A screen for cognitive assessments for patients with vascular cognitive impairment no dementia

Mini-ACE: Validation Study Among Older People in Long-Term Care

Background

The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a valid and reliable tool that accurately differentiates various types of cognitive impairment from Normal-cognition assessed in multiple settings. However, its validity among older individuals in long-term care (LTC) was not yet established. Therefore, we sought to assess the Portuguese M-ACE's validity, reliability, and accuracy in detecting cognitive impairment no-dementia (CIND) in LTC users.

Methods

A comprehensive assessment was performed on 196 LTC Portuguese users aged ≥ 60 years, among whom 71 had Normal-cognition, and 125 had CIND.

Results

The M-ACE was found to be reliable (McDonald's ω = .86, Cronbach's α = .85) and consistent over time (r = .72; ICC = .83) and between raters (k = .92). Strong correlations with related measures supported construct validity (both r = .67). The M-ACE accurately distinguished CIND from Normal-cognition with a cut-off of 17 points (AUC = 0.81, Sensitivity = 81.7%, Specificity = 74.4%).

Conclusion

Our findings suggest that the Portuguese M-ACE is a valid and reliable cognitive assessment tool for LTC users, allowing for accurate differentiation between CIND and Normal-cognition. Thus, the M-ACE's use could contribute to the early detection and intervention of cognitive disorders, especially among older adults in LTC.

Structural atrophy and functional dysconnectivity patterns in the cerebellum relate to cerebral networks in svMCI

Subcortical vascular mild cognitive impairment (svMCI) is associated with structural and functional changes in the cerebral cortex affecting major brain networks. While recent studies have shown that the intrinsic cerebral connectivity networks can be mapped onto the cerebellum, and the cortex and cerebellum are interconnected via the cortico-basal ganglia-cerebellar circuit, structural and functional disruptions in cerebellum in svMCI are rarely studied. In this study, we conducted voxel-based morphometry analysis to investigate gray matter atrophy pattern across cerebellar regions in 40 svMCI patients, and explored alterations in functional connectivity between the basal ganglia and cerebellum. The results showed that the amount of cerebellar atrophy within the default mode, salience, and frontoparietal networks correlated with their counterpart in the cerebral cortex. Moreover, key regions of the cerebellum, including the lobule VI, VIIb, VIII, and Crus I, which are reported to have a role in cognitive function, showed both anatomical atrophy and decreased functional connectivity with the striatum. These atrophy and connectivity patterns in the cerebellum also correlated with memory performances. These findings demonstrate that there are coupled changes in cerebral and cerebellar circuits, reflecting that degeneration patterns in svMCI are not limited to the cerebral cortex but similarly extend to the cerebellum as well, and suggest the cortico-basal ganglia-cerebellar circuit may play an important role in the pathology of svMCI.

Cognitive Domain Impairment and All-Cause Mortality in Older Patients Undergoing Hemodialysis

The highly prevalent cognitive impairment in hemodialysis patients is associated with all-cause mortality; however, the role of different cognitive domain impairments in this association is still not clarified. Our objective was to determine the association between cognitive domain impairment and all-cause mortality in elderly adult patients undergoing hemodialysis. We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. Baseline data were collected, and a series of neuropsychological batteries covering 5 domains of cognitive function were included for the assessment of cognitive function. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V), the patients were classified as normal, mild, and major cognitive impairment for global and domain cognitive function, then followed up for 1 year. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate in different cognitive domains. A multivariate Cox proportional hazards regression analysis was used to determine the association between global or domain cognitive impairment and all-cause mortality. A total of 613 patients were enrolled, the mean age was 63.82 ± 7.14 years old, and 42.1% were women. After 49.53 ± 8.42 weeks of follow-up, 69 deaths occurred. Kaplan-Meier plots demonstrated a significant association of cognitive impairment in memory, executive function, attention, and language domains with all-cause death. Multivariate Cox regression analysis showed that mild and major impairment of global cognition (HR = 2.89 (95% CI, 1.01-8.34), p = 0.049 and HR = 4.35 (95% CI, 1.55-12.16), p = 0.005, respectively), executive cognitive domain (HR = 2.51 (95% CI, 1.20-5.24), p = 0.014; HR = 3.91 (95% CI, 1.70-9.03), p = 0.001, respectively), and memory cognitive domain (HR = 2.13 (95% CI, 1.07-4.24), p = 0.031; HR = 3.67 (95% CI, 1.71-7.92), p = 0.001, respectively) were associated with all-cause mortality. Combined impairment of 3, 4, and 5 cognitive domains was associated with all-cause mortality [HR = 5.75 (95% CI, 1.88-17.57), p = 0.002; HR = 12.42 (95% CI, 3.69-41.80), p < 0.001; HR = 13.48 (95% CI, 3.38-53.73), p < 0.001, respectively]. We demonstrate an association between the executive and memory cognitive domain impairment and all-cause mortality in hemodialysis patients. Our data suggest that the impairments in these cognitive domains might help in the early identification of hemodialysis patients at risk of death.

Effects of White Matter Hyperintensities on Verbal Fluency in Healthy Older Adults and MCI/AD

BACKGROUND

White matter hyperintensities (WMHs) are markers for cerebrovascular pathology, which are frequently seen in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Verbal fluency is often impaired especially in AD, but little research has been conducted concerning the specific effects of WMH on verbal fluency in MCI and AD.

OBJECTIVE

Our aim was to examine the relationship between WMH and verbal fluency in healthy old age and pathological aging (MCI/AD) using quantified MRI data.

METHODS

Measures for semantic and phonemic fluency as well as quantified MRI imaging data from a sample of 42 cognitively healthy older adults and 44 patients with MCI/AD (total n = 86) were utilized. Analyses were performed both using the total sample that contained seven left-handed/ambidextrous participants, as well with a sample containing only right-handed participants (n = 79) in order to guard against possible confounding effects regarding language lateralization.

RESULTS

After controlling for age and education and adjusting for multiple correction, WMH in the bilateral frontal and parieto-occipital areas as well as the right temporal area were associated with semantic fluency in cognitively healthy and MCI/AD patients but only in the models containing solely right-handed participants.

CONCLUSION

The results indicate that white matter pathology in both frontal and parieto-occipital cerebral areas may have associations with impaired semantic fluency in right-handed older adults. However, elevated levels of WMH do not seem to be associated with cumulative effects on verbal fluency impairment in patients with MCI or AD. Further studies on the subject are needed.

Application of the P300 potential in cognitive impairment assessments after transient ischemic attack or minor stroke

Background The aims of this study were to determine the relationships between changes inlatency and amplitude of the P300 event-related potential component and cognitive impairmentsin patients after a transient ischemic attack (TIA) or a minor stroke and to assess thesuitability of the P300 for screening for cognitive impairments.Material and Method Sixty-five TIA or minor stroke patients diagnosed at the NeurologyDepartment of Beijing Tiantan Hospital, Capital Medical University from June 2015 toDecember 2016 and 30 healthy people evaluated in the same period were included. Allpatients were examing neuropsychological scales and event-related potentials within7 ± 3 days of onset of the disease. The TIA/minor stroke group was divided into normal cognition group(NC) and cognitive impairment group. The cognitive impairment group was further divided into vascular cognitive impairment with no dementia(VCIND) group and vascular dementia (VD) group to analyze the relationship between P300 latency.Results The P300 latency at each recording electrode was longer in the NC and VCIND groups than healthy control group (P < 0.001), the P300 latency of VCIND group longer than NC group (P < 0.001). When the P300-Fz latency cut-off value was 358.6 ms,the sensitivity for diagnosing cognitive impairment in patients after TIA/minor stroke was 0.875 and the specificity was 0.765.Conclusions The P300 latency delay can be used to detect cognitive impairments in patients after TIA/minor stroke and the P300-Fz latency is more sensitive for diagnosing cognitiveimpairments in TIA/minor stroke patients.

The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis

Objective

Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard.

Methods

We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman’s correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment.

Results

Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman’s rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (r_s = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859–0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786–0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752.

Conclusion

The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.

White Matter Hyperintensities Relate to Basal Ganglia Functional Connectivity and Memory Performance in aMCI and SVMCI

Cerebral small vessel diseases play a crucial role in both vascular and non-vascular dementias. The location of white matter hyperintensities (WMHs), a neuroimaging marker of cerebral small vessel disease, has been found to vary between different types of dementias, and those in the basal ganglia (BG) have been particularly associated with vascular cognitive impairment (VCI). However, anatomical variation of WMHs across BG nuclei and its effect on brain network dysconnectivity has not been clearly elucidated. The study sample consisted of 40 patients with amnestic mild cognitive impairment (aMCI), 40 with subcortical vascular MCI (SVMCI), and 40 healthy control subjects. We examined the volume of WMH using T2-weighted magnetic resonance imaging. We also assessed the disturbances in BG-cortical communication by measuring resting-state functional connectivity (rsFC) from the functional magnetic resonance imaging signal. WMHs were more pronounced in the SVMCI group particularly in the caudate regions. In SVMCI patients, while higher WMHs in the dorsal caudate correlated with weaker FC with executive control regions and worse immediate recall performance, WMHs in the ventral caudate were associated with weaker FC with anterior default mode regions and worse delayed recall performance. In contrast, in aMCI patients, BG WMHs were not correlated with their changes in functional connectivity changes, which showed weaker connectivity with almost all BG structures, rather than restricting to specific BG subdivisions as observed in the SVMCI group. Our findings demonstrate that heterogeneously distributed BG WMHs are associated with changes in functional network interactions and verbal episodic memory performance only in SVMCI patients, which establishes a link between cerebrovascular-related structural abnormality, functional integrity of BG circuits, and episodic memory impairments in SVMCI, and may reflect a differential role of the cerebrovascular pathology in disrupting network-level communications and cognition between Alzheimer's and subcortical vascular dementia.

The association of bone, fingernail and blood manganese with cognitive and olfactory function in Chinese workers

Occupational manganese (Mn) exposure has been associated with cognitive and olfactory dysfunction; however, few studies have incorporated cumulative biomarkers of Mn exposure such as bone Mn (BnMn). Our goal was to assess the cross-sectional association between BnMn, blood Mn (BMn), and fingernail Mn (FMn) with cognitive and olfactory function among Mn-exposed workers. A transportable in vivo neutron activation analysis (IVNAA) system was designed and utilized to assess BnMn among 60 Chinese workers. BMn and FMn were measured using inductively coupled plasma mass spectrometry. Cognitive and olfactory function was assessed using Animal and Fruit Naming tests, World Health Organization/University of California-Los Angeles Auditory Verbal Learning Test (AVLT) and the University of Pennsylvania Smell Identification Test (UPSIT). Additional data were obtained via questionnaire. Regression models adjusted for age, education, factory of employment, and smoking status (UPSIT only), were used to assess the relationship between Mn biomarkers and test scores. In adjusted models, increasing BnMn was significantly associated with decreased performance on average AVLT scores [β (95% confidence interval (CI)) = -0.65 (-1.21, -0.09)] and Animal Naming scores [β (95% CI) = -1.54 (-3.00, -0.07)]. Increasing FMn was significantly associated with reduced performance measured by the average AVLT [β (95% CI) = -0.35 (-0.70, -0.006)] and the difference in AVLT scores [β (95% CI) = -0.40 (-0.77, -0.03)]. BMn was not significantly associated with any test scores; no significant associations were observed with Fruit Naming or UPSIT tests. BnMn and FMn, but not BMn, are associated with cognitive function in Mn-exposed workers. None of the biomarkers were significantly associated with olfactory function.

Effect of Hormone Levels and Aging on Cognitive Function of Patients with Pituitary Adenomas Prior to Medical Treatment

BACKGROUND

Cognitive impairments have been reported in patients with pituitary adenomas (PAs). The aim of this research was to demonstrate the effects of hormones and age on cognitive decline in patients with PAs.

METHODS

A total of 64 patients with PA and 69 healthy control subjects (HCs) were recruited for this study. Both PAs and HCs were divided into a younger group (<50 years of age) and an older group (≥50 years of age). Neurocognitive domains were assessed using the Wechsler Adult Intelligence Scale-Chinese Revision (WAIS-RC) and Wechsler Memory Scale-Chinese Revision (WMS-RC) tests. Furthermore, we also investigated the relationship between cognitive domains and tumor volume, and the hormone levels and age of patients with PA.

RESULTS

Several of the cognitive impairments found on the WAIS-RC and WMS-RC tests were more frequently observed in untreated patients with PA. Importantly, no significant correlations were found between cognitive domains and tumor volume after controlling age, sex, and educational levels. Furthermore, several significant correlations were found between cognitive domains and hormone levels, such as free thyroxine and adrenocorticotropic hormone, after controlling age, sex, and educational levels. Finally, the age of the patients was found to correlate with a decrease in memory after controlling sex and educational levels.

CONCLUSIONS

Our findings demonstrate a significant decline in the cognitive performance of patients with PA prior to medical treatment, especially in older patients, which suggests that hormones and age have the ability to interact and aggravate cognitive decline in patients with PA.

Psychometric properties of cognitive screening for patients with cerebrovascular diseases A systematic review

Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients.

Objective

This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases.

Methods

A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed.

Results

A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated.

Conclusion

Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.

Validation of NINDS-VCI Neuropsychology Protocols for Vascular Cognitive Impairment in Taiwan

Objective

To validate the three time-difference neuropsychological protocols developed by the National Institute of Health/National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network for assessment of vascular cognitive impairment (VCI) in Mandarin-speaking subjects and to investigate the clinical application of the shortest form.

Methods

Patients aged 50 years or older who had a stroke were invited to participate in the study. Clinical diagnosis of VCI was made. The NINDS-VCI Neuropsychology Protocols, 60-, 30-, and two 5-minute protocols, were administered. The criteria validities of the cognitive protocols against the diagnoses of stroke and VCI were determined via Receiver Operating Characteristic (ROC) analysis. The optimal cut-off point for the 5-minute protocols total score was estimated for clinical use in screening.

Results

Eighty-three patients and 53 controls were recruited during the study period. Patients with stroke performed more poorly than the control group in the three neuropsychological protocols. Forty-two patients with stroke were diagnosed with VCI. VCI was used as the standard to estimate the criteria validities. The area under the ROC curve was 0.78, 0.80, 0.75, and 0.73 for the 60-, 30-, 5-mintue protocol-A and 5-minute protocol-B, respectively.

Conclusion

These modified neuropsychological protocols can be used as valid instruments when performing comprehensive cognitive assessment or for screening of VCI in Taiwan.

Volumetric magnetic resonance imaging correlates of the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment neuropsychology protocols

BACKGROUND

Vascular cognitive impairment (VCI) refers to the entire spectrum of cognitive dysfunction attributable to vascular changes in the brain. The objective of this study is to evaluate magnetic resonance imaging (MRI) correlates of performance on the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) VCI neuropsychology protocols.

METHOD

Fifty ischemic stroke patients and 50 normal elderly persons completed the VCI protocols and MRI. Relationships between the four cognitive domains (executive/activation, language, visuospatial, and memory) and three protocol (60-, 30-, and 5-min) summary scores with MRI measures of volumes of white matter hyperintensities (WMH) and global brain and hippocampal atrophy were assessed using linear regression.

RESULTS

All cognitive domain scores were associated with WMH volume and, with the exception of language domain, with global atrophy. Additional relationships were found between executive/activation and language domains with left hippocampal volume, visuospatial domain with right hippocampal volume, and memory domain with bilateral hippocampal volumes. All protocol summary scores showed comparable relationships with WMH and hippocampal volumes, with additional relationships found between the 60- and 30-min protocols with global brain volume.

CONCLUSIONS

Performance on the NINDS-CSN VCI protocols reflects underlying volumetric brain changes implicated in cognitive dysfunctions in VCI.

Neuroimaging criteria and cognitive performance in vascular mild cognitive impairment: A systematic review

The recognition of Cerebrovascular Disease (CVD) at earlier clinical stages may favor the control of vascular risk factors and prevention of dementia. However, operational criteria for symptomatic phases at non-dementia stages are often difficult, as the current criteria normally require the evidence of extensive subcortical disease.

Disrupted topological organization of resting-state functional brain network in subcortical vascular mild cognitive impairment

AIMS

Neuroimaging studies have demonstrated both structural and functional abnormalities in widespread brain regions in patients with subcortical vascular mild cognitive impairment (svMCI). However, whether and how these changes alter functional brain network organization remains largely unknown.

METHODS

We recruited 21 patients with svMCI and 26 healthy control (HC) subjects who underwent resting-state functional magnetic resonance imaging scans. Graph theory-based network analyses were used to investigate alterations in the topological organization of functional brain networks.

RESULTS

Compared with the HC individuals, the patients with svMCI showed disrupted global network topology with significantly increased path length and modularity. Modular structure was also impaired in the svMCI patients with a notable rearrangement of the executive control module, where the parietal regions were split out and grouped as a separate module. The svMCI patients also revealed deficits in the intra- and/or intermodule connectivity of several brain regions. Specifically, the within-module degree was decreased in the middle cingulate gyrus while it was increased in the left anterior insula, medial prefrontal cortex and cuneus. Additionally, increased intermodule connectivity was observed in the inferior and superior parietal gyrus, which was associated with worse cognitive performance in the svMCI patients.

CONCLUSION

Together, our results indicate that svMCI patients exhibit dysregulation of the topological organization of functional brain networks, which has important implications for understanding the pathophysiological mechanism of svMCI.

Structural and functional changes in subcortical vascular mild cognitive impairment: a combined voxel-based morphometry and resting-state fMRI study

The present study aimed to investigate changes in structural gray matter (GM) volume and functional amplitude of spontaneous low-frequency oscillations (LFO) and functional connectivity density in patients with subcortical vascular mild cognitive impairment (svMCI). Structural MRI and resting-sate functional MRI data were collected from 26 svMCI patients and 28 age- and gender-matched healthy controls. Structurally, widespread GM atrophy was found in the svMCI patients that resided primarily in frontal (e.g., the superior and middle frontal gyri and medial prefrontal cortex) and temporal (the superior and inferior temporal gyri) brain regions as well as several subcortical brain sites (e.g., the thalamus and the caudate). Functionally, svMCI-related changes were predominantly found in the default mode network (DMN). Compared with the healthy controls, the svMCI patients exhibited decreased LFO amplitudes in the anterior part of the DMN (e.g., the medial prefrontal cortex), whereas increased LFO amplitudes in the posterior part of the DMN (e.g., the posterior cingulate/precuneus). As for functional connectivity density, the DMN regions (e.g., the posterior cingulate/precuneus, the medial prefrontal cortex and the middle temporal gyrus) consistently exhibited decreased functional connectivity. Finally, the overall patterns of functional alterations in LFO amplitudes and functional connectivity density remained little changed after controlling for structural GM volume losses, which suggests that functional abnormalities can be only partly explained by morphological GM volume changes. Together, our results indicate that svMCI patients exhibit widespread abnormalities in both structural GM volume and functional intrinsic brain activity, which have important implications in understanding the pathophysiological mechanism of svMCI.

The neuropsychological characteristics and regional cerebral blood flow of vascular cognitive impairment-no dementia

OBJECTIVE

To investigate the neuropsychological characteristics of VCI-ND and to analyze the relationship between deficit pattern and regional cerebral blood flow (rCBF) in various VCI-ND subtypes defined by cognitive features.

METHODS

69 subjects diagnosed with VCI-ND were recruited, then further classified into four subtypes: amnestic VCI-ND with single memory impairment (subtype I, n = 19), amnestic VCI-ND with multi-domain impairment (subtype II, n = 27), non-amnestic VCI-ND with single domain impairment (subtype III, n = 16), and non-amnestic VCI-ND with multi-domain impairment (subtype IV, n = 7) according to their cognitive profile. Xenon-CT scan was administered to 31 VCI-ND patients (11 of subtype I, 12 of subtype II and 8 of subtype III) and 10 normal controls (NC) to evaluate rCBF.

RESULTS

The rate of different cognitive domains impairment in VCI-ND group ranged from 17 to 66%, lowest in clock drawing test and highest in time of modified version of trails making test A and maze tracing compared with NC, significant reduced rCBF was found in bilateral temporal lobe and thalamus, left periventricular white matter and caudate of subtype I, and in left temporal lobe and lenticular nucleus, bilateral periventricular white matter, white matter adjacent to left posterior horn of lateral ventricular and right caudate of subtype III, while significant reduced rCBF of subtype II was found in left subfrontal white matter, bilateral subtemporoparietal white matter, right lenticular nucleus, and in both regions of subtype I and III.

CONCLUSIONS

The manifestation of rCBF in VCI-ND subtypes was consistent with performance of neuropsychological assessment.