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Wang S, Xue Y, Zhang J, Meng H, Zhang J, Li X, Zhang Z, Li H, Pan B, Lu X, Zhang Q, Niu Q. Interaction between aluminum exposure and ApoEε4 gene on cognitive function of in-service workers. CHEMOSPHERE 2023; 323:138282. [PMID: 36868418 DOI: 10.1016/j.chemosphere.2023.138282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/28/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The occurrence and development of cognitive impairment, the early stage of AD, may be affected both by factors of environmental (aluminum exposure) and genetic (ApoEε4 gene). But whether there is an interaction between the two factors on cognitive function is still unknown. To explore the interaction between the two factors on cognitive function of in-service workers. A total of 1121 in-service workers in a large aluminum factory were investigated in Shanxi Province. Cognitive function was assessed by the Mini-mental State Examination (MMSE), the clock-drawing test (CDT), the Digit Span Test (DST, including DSFT and DSBT), the fuld object memory evaluation (FOM), and the verbal fluency task (VFT). The plasma-Al (p-Al) concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) as an internal exposure indicator, and the participants were divided into four Al exposure groups according to the quartile of p-Al concentrations, namely Q1, Q2, Q3, and Q4. ApoE genotype was determined by Ligase Detection Reaction (LDR). The multiplicative model was fitted using non-conditional logistic regression and additive model was fitted using crossover analysis to analyze the interaction between p-Al concentrations and the ApoEε4 gene. Finally, a dose-response relationship between p-Al concentrations and cognitive impairment was observed, with the p-Al concentrations increased, cognitive function performance gradually becomes worse (Ptrend<0.05), and the risk of cognitive impairment gradually increases (Ptrend<0.05), mainly in executive/visuospatial impairment, auditory memory impairment (particularly the working memory impairment). And ApoEε4 gene may be a risk factor for cognitive impairment, while no association between the ApoEε2 gene and cognitive impairment is observed. Additionally, an additive but no multiplicative interaction between p-Al concentrations and ApoEε4 gene is observed, and when the two factors work together, the risk of cognitive impairment further increased, of which 44.2% can be attributed to the interaction effect.
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Affiliation(s)
- Shanshan Wang
- Section of Occupational Medicine, Department of Special Medicine, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Yingjun Xue
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Jintao Zhang
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Huaxing Meng
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Jingsi Zhang
- Section of Occupational Medicine, Department of Special Medicine, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Xiaoyan Li
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Zhuoran Zhang
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Huan Li
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Department of Occupational Health, School of Public Health, Jining Medical University, Jining, Shandong, 272000, China
| | - Baolong Pan
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, 030001, China
| | - Xiaoting Lu
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Key Lab of Environmental Hazards and Health Damage of Shanxi Province, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Qinli Zhang
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Key Lab of Environmental Hazards and Health Damage of Shanxi Province, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Qiao Niu
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China; Key Lab of Environmental Hazards and Health Damage of Shanxi Province, Shanxi Medical University, Taiyuan, Shanxi, 030001, China.
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Abstract
OBJECTIVES We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. METHODS We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. RESULTS We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). CONCLUSIONS Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.
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Kor PPK, Kwan RYC, Cheung DSK, Lai C. The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice? Int J Nurs Pract 2022; 28:e13096. [PMID: 36003029 DOI: 10.1111/ijn.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 06/08/2022] [Accepted: 07/23/2022] [Indexed: 12/01/2022]
Abstract
AIM Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong. METHODS A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. RESULTS Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services. CONCLUSION Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.
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Affiliation(s)
- Patrick Pui-Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | | | | | - Claudia Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations. J Int Neuropsychol Soc 2020; 26:331-351. [PMID: 31511111 DOI: 10.1017/s1355617719000894] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations. METHOD A systematic review was performed using six databases, without restrictions on the year or language of publication. RESULTS Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29). CONCLUSIONS Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.
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Ho RTH, Fong TCT, Hon T, Chan WC, Kwan JSK, Chiu PKC, Lam LCW. Psychometric validation of Fuld Object Memory Evaluation in older adults with cognitive impairments. Aging Ment Health 2019. [PMID: 29517270 DOI: 10.1080/13607863.2018.1442414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) refers to an early but abnormal state of cognitive impairment with minimal functional impairment. The present study aimed to evaluate the validity of Fuld Object Memory Evaluation (FOME) as a measure of episodic memory function. METHOD The study sample included 204 Chinese older adults with cognitive impairments. The participants completed five recall trials and a delayed trial in FOME, neurocognitive measures on digit spans and trail making, and daily functioning. Discriminative power of FOME to differentiate between MCI and dementia was inspected via receiver operating characteristic curve analysis. RESULTS FOME showed good test-retest reliability and convergent validity with digit spans and trail making. Controlling for gender, age, and education, lower levels of FOME total retrieval, verbal fluency, and daily functioning significantly predicted a higher likelihood of dementia compared to MCI. The optimal cut-off scores for total retrieval, verbal fluency, and daily functioning to differentiate dementia were 37/38 (77% sensitivity and 83% specificity), 28/29 (85% sensitivity and 72% specificity), and 14/15 (92% sensitivity and 78% specificity), respectively, in the younger subgroup. The corresponding figures were 34/35 (69% sensitivity and 76% specificity) and 27/28 (92% sensitivity and 62% specificity), and 11/12 (74% sensitivity and 80% specificity), respectively, in the older subgroup. CONCLUSION The findings support the FOME as a valid assessment tool of episodic memory function in older Chinese adults. The combined use of FOME and daily functioning is recommended to distinguish persons with dementia from MCI.
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Affiliation(s)
- Rainbow T H Ho
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong.,c Sau Po Centre on Aging , The University of Hong Kong , Hong Kong
| | - Ted C T Fong
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong
| | - Tiffany Hon
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong
| | - Wai Chi Chan
- d Department of Psychiatry , The University of Hong Kong , Hong Kong
| | - Joseph S K Kwan
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Patrick K C Chiu
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Linda C W Lam
- f Department of Psychiatry , The Chinese University of Hong Kong , Hong Kong
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Cheung DSK, Li B, Lai DWL, Leung AYM, Yu CTK, Tsang KT. Cognitive Stimulating Play Intervention for Dementia: A Feasibility Randomized Controlled Trial. Am J Alzheimers Dis Other Demen 2019; 34:63-71. [PMID: 30370782 PMCID: PMC10852422 DOI: 10.1177/1533317518808036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigates the feasibility and the preliminary efficacy of a Cognitive Stimulating Play Intervention on cognitive functions. Thirty older people with early to moderate dementia were recruited from 2 day-care centers, which were randomized into intervention and control groups. The recruitment, attendance, completion rates, and the interview with staff showed that the intervention was feasible. Analysis of covariance results showed that there was a significant difference between groups on memory storage and retrieval functions. The mean memory storage and retrieval functions were 5.92 (95% confidence interval [CI]: 1.83-9.91; P = .006) and 4.12 (95% CI: 0.75-7.50; P = .018) points higher than that for the control group, respectively, which contributed moderate to large effects (partial η2 = 0.189-0.248). There was no significant difference between groups in global cognition measured using the Montreal Cognitive Assessment and verbal fluency. Practical issues that emerged during implementation were discussed.
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Affiliation(s)
| | - Bingyu Li
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Daniel Wing Leung Lai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Clare Tze Kiu Yu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Tat Tsang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Cheung DSK, Lai CKY, Wong FKY, Leung MCP. The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial. Aging Ment Health 2018; 22:306-315. [PMID: 27819483 DOI: 10.1080/13607863.2016.1251571] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effects of the six-week music-with-movement (MM) intervention, as compared with music listening (ML) and social activity (SA), on the cognitive functions of people with moderate dementia over time. METHODS A multi-center randomized controlled trial was conducted on 165 nursing home residents with moderate dementia. The MM intervention protocol was developed based on a critical literature review, and tested in three rounds of pilot studies before undergoing testing in this study. The participants were randomly allocated into three groups. Intervention participants (n = 58) received a 12-week MM program led by a trained health care professional, while the participants in the comparison ML group (n = 54) listened to their preferred music, and those in the SA group (n = 53) engaged in social chatting. Cognitive functions, depressive symptoms, and anxiety were measured at baseline, the sixth week, and six weeks post-intervention. RESULTS Greater improvements in memory and depressive symptoms for the MM group were revealed in the univariate analysis and pairwise comparisons. The effects on memory could last for at least six weeks post-intervention. However, a mixed multivariate analysis of variance (MANOVA) analysis indicated that there were no significant interactions of group by time effect Conclusion: The findings revealed that the MM intervention may be useful for enhancing the cognitive functions of people with dementia. However, there is insufficient evidence to show that the effects of the MM intervention on outcome variables over time significantly different from those observed among the comparison groups.
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Affiliation(s)
- Daphne Sze Ki Cheung
- a School of Nursing , The Hong Kong Polytechnic University , Hong Kong SAR, China
| | - Claudia Kam Yuk Lai
- a School of Nursing , The Hong Kong Polytechnic University , Hong Kong SAR, China
| | | | - Mason Chin Pang Leung
- b Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Hong Kong SAR, China
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Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis. Int Psychogeriatr 2017; 29:897-929. [PMID: 28274299 DOI: 10.1017/s1041610216001976] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use. METHOD A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed. RESULTS Forty-five eligible studies were quality assessed. A significant proportion utilized a case-control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853. CONCLUSION Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.
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Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: From the past knowledge to the future new instruments. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:174-187. [PMID: 27841690 DOI: 10.1080/23279095.2016.1250211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The lifetime learning of illiterate and low-educated individuals shapes their cognitive skills, which are challenging to grade by the current available neuropsychological tools. Eight hundred million of the global population are illiterate. It is very challenging to interpret the cognitive performance of this population by the available formal neuropsychological tests, mainly developed for higher educated people. From extensive literature investigation, we reviewed the cognitive process and performance of illiterate and low-educated population on various cognitive domains including language, executive function, memory, visual-related function, and motor skills. We also suggested the concept in the development of the appropriate tools for the cognitive assessment among this population. Finally, we provide the available cognitive screening tools validated in the illiterate and low-educated subjects within the last three decades.
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Affiliation(s)
- Parunyou Julayanont
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
| | - Doungporn Ruthirago
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
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Huang SF, Liu CK, Chang CC, Su CY. Sensitivity and specificity of executive function tests for Alzheimer's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:493-504. [PMID: 27420924 DOI: 10.1080/23279095.2016.1204301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Decline in executive function (EF) occurs early in Alzheimer's disease (AD) and can interfere with daily functioning. Unfortunately, little is known about the relative ability of traditional EF tests to detect these cognitive changes. Given that timely diagnosis and intervention are essential to improving functional outcome in this population, our aim was to identify the specific EF measures that best differentiated mild dementia from normal aging. Thirty-one patients with mild AD and 31 controls were administered 7 EF tests. Findings indicated significant between-group differences on all measures except Wisconsin Card Sorting Test. The remaining 6 tests displayed fair to good accuracy discriminating between AD cases and controls. Only category fluency and Tower of London test remained in the final regression model that yielded the highest AUC of 0.90, which was not statistically different from that of either test alone. Overall, most of the tests employed were valid for assessing mild EF disturbances. Specifically, the two measures can be used in isolation for quick screening or in combination to facilitate a more in-depth evaluation of EF performance. This study contributes to clinical field by testifying to the validity of various EF tests to identify AD-related compromises in this cognitive domain.
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Affiliation(s)
- Shu-Fen Huang
- a Department of Rehabilitation Medicine, Ministry of Health and Welfare Pingtung Hospital , Pingtung , Taiwan
| | - Ching-Kuan Liu
- b Department of Neurology, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chiung-Chih Chang
- c Department of Neurology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chwen-Yng Su
- d Occupational Therapy, Kaohsiung Medical University , Kaohsiung , Taiwan
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Tang JYM, Wong GHY, Ng CKM, Kwok DTS, Lee MNY, Dai DLK, Lum TYS. Neuropsychological Profile and Dementia Symptom Recognition in Help-Seekers in a Community Early-Detection Program in Hong Kong. J Am Geriatr Soc 2016; 64:584-9. [PMID: 26928890 DOI: 10.1111/jgs.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the neuropsychological and clinical profile of help-seekers in an early-detection community dementia program and to explore any relationship between profiles and time to seek help. DESIGN Cross-sectional. SETTING Early-detection community dementia program. PARTICIPANTS Help-seekers (N = 1,005) with subjective cognitive complaints or complaints from an informant. MEASUREMENTS Neurocognitive testing, including the Cantonese Mini-Mental State Examination (MMSE), Clock Drawing Test, Digit Span, and Fuld Object Memory Evaluation and other clinical and functioning assessments, including the Clinical Dementia Rating (CDR), activities of daily living (ADLs), instrumental ADLs (IADLs), and depressive symptoms. Time since the person or an informant reported that they first noticed symptoms. RESULTS Eighty-six percent of help-seekers had at least very mild dementia (CDR score ≥0.5). Cognitive performance was moderately impaired (mean MMSE score 18.4 ± 6.1). They required some assistance with IADLs, had very mild ADL impairments, and had few depressive symptoms. Median time to seek assessment was 12 months (interquartile range 7-30 months) according to the person or the informant (an adult child in 75% of the sample). Using the median-split method, time to seek assessment was classified as early (0-12 months) and late (>12 months). Worse cognitive and IADL performance but not ADL performance or depressive symptoms were observed in late than in early help-seekers. Longer time intervals between symptom recognition and early assessment showed a trend of further impairments on all measures except ADLs. CONCLUSION A time interval of more than 12 months between symptom recognition and early assessment appears to be associated with worse cognitive function upon presentation.
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Affiliation(s)
| | - Gloria H-Y Wong
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong.,Department of Psychiatry, LKS Faculty of Medicine, University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.,Hong Kong Alzheimer's Disease Association, Hong Kong
| | - Carmen K-M Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | | | | | - David L-K Dai
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong.,Hong Kong Alzheimer's Disease Association, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Terry Y-S Lum
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
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Abstract
BACKGROUND The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia. METHODS Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained. RESULTS Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derived de novo from Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17-29/30) and MoCA (21-26/30), with 13/19 (68%) of studies reporting educational bias. CONCLUSIONS Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.
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Rahman-Filipiak A, Woodard JL, Miller LS, Martin P, Davey A, Poon LW. Octogenarian and centenarian performance on the Fuld Object Memory Evaluation. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:438-51. [PMID: 25513737 DOI: 10.1080/13825585.2014.968085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Fuld Object Memory Evaluation (FOME) has considerable utility for cognitive assessment in older adults, but there are few normative data, particularly for the oldest old. In this study, 80 octogenarians and 244 centenarians from the Georgia Centenarian Study completed the FOME. Total and trial-to-trial performance on the storage, retrieval, repeated retrieval, and ineffective reminder indices were assessed. Additional data stratified by age group, education, and cognitive impairment are provided in the Supplemental data. Octogenarians performed significantly better than centenarians on all FOME measures. Neither age group benefitted from additional learning trials beyond Trial 3 for storage and Trial 2 for retention and retrieval. Ineffective reminders showed no change across learning trials for octogenarians, while centenarians improved only between Trials 1 and 2. This minimal improvement past Trial 2 indicates that older adults might benefit from a truncated version of the test that does not include trials three through five, with the added benefit of reducing testing burden in this population.
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Zhang Y, Zhang Z, Yang B, Li Y, Zhang Q, Qu Q, Wang Y, Zhang S, Yue W, Tan Y, Zhang B, Liang J. Effects of Antiplatelet Agents on Functional Outcome and Cognitive Status in Patients with Acute Ischemic Stroke. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
BACKGROUND As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests. METHODS Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data. RESULTS 22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings. CONCLUSIONS Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.
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Incidence and risk factors of cognitive impairment 3 months after first-ever stroke: a cross-sectional study of 5 geographic areas of China. ACTA ACUST UNITED AC 2012; 32:906-911. [PMID: 23271295 DOI: 10.1007/s11596-012-1056-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Indexed: 02/05/2023]
Abstract
This study examined the incidence, neuropsychological characteristics and risk factors of cognitive impairment 3 months after stroke in China. Five regions that differed in geography and economy in China were selected. Patients from the hospitals located in the five regions were prescreened at admission, and the demographic data, vascular risk factors and clinical characteristics of stroke were obtained. A battery of cognitive-specific domain tests was performed in the patients who failed to pass cognitive screening 3 months post stroke. Patients were diagnosed as having post-stroke cognitive impairment (PSCI) or no cognitive impairment (NCI) based on the results of the neuropsychological tests. Univariate analysis was performed for suspect risk factors, and significant variables were entered in multivariable logistic regression analysis. Our results showed that a total of 633 patients were recruited 3 months after stroke; complete cognitive tests were performed in 577 of the stroke patients. The incidence of PSCI in these Chinese patients was 30.7%. There were 129 (22.4%) patients with visuospatial impairment, 67 (11.6%) with executive impairment, 60 (10.4%) with memory impairment and 18 (3.1%) with attention impairment. The risk factors associated with PSCI were older age (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.20-2.58), low education level (OR 2.45, 95% CI 1.65-3.64), depressive symptom (OR 1.69, 95% CI 1.09-2.61), obesity (OR 2.57, 95% CI 1.41-4.71), stroke severity 3 months post stroke (OR 1.62, 95%CI 1.10-2.37) and cortex lesion (OR 1.55, 95% CI 1.04-2.31). It was concluded that PSCI occurs commonly 3 months after first-ever stroke in Chinese patients. Visuospatial ability may be the most frequently impaired cognitive domain for the patients with stroke. The critical risk factors of PSCI are older age, low education level, depressive symptom, obesity, stroke severity 3 months post stroke and cortex lesion.
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Anderson-Hanley C, Miele AS, Dunnam M. The Fuld Object-Memory Evaluation: Development and Validation of an Alternate Form. APPLIED NEUROPSYCHOLOGY-ADULT 2012; 20:1-6. [DOI: 10.1080/09084282.2012.670156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Andrea S. Miele
- b Department of Psychology , University at Albany , Albany , New York
| | - Mina Dunnam
- c Behavioral Health Care, Albany Stratton VA Medical Center , Albany , New York
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Man DWK, Chung JCC, Lee GYY. Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study. Int J Geriatr Psychiatry 2012; 27:513-20. [PMID: 21681818 DOI: 10.1002/gps.2746] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/18/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Older adults with questionable dementia are at risk of progressing to dementia, and early intervention is considered important. The present study investigated the effectiveness of a virtual reality (VR)-based memory training for older adults with questionable dementia. METHODS A pre-test and post-test design was adopted. Twenty and 24 older adults with questionable dementia were randomly assigned to a VR-based and a therapist-led memory training group, respectively. Primary outcome measures included the Multifactorial Memory Questionnaire and Fuld Object Memory Evaluation. RESULTS Both groups demonstrated positive training effects, with the VR group showing greater improvement in objective memory performance and the non-VR group showing better subjective memory subtest results in the Multifactorial Memory Questionnaire. CONCLUSION The use of VR seems to be acceptable for older adults with questionable dementia. Further study on the effect of educational background and memory training modality (visual, auditory) is warranted.
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Affiliation(s)
- David W K Man
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China.
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