional relevant studies. No language or date restrictions were applied to electronic searches. SELECTION CRITERIA We included studies that had prospectively defined cohorts with any accepted definition of MCI at time of performing the test and the use of 18F-florbetaben scan to evaluate the DTA of the progression from MCI to ADD or other forms of dementia. In addition, we only selected studies that applied a reference standard for Alzheimer's dementia diagnosis, for example, the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) or Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. DATA COLLECTION AND ANALYSIS We screened all titles and abstracts identified in electronic-database searches. Two review authors independently selected studies for inclusion and extracted data to create two-by-two tables, showing the binary test results cross-classified with the binary reference standard. We used these data to calculate sensitivities, specificities, and their 95% confidence intervals. Two independent assessors performed quality assessment using the QUADAS-2 tool plus some additional items to assess the methodological quality of the included studies. MAIN RESULTS Progression from MCI to ADD, any other form of dementia, and any form of dementia was evaluated in one study (Ong 2015). It reported data on 45 participants at four years of follow-up; 21 participants met NINCDS-ADRDA criteria for Alzheimer's disease dementia at four years of follow-up, the proportion converting to ADD was 47% of the 45 participants, and 11% of the 45 participants met criteria for other types of dementias (three cases of FrontoTemporal Dementia (FTD), one of Dementia with Lewy body (DLB), and one of Progressive Supranuclear Palsy (PSP)). We considered the study to be at high risk of bias in the domains of the reference standard, flow, and timing (QUADAS-2). MCI to ADD; 18F-florbetaben PET scan analysed visually: the sensitivity was 100% (95% confidence interval (CI) 84% to 100%) and the specificity was 83% (95% CI 63% to 98%) (n = 45, 1 study). Analysed quantitatively: the sensitivity was 100% (95% CI 84% to 100%) and the specificity was 88% (95% CI 68% to 97%) for the diagnosis of ADD at follow-up (n = 45, 1 study). MCI to any other form of dementia (non-ADD); 18F-florbetaben PET scan analysed visually: the sensitivity was 0% (95% CI 0% to 52%) and the specificity was 38% (95% CI 23% to 54%) (n = 45, 1 study). Analysed quantitatively: the sensitivity was 0% (95% CI 0% to 52%) and the specificity was 40% (95% CI 25% to 57%) for the diagnosis of any other form of dementia at follow-up (n = 45, 1 study). MCI to any form of dementia;18F-florbetaben PET scan analysed visually: the sensitivity was 81% (95% CI 61% to 93%) and the specificity was 79% (95% CI 54% to 94%) (n = 45, 1 study). Analysed quantitatively: the sensitivity was 81% (95% CI 61% to 93%) and the specificity was 84% (95% CI 60% to 97%) for the diagnosis of any form of dementia at follow-up (n = 45, 1 study). AUTHORS' CONCLUSIONS Although we were able to calculate one estimation of DTA in, especially, the prediction of progression from MCI to ADD at four years follow-up, the small number of participants implies imprecision of sensitivity and specificity estimates. We cannot make any recommendation regarding the routine use of 18F-florbetaben in clinical practice based on one single study with 45 participants. 18F-florbetaben has high financial costs, therefore, clearly demonstrating its DTA and standardising the process of the 18F-florbetaben modality are important prior to its wider use.
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Affiliation(s)
- Gabriel Martínez
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
- Institut Català de Neurociències AplicadesAlzheimer Research Center and Memory Clinic of Fundació ACEBarcelonaSpain
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
| | - Paulina Fuentes Padilla
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167Pavelló 18 Planta 0BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
| | - Javier Zamora
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid (Spain) and Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of LondonClinical Biostatistics UnitLondonMadridUK
| | - Leon Flicker
- University of Western AustraliaWestern Australian Centre for Health & Ageing ‐ WACHACrawleyPerthWestern AustraliaAustralia6014
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
- Universitat Autònoma de BarcelonaSant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaCatalunyaSpain08025
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Wang N, Ou Y, Qing W. Combined acupuncture and general anesthesia on immune and cognitive function in elderly patients following subtotal gastrectomy for gastric cancer. Oncol Lett 2017; 15:189-194. [PMID: 29391879 PMCID: PMC5769376 DOI: 10.3892/ol.2017.7262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/25/2017] [Indexed: 12/12/2022] Open
Abstract
This study investigated the effects of acupuncture combined with general anesthesia on postoperative immune and cognitive functions in elderly patients undergoing subtotal gastrectomy. We recruited 96 elderly patients who received anesthesia for subtotal gastrectomy and randomly divided them into control (n=48) and experimental (n=48) groups. The control group received general anesthesia and the experimental group received combined acupuncture and general anesthesia. We measured hemodynamic immediately before and after anesthesia induction, and immune observations before and after surgery. We found no significant differences in mean heart rate (HR), mean oxygen saturation (SpO2), and partial pressure of end-tidal carbon dioxide (PETCO2) in the perioperative period between the two groups. Mean arterial pressure (MAP) was lower in the experimental group than that in the control group (P<0.05). The levels of cluster of differentiation 3 (CD3+), CD4+ and CD4+/CD8+ in both groups were significantly lower after surgery in both groups (P<0.05). We also found some time-points in which the immune markers where significantly higher in the experimental group. In terms of adverse reactions, there were no differences in nausea, vomiting, and hypoxemia between the two groups (P>0.05), but the incidence of delayed recovery and postoperative agitation were significantly lower in the experimental group compared with those in the control group (P<0.05). One day after surgery, the experimental group showed better protection of cognitive function than the control group (P<0.05). Overall, combined acupuncture and general anesthesia in elderly gastric cancer patients receiving subtotal gastrectomy showed more stable hemodynamics and fewer stress responses during surgery. Thus, combined acupuncture and general anesthesia can shorten the recovery time from anesthesia, have less negative effects on immune function and decrease the incidence of postoperative cognitive impairment.
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Affiliation(s)
- Ningke Wang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Yangwen Ou
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Wenxiang Qing
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
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286
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Bature F, Guinn BA, Pang D, Pappas Y. Signs and symptoms preceding the diagnosis of Alzheimer's disease: a systematic scoping review of literature from 1937 to 2016. BMJ Open 2017; 7:e015746. [PMID: 28851777 PMCID: PMC5724073 DOI: 10.1136/bmjopen-2016-015746] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Late diagnosis of Alzheimer's disease (AD) may be due to diagnostic uncertainties. We aimed to determine the sequence and timing of the appearance of established early signs and symptoms in people who are subsequently diagnosed with AD. METHODS We used systematic review methodology to investigate the existing literature. Articles were reviewed in May 2016, using the following databases: MEDLINE, PsycINFO, CINAHL, British Nursing Index, PubMed central and the Cochrane library, with no language restriction. Data from the included articles were extracted independently by two authors and quality assessment was undertaken with the quality assessment and diagnostic accuracy tool-2 (QUADAS tool-2 quality assessment tool). RESULTS We found that depression and cognitive impairment were the first symptoms to appear in 98.5% and 99.1% of individuals in a study with late-onset AD (LOAD) and 9% and 80%, respectively, in early-onset AD (EOAD). Memory loss presented early and was experienced 12 years before the clinically defined AD dementia in the LOAD. However, the rapidly progressive late-onset AD presented predominantly with 35 non-established focal symptoms and signs including myoclonus (75%), disturbed gait (66%) and rigidity. These were misdiagnosed as symptoms of Creutzfeldt-Jacob disease (CJD) in all the cases. The participant with the lowest mini-mental state examination score of 25 remained stable for 2 years, which is consistent with the score of the healthy family members. CONCLUSIONS The findings of this review suggest that neurological and depressive behaviours are an early occurrence in EOAD with depressive and cognitive symptoms in the measure of semantic memory and conceptual formation in LOAD. Misdiagnosis of rapidly progressive AD as CJD and the familial memory score can be confounding factors while establishing a diagnosis. However, the study was limited by the fact that each one of the findings was based on a single study.
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Affiliation(s)
- Fidelia Bature
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
| | - Barbara-ann Guinn
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
- School of Life Sciences, The University of Hull, Hull, UK
| | - Dong Pang
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, Putteridge Bury Campus, University of Bedfordshire, Putteridgebury, Luton, UK
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287
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Xu H, Zhang Y, Wu B. Association between migration and cognitive status among middle-aged and older adults: a systematic review. BMC Geriatr 2017; 17:184. [PMID: 28818064 PMCID: PMC5561610 DOI: 10.1186/s12877-017-0585-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022] Open
Abstract
Background This study aimed to synthesize the current literature examining the association between migration and cognitive function among middle-aged and older adults. Methods We used the PRISMA as a guideline for this systematic review and searched the following databases: PubMed, CINAHL, EMBASE, and Global Health. Results Twenty-five published studies were included. Twenty-two studies were focused on international migrants, while only 3 studied internal migrants. Fourteen studies were conducted in the United States, followed by UK (n = 2), Israel (n = 2), India (n = 2) and other countries like Canada and Australia. Some studies showed that middle-aged and older migrants demonstrated poorer cognitive function comparing to non-migrants in hosting places; while other studies indicated no association between migration and cognitive function. A higher level of acculturation was associated with better performance on cognitive function tests among migrants. Conclusion It is unclear how or whether migration and cognitive function are related. The quality of current literature suffered from methodological deficiencies. Additional research is needed to examine the linkages using more comprehensive measures of migration and cognitive function.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, NC, USA. .,Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA.
| | - Yinan Zhang
- Chinese Center for Health Education, Beijing, China
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY, USA
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Maurano STP, da Silva DJ, Ávila MP, Magacho L. Cognitive evaluation of patients with glaucoma and its comparison with individuals with Alzheimer’s disease. Int Ophthalmol 2017; 38:1839-1844. [DOI: 10.1007/s10792-017-0658-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
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Necroptosis activation in Alzheimer's disease. Nat Neurosci 2017; 20:1236-1246. [PMID: 28758999 DOI: 10.1038/nn.4608] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is characterized by severe neuronal loss; however, the mechanisms by which neurons die remain elusive. Necroptosis, a programmed form of necrosis, is executed by the mixed lineage kinase domain-like (MLKL) protein, which is triggered by receptor-interactive protein kinases (RIPK) 1 and 3. We found that necroptosis was activated in postmortem human AD brains, positively correlated with Braak stage, and inversely correlated with brain weight and cognitive scores. In addition, we found that the set of genes regulated by RIPK1 overlapped significantly with multiple independent AD transcriptomic signatures, indicating that RIPK1 activity could explain a substantial portion of transcriptomic changes in AD. Furthermore, we observed that lowering necroptosis activation reduced cell loss in a mouse model of AD. We anticipate that our findings will spur a new area of research in the AD field focused on developing new therapeutic strategies aimed at blocking its activation.
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290
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Behrndt EM, Straubmeier M, Seidl H, Book S, Graessel E, Luttenberger K. The German day-care study: multicomponent non-drug therapy for people with cognitive impairment in day-care centres supplemented with caregiver counselling (DeTaMAKS) - study protocol of a cluster-randomised controlled trial. BMC Health Serv Res 2017; 17:492. [PMID: 28716141 PMCID: PMC5513135 DOI: 10.1186/s12913-017-2422-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022] Open
Abstract
Background It is the wish of both people with cognitive impairment and their informal caregivers for the impaired person to live at home for as long as possible. This is also in line with economic arguments about health. The existing structure of day-care services for the elderly can be used to achieve this. Due to the current lack of empirical evidence in this field, most day-care centres do not offer a scientifically evaluated, structured intervention, but instead offer a mixture of individual activities whose efficacy has not yet been established. Informal caregivers of people with dementia use day-care centres primarily to relieve themselves of their care tasks and as a support service. Methods/design The present study therefore investigates the effectiveness of a combination of a multicomponent activation therapy for people with mild cognitive impairment (MCI) or mild to moderate dementia at day-care centres and a brief telephone intervention for their informal caregivers. The study is conducted as a cluster-randomised intervention trial at 34 day-care centres in Germany with a 6-month treatment phase. The centres in the waitlist control group provide “care as usual”. A power analysis indicated that 346 people should initially be included in the study. The primary endpoints of the study include the ability to perform activities of daily living (ADL) and cognitive capacities on the side of the day-care centre users and the subjectively perceived burden and well-being of the informal caregivers. The total duration of the study is 3 years, during which data are collected both by the psychometric testing of the people with cognitive impairment and by telephone interviews with informal caregivers. Discussion The project has three distinctive quality features. First, it is embedded in real care situations since the day-care services have already been established for this target group. Second, due to the large number of cases and the fact that the participating day-care centres are spread across the entire country, the results can be expected to be generalisable. Third, the interventions can be assumed to be implementable as they required only a one-day training event for the staff already working at the centres. Trial registration ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
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Affiliation(s)
- Elisa-Marie Behrndt
- Department of Psychiatry and Psychotherapy, Centre for Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Melanie Straubmeier
- Department of Psychiatry and Psychotherapy, Centre for Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum, München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Stephanie Book
- Department of Psychiatry and Psychotherapy, Centre for Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Elmar Graessel
- Department of Psychiatry and Psychotherapy, Centre for Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Katharina Luttenberger
- Department of Psychiatry and Psychotherapy, Centre for Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Yue T, Jia X, Petrosino J, Sun L, Fan Z, Fine J, Davis R, Galster S, Kuret J, Scharre DW, Zhang M. Computational integration of nanoscale physical biomarkers and cognitive assessments for Alzheimer's disease diagnosis and prognosis. SCIENCE ADVANCES 2017; 3:e1700669. [PMID: 28782028 PMCID: PMC5533537 DOI: 10.1126/sciadv.1700669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/26/2017] [Indexed: 05/16/2023]
Abstract
With the increasing prevalence of Alzheimer's disease (AD), significant efforts have been directed toward developing novel diagnostics and biomarkers that can enhance AD detection and management. AD affects the cognition, behavior, function, and physiology of patients through mechanisms that are still being elucidated. Current AD diagnosis is contingent on evaluating which symptoms and signs a patient does or does not display. Concerns have been raised that AD diagnosis may be affected by how those measurements are analyzed. Unbiased means of diagnosing AD using computational algorithms that integrate multidisciplinary inputs, ranging from nanoscale biomarkers to cognitive assessments, and integrating both biochemical and physical changes may provide solutions to these limitations due to lack of understanding for the dynamic progress of the disease coupled with multiple symptoms in multiscale. We show that nanoscale physical properties of protein aggregates from the cerebral spinal fluid and blood of patients are altered during AD pathogenesis and that these properties can be used as a new class of "physical biomarkers." Using a computational algorithm, developed to integrate these biomarkers and cognitive assessments, we demonstrate an approach to impartially diagnose AD and predict its progression. Real-time diagnostic updates of progression could be made on the basis of the changes in the physical biomarkers and the cognitive assessment scores of patients over time. Additionally, the Nyquist-Shannon sampling theorem was used to determine the minimum number of necessary patient checkups to effectively predict disease progression. This integrated computational approach can generate patient-specific, personalized signatures for AD diagnosis and prognosis.
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Affiliation(s)
- Tao Yue
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Xinghua Jia
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
- ULC Robotics, Hauppauge, NY 11788, USA
| | - Jennifer Petrosino
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Leming Sun
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Zhen Fan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Jesse Fine
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Rebecca Davis
- Department of Neurology, Division of Cognitive Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Scott Galster
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, OH 45433, USA
| | - Jeff Kuret
- Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Douglas W. Scharre
- Department of Neurology, Division of Cognitive Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Mingjun Zhang
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH 43210, USA
- Corresponding author.
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292
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Shimada H, Makizako H, Park H, Doi T, Lee S. Validity of the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination for detecting the incidence of dementia in older Japanese adults. Geriatr Gerontol Int 2017. [DOI: 10.1111/ggi.13079] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Hyuma Makizako
- Department of Preventive Gerontology, Center for Gerontology and Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Hyuntae Park
- Department of Health Care and Science, College of Health Science; Dong-A University; Busan Korea
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science; National Center for Geriatrics and Gerontology; Obu Japan
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293
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Hunt HA, Van Kampen S, Takwoingi Y, Llewellyn DJ, Pearson M, Hyde CJ. The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol. Diagn Progn Res 2017; 1:14. [PMID: 31093543 PMCID: PMC6460787 DOI: 10.1186/s41512-017-0014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family practice setting.Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting. METHODS We will employ robust systematic review methods to assess studies of diagnostic accuracy where both the MMSE and GPCOG have been evaluated as direct comparisons, i.e. within the same study population. This approach will enable us to minimise between-study heterogeneity, to eliminate the risk of bias due to confounding and increase the opportunity to make clinically useful and useable comparisons of diagnostic accuracy across both the MMSE and GPCOG. This systematic review will be conducted using a pragmatic search strategy, refining searches that build upon studies identified as part of our overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care. DISCUSSION Through this systematic review, we aim to improve existing evidence on how the diagnostic accuracy of MMSE and GPCOG compares when used to identify dementia within the family practice setting. We also aim to make clinical practice recommendations based upon the variations in diagnostic accuracy identified between the MMSE and GPCOG.
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Affiliation(s)
- Harriet A. Hunt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter, Devon EX1 1TE UK
| | - Sanne Van Kampen
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC building, Tamar Science Park, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - David J. Llewellyn
- University of Exeter Medical School, St Luke’s Campus, Exeter, Devon EX1 1TE UK
| | - Mark Pearson
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter, Devon EX1 1TE UK
| | - Christopher J. Hyde
- Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter, Devon EX1 1TE UK
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294
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Tsang S, Sperling SA, Park MH, Helenius IM, Williams IC, Manning C. Health Variables Are Informative in Screening for Mild Cognitive Impairment Among Elderly African Americans. J Appl Gerontol 2017; 38:1421-1444. [PMID: 28554264 DOI: 10.1177/0733464817711961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To aid primary care providers in identifying people at increased risk for cognitive decline, we explored the relative importance of health and demographic variables in detecting potential cognitive impairment using the Mini-Mental State Examination (MMSE). Participants were 94 older African Americans coming to see their primary care physicians for reasons other than cognitive complaints. Education was strongly associated with cognitive functioning. Among those with at least 9 years of education, patients with more vascular risk factors were at greater risk for mild cognitive impairment. For patients with fewer than 9 years of education, those with fewer prescribed medications were at increased risk for dementia. These results suggest that in addition to the MMSE, primary care physicians can make use of patients' health information to improve identification of patients at increased risk for cognitive impairment. With improved identification, physicians can implement strategies to mitigate the progression and impact of cognitive difficulties.
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Affiliation(s)
- Siny Tsang
- 1 Columbia University, New York, NY, USA
| | | | - Moon-Ho Park
- 3 Korea University College of Medicine, Republic of Korea
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295
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Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery. J Clin Monit Comput 2017; 32:285-293. [DOI: 10.1007/s10877-017-0024-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/26/2017] [Indexed: 11/27/2022]
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296
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Ritchie C, Smailagic N, Noel‐Storr AH, Ukoumunne O, Ladds EC, Martin S. CSF tau and the CSF tau/ABeta ratio for the diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2017; 3:CD010803. [PMID: 28328043 PMCID: PMC6464349 DOI: 10.1002/14651858.cd010803.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Research suggests that measurable change in cerebrospinal fluid (CSF) biomarkers occurs years in advance of the onset of clinical symptoms (Beckett 2010). In this review, we aimed to assess the ability of CSF tau biomarkers (t-tau and p-tau) and the CSF tau (t-tau or p-tau)/ABeta ratio to enable the detection of Alzheimer's disease pathology in patients with mild cognitive impairment (MCI). These biomarkers have been proposed as important in new criteria for Alzheimer's disease dementia that incorporate biomarker abnormalities. OBJECTIVES To determine the diagnostic accuracy of 1) CSF t-tau, 2) CSF p-tau, 3) the CSF t-tau/ABeta ratio and 4) the CSF p-tau/ABeta ratio index tests for detecting people with MCI at baseline who would clinically convert to Alzheimer's disease dementia or other forms of dementia at follow-up. SEARCH METHODS The most recent search for this review was performed in January 2013. We searched MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Thomson Reuters Web of Science), Web of Science Core Collection, including Conference Proceedings Citation Index (Thomson Reuters Web of Science), PsycINFO (OvidSP), and LILACS (BIREME). We searched specialized sources of diagnostic test accuracy studies and reviews. We checked reference lists of relevant studies and reviews for additional studies. We contacted researchers for possible relevant but unpublished data. We did not apply any language or data restriction to the electronic searches. We did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We selected those studies that had prospectively well-defined cohorts with any accepted definition of MCI and with CSF t-tau or p-tau and CSF tau (t-tau or p-tau)/ABeta ratio values, documented at or around the time the MCI diagnosis was made. We also included studies which looked at data from those cohorts retrospectively, and which contained sufficient data to construct two by two tables expressing those biomarker results by disease status. Moreover, studies were only selected if they applied a reference standard for Alzheimer's disease dementia diagnosis, for example, the NINCDS-ADRDA or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. 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, and the full papers for eligibility. Two independent assessors performed data extraction and quality assessment. Where data allowed, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic (ROC) curve. MAIN RESULTS In total, 1282 participants with MCI at baseline were identified in the 15 included studies of which 1172 had analysable data; 430 participants converted to Alzheimer's disease dementia and 130 participants to other forms of dementia. Follow-up ranged from less than one year to over four years for some participants, but in the majority of studies was in the range one to three years. Conversion to Alzheimer's disease dementia The accuracy of the CSF t-tau was evaluated in seven studies (291 cases and 418 non-cases).The sensitivity values ranged from 51% to 90% while the specificity values ranged from 48% to 88%. At the median specificity of 72%, the estimated sensitivity was 75% (95% CI 67 to 85), the positive likelihood ratio was 2.72 (95% CI 2.43 to 3.04), and the negative likelihood ratio was 0.32 (95% CI 0.22 to 0.47).Six studies (164 cases and 328 non-cases) evaluated the accuracy of the CSF p-tau. The sensitivities were between 40% and 100% while the specificities were between 22% and 86%. At the median specificity of 47.5%, the estimated sensitivity was 81% (95% CI: 64 to 91), the positive likelihood ratio was 1.55 (CI 1.31 to 1.84), and the negative likelihood ratio was 0.39 (CI: 0.19 to 0.82).Five studies (140 cases and 293 non-cases) evaluated the accuracy of the CSF p-tau/ABeta ratio. The sensitivities were between 80% and 96% while the specificities were between 33% and 95%. We did not conduct a meta-analysis because the studies were few and small. Only one study reported the accuracy of CSF t-tau/ABeta ratio.Our findings are based on studies with poor reporting. A significant number of studies had unclear risk of bias for the reference standard, participant selection and flow and timing domains. According to the assessment of index test domain, eight of 15 studies were of poor methodological quality.The accuracy of these CSF biomarkers for 'other dementias' had not been investigated in the included primary studies. Investigation of heterogeneity The main sources of heterogeneity were thought likely to be reference standards used for the target disorders, sources of recruitment, participant sampling, index test methodology and aspects of study quality (particularly, inadequate blinding).We were not able to formally assess the effect of each potential source of heterogeneity as planned, due to the small number of studies available to be included. AUTHORS' CONCLUSIONS The insufficiency and heterogeneity of research to date primarily leads to a state of uncertainty regarding the value of CSF testing of t-tau, p-tau or p-tau/ABeta ratio for the diagnosis of Alzheimer's disease in current clinical practice. Particular attention should be paid to the risk of misdiagnosis and overdiagnosis of dementia (and therefore over-treatment) in clinical practice. These tests, like other biomarker tests which have been subject to Cochrane DTA reviews, appear to have better sensitivity than specificity and therefore might have greater utility in ruling out Alzheimer's disease as the aetiology to the individual's evident cognitive impairment, as opposed to ruling it in. The heterogeneity observed in the few studies awaiting classification suggests our initial summary will remain valid. However, these tests may have limited clinical value until uncertainties have been addressed. Future studies with more uniformed approaches to thresholds, analysis and study conduct may provide a more homogenous estimate than the one that has been available from the included studies we have identified.
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Affiliation(s)
- Craig Ritchie
- University of EdinburghCentre for Clinical Brain SciencesEdinburghUK
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Obioha Ukoumunne
- University of Exeter Medical School, University of ExeterNIHR CLAHRC South West Peninsula (PenCLAHRC)Veysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Emma C Ladds
- North Bristol NHS TrustSouthmead hospitalBristolUK
| | - Steven Martin
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
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297
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Zanchi D, Giannakopoulos P, Borgwardt S, Rodriguez C, Haller S. Hippocampal and Amygdala Gray Matter Loss in Elderly Controls with Subtle Cognitive Decline. Front Aging Neurosci 2017; 9:50. [PMID: 28326035 PMCID: PMC5340094 DOI: 10.3389/fnagi.2017.00050] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
In contrast to the idea that hippocampal and amygdala volume loss occur in late phases of neurodegeneration, recent contributions point to the relevance of preexisting structural deficits that are associated with aging and are independent of amyloid deposition in preclinical Alzheimer disease cases. The present work explores GM hippocampal and amygdala volumes in elderly controls displaying the first signs of cognitive decline. 455 subjects (263 females), including 374 controls (228 females) and 81 middle cognitive impairment subjects (35 females), underwent two neuropsychological evaluations (baseline and 18 months follow-up) and a MRI-T1 examination (only baseline). Clinical assessment included Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale, Hospitalized Anxiety and Depression scale, the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery and RI-48 Cued Recall Test (RI-48) for episodic memory. Based on their cognitive performance, we defined the controls as stable controls (sCON) and deteriorating controls (dCONs). Analyses included volumetric assessment, shape analyses and linear regressions between GM volume loss and differences in clinical scores between baseline and follow-up. Significant GM volume decrease in hippocampus bilaterally and right amygdala was found in dCON compared to sCON (p < 0.05). Lower right amygdala volumes were measured in mild cognitive impairment (MCI) compared to sCON (p < 0.05). Shape analyses revealed that atrophy was more pronounced at the superior- posterior lateral side of the hippocampus and amygdala. Significant correlations were found between GM volume of left hippocampus and the delta of MMSE and RI-48 scores in dCON and MCI groups separately. Decreased hippocampal and right amygdala volumes precede the first signs of cognitive decline in healthy elderly controls at the pre-MCI state. Left hippocampus volume may also predict short-term changes of overall cognition in these vulnerable cases.
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Affiliation(s)
- Davide Zanchi
- Department of Psychiatry, University of BaselBasel, Switzerland; Department of Neuropsychiatry, University Psychiatry ClinicBasel, Switzerland
| | | | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Basel, Switzerland
| | - Cristelle Rodriguez
- Department of Psychiatry, Faculty of Medicine, University of Geneva Geneva, Switzerland
| | - Sven Haller
- Affidea Carouge Radiologic Diagnostic Center, GenevaSwitzerland; Department of Surgical Sciences, Radiology, Uppsala University, UppsalaSweden; Department of Neuroradiology, University Hospital FreiburgFreiburg, Germany; Department of Neuroradiology, Faculty of Medicine of the University of GenevaGeneva, Switzerland
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298
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Evlice A, Ulusu NN. Glucose-6-phosphate dehydrogenase a novel hope on a blood-based diagnosis of Alzheimer's disease. Acta Neurol Belg 2017; 117:229-234. [PMID: 27378307 DOI: 10.1007/s13760-016-0666-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
Abstract
Alzheimer's disease (AD) is a multi-factorial neurodegenerative disorder that numerous factors have key properties in the development of this proteopathy. Glucose-6-phosphate dehydrogenase (G6PD) is the most common form of enzymopathy. We have examined G6PD enzyme activity levels in the serum of newly diagnosed AD patients compared with control subjects without dementia from the both sexes. Serum G6PD levels were found to be significantly higher (approximately two times) in AD patients compared to control geriatric subjects in both sexes. We have concluded that G6PD seems to play an integral role in the progress and/or prevention of AD.
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Affiliation(s)
- Ahmet Evlice
- Department of Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nuriye Nuray Ulusu
- Department of Biochemistry, School of Medicine, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, Turkey.
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299
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Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical Activity: A Viable Way to Reduce the Risks of Mild Cognitive Impairment, Alzheimer's Disease, and Vascular Dementia in Older Adults. Brain Sci 2017; 7:E22. [PMID: 28230730 PMCID: PMC5332965 DOI: 10.3390/brainsci7020022] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
A recent alarming rise of neurodegenerative diseases in the developed world is one of the major medical issues affecting older adults. In this review, we provide information about the associations of physical activity (PA) with major age-related neurodegenerative diseases and syndromes, including Alzheimer's disease, vascular dementia, and mild cognitive impairment. We also provide evidence of PA's role in reducing the risks of these diseases and helping to improve cognitive outcomes in older adults. Finally, we describe some potential mechanisms by which this protective effect occurs, providing guidelines for future research.
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Affiliation(s)
- Patrick J Gallaway
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ 85721-0038, USA.
| | - Hiroji Miyake
- Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo 663-8211, Japan.
| | - Maciej S Buchowski
- Department of Medicine, Vanderbilt University, Nashville, TN 37232-5280, USA.
| | - Mieko Shimada
- Chiba Prefectural University of Health Sciences, Chiba 261-0014, Japan.
| | - Yutaka Yoshitake
- National Institute of Fitness & Sport in Kanoya, Kagoshima 891-2311, Japan.
| | - Angela S Kim
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ 85721-0038, USA.
| | - Nobuko Hongu
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ 85721-0038, USA.
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300
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Ismail Z, Mortby ME. Cognitive and Neuropsychiatric Screening Tests in Older Adults. MENTAL HEALTH AND ILLNESS WORLDWIDE 2017. [DOI: 10.1007/978-981-10-2414-6_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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