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McDaniel SL, Shuster LI, Kennedy MRT. Clock Drawing Test Performance of Young Adults Based on a One-Shot Case Study. Arch Clin Neuropsychol 2024; 39:175-185. [PMID: 37565493 DOI: 10.1093/arclin/acad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE The clock drawing test (CDT) is being used regularly by medical professionals in a variety of settings to aid in assessing cognitive functioning in adults of all ages. As our technological environment has changed significantly, because of the inception of this measure, the use of and exposure to the analog clock have diminished. We investigated whether young adults, who have grown up in a mainly digital world, can draw and tell time on an analog clock. METHOD Participants aged 18-30 years (N = 80, Mage = 24.2, SD = 3.93), who self-identified as having normal cognition, completed the CDT, as well as setting hands on a pre-drawn clock and identifying analog clock times. RESULTS About 25% of participants received a CDT score below the expected range. There was a moderate, positive correlation between analog clock hand setting and time identification in the group who scored below the expected range on the CDT only (rs(16) = 0.472, p = .048). Most participants reported not wearing an analog watch. CONCLUSIONS Based on these findings, the CDT should be used with caution to screen cognitive functioning in young adults (i.e., aged 18-30 years). Consideration of an alternative approach to screening cognition and modifying cognitive assessments in which the CDT is embedded is recommended for this population. These findings warrant further investigation into CDT performance in the young adult population.
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Affiliation(s)
- Samantha L McDaniel
- Department of Health and Human Services, Interdisciplinary Health Sciences, Western Michigan University, Kalamazoo, MI 49008, USA
- Georgia Southern University, Communication Sciences and Disorders Program, Savannah, GA 31419, USA
| | - Linda I Shuster
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo, MI 49008, USA
| | - Mary R T Kennedy
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA 92618, USA
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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Yang D, Zhang X, Luo X, Zhang F, Sun S, Shaocheng L, Zhao X, Zhou J. Abnormal Local Brain Activity and Cognitive Impairments in Young Non-Disabled Patients With Intracerebral Hemorrhage: A Resting-State Functional MRI Study. J Magn Reson Imaging 2023. [PMID: 38146647 DOI: 10.1002/jmri.29166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Resting-state functional MRI (rs-fMRI) has identified static changes of local brain activity among patients with intracerebral hemorrhage (ICH). However, the dynamic and concordance-related characteristics of brain activity remain unclear. PURPOSE To investigate static, dynamic, and concordance-related features of the regional brain activity of young non-disabled ICH patients. STUDY TYPE Prospective. SUBJECTS Thirty-three ICH patients (modified Rankin Scale score ≤2, 21% female, 46.36 ± 6.53) and 33 matched healthy controls (HCs) (21% female, 47.64 ± 6.16). FIELD STRENGTH/SEQUENCE 3-T, rs-fMRI using gradient echo-planar imaging, T1-weighted imaging. ASSESSMENT Neuropsychological and rs-fMRI data were acquired from all participants. Amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity, global signal correlation (GSCorr) and degree centrality (DC), and their dynamic and concordance-related changes with sliding window analysis were calculated based on rs-fMRI data at a whole-brain level. The burden of cerebral small vascular diseases (cSVD) was assessed by cSVD scores. All hemorrhage lesions were delineated on normalized T1 images. STATISTICAL TESTS Multiple regression models, a voxel-level uncorrected P < 0.001, a cluster-level false discovery rate (FDR) corrected q < 0.05, a re-corrected qFDR <0.05 were considered significant. Pearson or Spearman correlation analyses between fMRI data and neurocognitive performance were performed. RESULTS Compared to HCs, ICH patients showed significant abnormal changes of ALFF, dynamic ALFF, fALFF, ReHo, dynamic ReHo, GSCorr, DC, and voxel-wise concordance in multiple brain regions mainly including the bilateral cerebellar hemispheres, ipsilesional thalamus, and bilateral middle cingulum gyrus. The ALFF in the cerebellar posterior lobe and thalamus were significantly associated with attention (r = -0.481) and executive function (rho = -0.521) in ICH patients. DATA CONCLUSION Young non-disabled ICH patients exhibit static, dynamic, and concordance-related alterations of local brain activity, part of which shows associations with cognitive functions. These findings may help comprehensively understand the mechanism of cognitive impairment after ICH. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Dan Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangqi Luo
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Fengxia Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liu Shaocheng
- Department of Neurology, Beijing Mentougou District Hospital, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Gerb J, Brandt T, Dieterich M. Shape configuration of mental targets representation as a holistic measure in a 3D real world pointing test for spatial orientation. Sci Rep 2023; 13:20449. [PMID: 37993521 PMCID: PMC10665407 DOI: 10.1038/s41598-023-47821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
Deficits in spatial memory are often early signs of neurological disorders. Here, we analyzed the geometrical shape configuration of 2D-projections of pointing performances to a memorized array of spatially distributed targets in order to assess the feasibility of this new holistic analysis method. The influence of gender differences and cognitive impairment was taken into account in this methodological study. 56 right-handed healthy participants (28 female, mean age 48.89 ± 19.35 years) and 22 right-handed patients with heterogeneous cognitive impairment (12 female, mean age 71.73 ± 7.41 years) underwent a previously validated 3D-real-world pointing test (3D-RWPT). Participants were shown a 9-dot target matrix and afterwards asked to point towards each target in randomized order with closed eyes in different body positions relative to the matrix. Two-dimensional projections of these pointing vectors (i.e., the shapes resulting from the individual dots) were then quantified using morphological analyses. Shape configurations in healthy volunteers largely reflected the real-world target pattern with gender-dependent differences (ANCOVA area males vs. females F(1,73) = 9.00, p 3.69 × 10-3, partial η2 = 0.10, post-hoc difference = 38,350.43, pbonf=3.69 × 10-3**, Cohen's d 0.76, t 3.00). Patients with cognitive impairment showed distorted rectangularity with more large-scale errors, resulting in decreased overall average diameters and solidity (ANCOVA diameter normal cognition/cognitive impairment F(1,71) = 9.30, p 3.22 × 10-3, partial η2 = 0.09, post-hoc difference = 31.22, pbonf=3.19 × 10-3**, Cohen's d 0.92, t 3.05; solidity normal cognition/cognitive impairment F(1,71) = 7.79, p 6.75 × 10-3, partial η2 = 0.08, post-hoc difference = 0.07, pbonf=6.76 × 10-3** Cohen's d 0.84, t 2.79). Shape configuration analysis of the 3D-RWPT target array appears to be a suitable holistic measure of spatial performance in a pointing task. The results of this methodological investigation support further testing in a clinical study for differential diagnosis of disorders with spatial memory deficits.
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Affiliation(s)
- J Gerb
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany.
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- Hertie Senior Professor for Clinical Neuroscience, Ludwig-Maximilians University, Munich, Germany
| | - M Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Del Ser T, Frades B, Valentí-Soler M, Zea-Sevilla MA, Valeriano-Lorenzo E, Carnero-Pardo C. [Discriminant validity and inter-rater concordance of two scoring systems for the clock test]. Rev Esp Geriatr Gerontol 2023; 58:101404. [PMID: 37672820 DOI: 10.1016/j.regg.2023.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To compare the discriminant validity and inter-rater reliability of the two scoring systems for the Clock test that are most used in Spain. METHODOLOGY Two collections of clock drawings obtained in a clinical context (116 cases; 56.8% women, mean age 73.1±7.7 years) and in a cohort of volunteers (2039 drawings of 579 subjects; 59.5% women, mean age 78.3±3.8 years) have been assessed. All subjects were classified as cognitively normal (CN) or cognitively impaired (CI) after extensive clinical and neuropsychological evaluation. Expert raters have evaluated these drawings independently and without knowledge of the diagnosis using the Sunderland and Solomon systems standardized in Spanish by Cacho (range 0 to 10) and del Ser (range 0 to 7) respectively. The discriminant validity of each method was calculated in the two samples using the area under the ROC curve (aROC), and the inter-rater reliability was calculated in the clinical sample, that was assessed by the two evaluators, using the intraclass correlation coefficient (ICC) and the kappa coefficient. RESULTS There are no significant differences in the discriminant validity of the Sunderland and Solomon systems in any of the samples (clinical: aROC 0.73 [CI95%: 0.64-0.81] and 0.77 [CI95%: 0.69-0.85] respectively, P=.19; volunteers: aROC 0.69 [CI95%: 0.67-0.71] and 0.72 [CI95%: 0.69-0.73] respectively, P=.08). The cut-off points ≤8 and ≤5 correctly classify 71% and 73% of the clinical sample and 82% and 84% of the volunteer sample, respectively. Both systems have good agreement in the clinical sample (Sunderland: ICC 0.90 [CI95%: 0.81-0.93], kappa 0.76 [CI95%: 0.70-0.83]; Solomon: 0.92 [CI95%: 0.88-0.95] and 0.77 [CI95%: 0.71-0.83] respectively), somewhat higher in the second, although the differences are not significant. CONCLUSIONS The discriminant validity and inter-observer reliability of these two Clock Test correction systems are similar. Solomon's method, shorter and simpler, may be more advisable in pragmatic terms.
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Affiliation(s)
- Teodoro Del Ser
- Unidad de Investigación Enfermedad de Alzheimer, Fundación CIEN. Instituto de Salud Carlos III, Madrid, España.
| | - Belén Frades
- Unidad de Investigación Enfermedad de Alzheimer, Fundación CIEN. Instituto de Salud Carlos III, Madrid, España
| | - Meritxell Valentí-Soler
- Unidad de Investigación Enfermedad de Alzheimer, Fundación CIEN. Instituto de Salud Carlos III, Madrid, España
| | - María Ascensión Zea-Sevilla
- Unidad de Investigación Enfermedad de Alzheimer, Fundación CIEN. Instituto de Salud Carlos III, Madrid, España
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Padulo C, Sestieri C, Punzi M, Picerni E, Chiacchiaretta P, Tullo MG, Granzotto A, Baldassarre A, Onofrj M, Ferretti A, Delli Pizzi S, Sensi SL. Atrophy of specific amygdala subfields in subjects converting to mild cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12436. [PMID: 38053753 PMCID: PMC10694338 DOI: 10.1002/trc2.12436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
Introduction Accumulating evidence indicates that the amygdala exhibits early signs of Alzheimer's disease (AD) pathology. However, it is still unknown whether the atrophy of distinct subfields of the amygdala also participates in the transition from healthy cognition to mild cognitive impairment (MCI). Methods Our sample was derived from the AD Neuroimaging Initiative 3 and consisted of 97 cognitively healthy (HC) individuals, sorted into two groups based on their clinical follow-up: 75 who remained stable (s-HC) and 22 who converted to MCI within 48 months (c-HC). Anatomical magnetic resonance (MR) images were analyzed using a semi-automatic approach that combines probabilistic methods and a priori information from ex vivo MR images and histology to segment and obtain quantitative structural metrics for different amygdala subfields in each participant. Spearman's correlations were performed between MR measures and baseline and longitudinal neuropsychological measures. We also included anatomical measurements of the whole amygdala, the hippocampus, a key target of AD-related pathology, and the whole cortical thickness as a test of spatial specificity. Results Compared with s-HC individuals, c-HC subjects showed a reduced right amygdala volume, whereas no significant difference was observed for hippocampal volumes or changes in cortical thickness. In the amygdala subfields, we observed selected atrophy patterns in the basolateral nuclear complex, anterior amygdala area, and transitional area. Macro-structural alterations in these subfields correlated with variations of global indices of cognitive performance (measured at baseline and the 48-month follow-up), suggesting that amygdala changes shape the cognitive progression to MCI. Discussion Our results provide anatomical evidence for the early involvement of the amygdala in the preclinical stages of AD. Highlights Amygdala's atrophy marks elderly progression to mild cognitive impairment (MCI).Amygdala's was observed within the basolateral and amygdaloid complexes.Macro-structural alterations were associated with cognitive decline.No atrophy was found in the hippocampus and cortex.
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Affiliation(s)
- Caterina Padulo
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Department of HumanitiesUniversity of Naples Federico IINaplesItaly
| | - Carlo Sestieri
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)“G. d'Annunzio” University, Chieti‐PescaraChietiItaly
| | - Miriam Punzi
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Eleonora Picerni
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Piero Chiacchiaretta
- Department of Innovative Technologies in Medicine and Dentistry“G. d'Annunzio” University of Chieti‐Pescara, ChietiChietiItaly
- Advanced Computing CoreCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Maria Giulia Tullo
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Alberto Granzotto
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Antonello Baldassarre
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Antonio Ferretti
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging, and Clinical SciencesUniversity “G. d'Annunzio” of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)“G. d'Annunzio” University, Chieti‐PescaraChietiItaly
- Molecular Neurology UnitCenter for Advanced Studies and Technology (CAST)University “G. d'Annunzio” of Chieti‐PescaraChietiItaly
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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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Heyrani R, Sarabi-Jamab A, Grafman J, Asadi N, Soltani S, Mirfazeli FS, Almasi-Dooghaei M, Shariat SV, Jahanbakhshi A, Khoeini T, Joghataei MT. Limits on using the clock drawing test as a measure to evaluate patients with neurological disorders. BMC Neurol 2022; 22:509. [PMID: 36585622 PMCID: PMC9805016 DOI: 10.1186/s12883-022-03035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Clock Drawing Test (CDT) is used as a quick-to-conduct test for the diagnosis of dementia and a screening tool for cognitive impairments in neurological disorders. However, the association between the pattern of CDT impairments and the location of brain lesions has been controversial. We examined whether there is an association between the CDT scores and the location of brain lesions using the two available scoring systems. METHOD One hundred five patients with brain lesions identified by CT scanning were recruited for this study. The Montreal Cognitive Assessment (MoCA) battery including the CDT were administered to all partcipants. To score the CDT, we used a qualitative scoring system devised by Rouleau et al. (1992). For the quantitative scoring system, we adapted the algorithm method used by Mendes-Santos et al. (2015) based on an earlier study by Sunderland et al. (1989). For analyses, a machine learning algorithm was used. RESULTS Remarkably, 30% of the patients were not detected by the CDT. Quantitative and qualitative errors were categorized into different clusters. The classification algorithm did not differentiate the patients with traumatic brain injury 'TBI' from non-TBI, or the laterality of the lesion. In addition, the classification accuracy for identifying patients with specific lobe lesions was low, except for the parietal lobe with an accuracy of 63%. CONCLUSION The CDT is not an accurate tool for detecting focal brain lesions. While the CDT still is beneficial for use with patients suspected of having a neurodegenerative disorder, it should be cautiously used with patients with focal neurological disorders.
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Affiliation(s)
- Raheleh Heyrani
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Atiye Sarabi-Jamab
- grid.418744.a0000 0000 8841 7951School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Jordan Grafman
- grid.477681.bShirly Ryan AbilityLab, Departments of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology, and Alzheimer’s Center, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL USA
| | - Nesa Asadi
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Soltani
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran ,grid.490421.a0000 0004 0612 3773Faculty of Medicine, Rasool Akram Hospital, Iran Unversity of Medical Sciences, Tehran, Iran
| | - Mostafa Almasi-Dooghaei
- grid.411746.10000 0004 4911 7066Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Shariat
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- grid.411746.10000 0004 4911 7066Department of Neurosurgery, Skull Base Research Center, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran ,grid.411746.10000 0004 4911 7066Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tara Khoeini
- grid.411746.10000 0004 4911 7066Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- grid.411746.10000 0004 4911 7066Cellular and Molecular Research Center (CMRC), Iran University of Medical Sciences, Tehran, Iran
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Wang D, Yao Q, Lin X, Hu J, Shi J. Disrupted topological properties of the structural brain network in patients with cerebellar infarction on different sides are associated with cognitive impairment. Front Neurol 2022; 13:982630. [PMID: 36203973 PMCID: PMC9530262 DOI: 10.3389/fneur.2022.982630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore changes in the brain structural network in patients with cerebellar infarction on different sides and their correlations with changes in cognitive function. Methods Nineteen patients with acute left posterior cerebellar infarction and 18 patients with acute right posterior cerebellar infarction seen from July 2016 to September 2019 in the Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, were selected. A total of 27 healthy controls matched for sex, age, and years of education were recruited. The subjects underwent head diffusion magnetic resonance imaging examination and neuropsychological cognitive scale evaluation, and we analyzed changes in brain structural network properties in patients with cerebellar infarction and their correlation with changes in patients' cognitive function. Results The Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MOCA) and the Rey auditory verbal learning test (RAVLT) scores in the left and right cerebellar infarction groups were significantly lower than those in the healthy control group (p < 0.05). In addition, the digit span test (DST) scores were lower in the left cerebellar infarction group (p < 0.05); the trail-making test (TMT) times in the right cerebellar infarction group were significantly higher than those in the left cerebellar infarction group (p < 0.05). Meanwhile, the left and right cerebellar infarction groups had abnormal brain topological properties, including clustering coefficient, shortest path length, global efficiency, local efficiency and nodal efficiency. After unilateral cerebellar infarction, bilateral cerebral nodal efficiency was abnormal. Correlation analysis showed that there was a close correlation between decreased processing speed in patients with left cerebellar infarction and decreased efficiency of right cerebral nodes (p < 0.05), and there was a close relationship between executive dysfunction and decreased efficiency of left cerebral nodes in patients with right cerebellar infarction (p < 0.05). Conclusion Patients with cerebellar infarction have cognitive impairment. Unilateral cerebellar infarction can reduce the network efficiency of key regions in the bilateral cerebral hemispheres, and these abnormal changes are closely related to patient cognitive impairment. The results of this study provide evidence for understanding the underlying neural mechanisms of cerebellar cognitive impairment and suggest that brain topological network properties may be markers of cerebellar cognitive impairment.
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Affiliation(s)
- Duohao Wang
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qun Yao
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xingjian Lin
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Hu
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingping Shi
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Jingping Shi
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10
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Kobayashi M, Yamada Y, Shinkawa K, Nemoto M, Nemoto K, Arai T. Automated Early Detection of Alzheimer's Disease by Capturing Impairments in Multiple Cognitive Domains with Multiple Drawing Tasks. J Alzheimers Dis 2022; 88:1075-1089. [PMID: 35723100 PMCID: PMC9484124 DOI: 10.3233/jad-215714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Automatic analysis of the drawing process using a digital tablet and pen has been applied to successfully detect Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, most studies focused on analyzing individual drawing tasks separately, and the question of how a combination of drawing tasks could improve the detection performance thus remains unexplored. OBJECTIVE We aimed to investigate whether analysis of the drawing process in multiple drawing tasks could capture different, complementary aspects of cognitive impairments, with a view toward combining multiple tasks to effectively improve the detection capability. METHODS We collected drawing data from 144 community-dwelling older adults (27 AD, 65 MCI, and 52 cognitively normal, or CN) who performed five drawing tasks. We then extracted motion- and pause-related drawing features for each task and investigated the statistical associations of the features with the participants' diagnostic statuses and cognitive measures. RESULTS The drawing features showed gradual changes from CN to MCI and then to AD, and the changes in the features for each task were statistically associated with cognitive impairments in different domains. For classification into the three diagnostic categories, a machine learning model using the features from all five tasks achieved a classification accuracy of 75.2%, an improvement by 7.8% over that of the best single-task model. CONCLUSION Our results demonstrate that a common set of drawing features from multiple drawing tasks can capture different, complementary aspects of cognitive impairments, which may lead to a scalable way to improve the automated detection of AD and MCI.
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11
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Yao Q, Tang F, Wang Y, Yan Y, Dong L, Wang T, Zhu D, Tian M, Lin X, Shi J. Effect of cerebellum stimulation on cognitive recovery in patients with Alzheimer disease: A randomized clinical trial. Brain Stimul 2022; 15:910-920. [PMID: 35700915 DOI: 10.1016/j.brs.2022.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Evidence indicates that the cerebellum is involved in cognitive processing. However, the specific mechanisms through which the cerebellum repetitive transcranial magnetic stimulation (rTMS) contributes to the cognitive state are unclear. METHODS In the current randomized, double-blind, sham-controlled trial, 27 patients with Alzheimer's disease (AD) were randomly allotted to one of the two groups: rTMS-real or rTMS-sham. We investigated the efficacy of a four-week treatment of bilateral cerebellum rTMS to promote cognitive recovery and alter specific cerebello-cerebral functional connectivity. RESULTS The cerebellum rTMS significantly improves multi-domain cognitive functions, directly associated with the observed intrinsic functional connectivity between the cerebellum nodes and the dorsolateral prefrontal cortex (DLPFC), medial frontal cortex, and the cingulate cortex in the real rTMS group. In contrast, the sham stimulation showed no significant impact on the clinical improvements and the cerebello-cerebral connectivity. CONCLUSION Our results depict that 5 Hz rTMS of the bilateral cerebellum is a promising, non-invasive treatment of cognitive dysfunction in AD patients. This cognitive improvement is accompanied by brain connectivity modulation and is consistent with the pathophysiological brain disconnection model in AD patients.
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Affiliation(s)
- Qun Yao
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Fanyu Tang
- Department of Neurology, The Second People's Hospital of Bengbu, Bengbu, Anhui, China.
| | - Yingying Wang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Yixin Yan
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Lin Dong
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Tong Wang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Donglin Zhu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Minjie Tian
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Xingjian Lin
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
| | - Jingping Shi
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
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12
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Yamada Y, Shinkawa K, Kobayashi M, Badal VD, Glorioso D, Lee EE, Daly R, Nebeker C, Twamley EW, Depp C, Nemoto M, Nemoto K, Kim HC, Arai T, Jeste DV. Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets. JMIR Form Res 2022; 6:e37014. [PMID: 35511253 PMCID: PMC9121219 DOI: 10.2196/37014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. OBJECTIVE The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. METHODS We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning-based regression analyses. RESULTS We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen's horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001). CONCLUSIONS This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment.
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Affiliation(s)
| | | | | | - Varsha D Badal
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Camille Nebeker
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Colin Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Miyuki Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Almaden Research Center, San Jose, CA, United States
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
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13
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Mendez M. Mental Status Scales. THE MENTAL STATUS EXAMINATION HANDBOOK 2022:245-262. [DOI: 10.1016/b978-0-323-69489-6.00020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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14
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Reorganization of rich clubs in functional brain networks of dementia with Lewy bodies and Alzheimer's disease. Neuroimage Clin 2021; 33:102930. [PMID: 34959050 PMCID: PMC8856913 DOI: 10.1016/j.nicl.2021.102930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/18/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
Abstract
DLB and AD had the different functional reorganization patterns. Rich club nodes increased in frontal-parietal network in patients with DLB. The rich club nodes in temporal lobe decreased and those in cerebellum increased for AD. Compared with HC, rich club connectivity was enhanced in the DLB and AD groups.
The purpose of this study was to reveal the patterns of reorganization of rich club organization in brain functional networks in dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD). The study found that the rich club node shifts from sensory/somatomotor network to fronto-parietal network in DLB. For AD, the rich club nodes switch between the temporal lobe with obvious structural atrophy and the frontal lobe, parietal lobe and cerebellum with relatively preserved structure and function. In addition, compared with healthy controls, rich club connectivity was enhanced in the DLB and AD groups. The connection strength of DLB patients was related to cognitive assessment. In conclusion, we revealed the different functional reorganization patterns of DLB and AD. The conversion and redistribution of rich club members may play a causal role in disease-specific outcomes. It may be used as a potential biomarker to provide more accurate prevention and treatment strategies.
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15
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Graeff DB, Lui JM, Zucco NDP, Alves ALS, Forcelini CM, Dalmolin BM. Clock drawing test: comparison between the Pfizer and the Shulman systems. Dement Neuropsychol 2021; 15:480-484. [PMID: 35509798 PMCID: PMC9018089 DOI: 10.1590/1980-57642021dn15-040009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects’ CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman’s rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
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16
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Mørup-Petersen A, Skou ST, Holm CE, Holm PM, Varnum C, Krogsgaard MR, Laursen M, Odgaard A. Measurement properties of UCLA Activity Scale for hip and knee arthroplasty patients and translation and cultural adaptation into Danish. Acta Orthop 2021; 92:681-688. [PMID: 34530681 PMCID: PMC8635665 DOI: 10.1080/17453674.2021.1977533] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The UCLA Activity Scale (UCLA) is a questionnaire assessing physical activity level from 1 (low) to 10 (high) in patients undergoing hip or knee arthroplasty (HA/KA). After translation and cultural adaptation, we evaluated the measurement properties of the Danish UCLA.Patients and methods - After dual panel translation, cognitive interviews were performed among 55 HA/KA patients. An orthopedic surgeon and a physiotherapist estimated UCLA scores for 80 KA patients based on short interviews. Measurement properties were evaluated in 130 HA and 134 KA patients preoperatively and 1-year postoperatively.Results - To suit Danish patients of today, several adaptations were required. Prior to interviews, 4 patients were excluded, and 11 misinterpreted the answer options. Examiners rated the remaining 65 patients (mean age 67 years) 0.2-1.6 UCLA levels lower than patients themselves. The 130 HA and 134 KA patients (mean age 71/68 years) changed from 4.3 (SD 1.9)/4.5 (1.8) preoperatively to 6.6 (1.8)/6.2 (1.0) at 1-year follow-up. 103 (79%) HA and 89 (66%) KA patients reported increased activity. Effect sizes were large (1.2/0.96). Knee patients reaching minimal important change (MIC, ≥ 8 Oxford Knee Score points) had higher 1-year UCLA scores than patients not reaching MIC.Interpretation - Original scale development was undocumented. Content validity was questionable, and there was discrepancy between patient and examiner estimates. UCLA appears valuable for measuring change in self-reported physical activity on a group level. 4 out of 5 HA patients and 2 out of 3 KA patients were more physically active 1 year after joint replacement surgery.
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Affiliation(s)
- Anne Mørup-Petersen
- Department of Orthopedic Surgery, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense; Research unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand
| | - Christina E Holm
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet
| | - Paetur M Holm
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense; Research unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand
| | - Claus Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of SouthernDenmark; Department of Regional Health Research, Faculty of Health Science, University of SouthernDenmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen
| | - Mogens Laursen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg & Farsø
| | - Anders Odgaard
- Department of Orthopedic Surgery, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Umegaki H, Suzuki Y, Komiya H, Watanabe K, Yamada Y, Nagae M, Kuzuya M. Frequencies and Neuropsychological Characteristics of Errors in the Clock Drawing Test. J Alzheimers Dis 2021; 82:1291-1300. [PMID: 34151812 DOI: 10.3233/jad-210456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have investigated associations between types of clock drawing test (CDT) errors and cognitive impairment. OBJECTIVE To explore associations of qualitative errors in the CDT with comprehensive neurocognitive assessment scores and clinical diagnosis. METHODS Outpatients at a memory clinic were enrolled. Frequencies of errors determined by Cahn's method were explored according to cognitive status (cognitively normal [CN] (n = 279), mild cognitive impairment [MCI] (n = 321), and Alzheimer's disease [AD]) (n = 575). Neuropsychological assessment scores were compared between participants with and without errors. RESULTS Stimulus-bound response (SB) was relatively rare (6.8%) in the CN group but was markedly more common in the MCI (23.4%) and AD (33.2%) groups. Conceptual deficit (CD) was found in more than 20%of CN individuals, as well as about 50%of AD patients. Planning deficit (PD) frequencies were relatively similar among the groups. SB in both of CN and MCI individuals, and CD in both of CN and MCI individuals were associated with lower scores in several neuropsychological assessments. Meanwhile, PD was not associated with lower assessment scores in any of CN, MCI, or AD individuals. CONCLUSION The frequencies of SB and CD increased from CN, MCI, to AD but showed somewhat different patterns. Both SB and CD were associated with lower cognition in all three cognitive stages.
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18
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Trajectories and risk factors of dementia progression: a memory clinic cohort followed up to 3 years from diagnosis. Int Psychogeriatr 2021; 33:779-789. [PMID: 33213607 DOI: 10.1017/s1041610220003270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership. DESIGN Longitudinal observational study. SETTING Specialized memory clinic, Oslo University Hospital in Norway. PARTICIPANTS Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations. MEASUREMENTS Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer's disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership. RESULTS Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis. CONCLUSIONS Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.
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Bouati N, Drevet S, Zerhouni N, Bioteau C, Mitha N, Gavazzi G. Cognitive Screening Tool for Geriatrics: A Retrospective Observational Study on the Correlation of the Scores in 30-Point Clock Face Test and MMSE. Indian J Psychol Med 2021; 43:306-311. [PMID: 34385723 PMCID: PMC8327860 DOI: 10.1177/0253717620961335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Over the past 30 years, the clock drawing test (CDT) has generated considerable interest due to its usefulness in the early detection of cognitive impairments, particularly those seen in neurodegenerative dementias (including Alzheimer's disease), vascular dementia, and mixed dementia. The present study aimed to determine whether the results of the "30-Point Clock Face Test" (CFT-30), a standardized version of the CDT that uses a 30-point scale, correlate with those of the Mini-Mental State Examination (MMSE). METHODS This is a retrospective, observational study. All patients hospitalized in a Hospital-University Clinic Geriatrics Unit (Grenoble Alpes University Hospital, Grenoble, France), from January 1, 2017, to December 31, 2018, were included. Patient data and scores were retrieved from hospital archives, and the results of the two tests of interest, MMSE and the CFT-30, were analyzed. RESULTS We included 214 patients aged ≥75 years. The mean ± SD age was 86.4 ± 5.6 years, and 68.7% were female. A strongly positive, significant correlation was seen between the CFT-30 and MMSE (r = 0.73, P < 0.001) scores. The total scores obtained by these two tests were identical (t = 1.22, P = 0.22). CONCLUSION CFT-30 is a good complement to the tools usually used in the investigation of cognitive impairments in older people. In addition to its metrological qualities, the standardized and normalized CFT-30 is extremely simple and very fast to use.
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Affiliation(s)
- Noureddine Bouati
- Hospital-University Clinic Geriatrics Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Sabine Drevet
- Hospital-University Clinic Geriatrics Unit, Grenoble Alpes University Hospital, Grenoble, France.,OrthoGeriatric Unit, Grenoble Alpes University Hospital, Grenoble, France.,Clinic of Geriatric Medicine, Grenoble Alpes University, Grenoble, France
| | - Nabil Zerhouni
- Hospital-University Clinic Geriatrics Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Catherine Bioteau
- OrthoGeriatric Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Nathalie Mitha
- Hospital-University Clinic Geriatrics Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Gaëtan Gavazzi
- Hospital-University Clinic Geriatrics Unit, Grenoble Alpes University Hospital, Grenoble, France.,Research and Studies Group of the Inflammatory Process (GREPI) EA 7408, Grenoble Alpes University, Grenoble, France
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Tang F, Zhu D, Ma W, Yao Q, Li Q, Shi J. Differences Changes in Cerebellar Functional Connectivity Between Mild Cognitive Impairment and Alzheimer's Disease: A Seed-Based Approach. Front Neurol 2021; 12:645171. [PMID: 34220669 PMCID: PMC8248670 DOI: 10.3389/fneur.2021.645171] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Recent studies have discovered that functional connections are impaired among patients with Alzheimer's disease (AD), even at the preclinical stage. The cerebellum has been implicated as playing a role in cognitive processes. However, functional connectivity (FC) among cognitive sub-regions of the cerebellum in patients with AD and mild cognitive impairment (MCI) remains to be further elucidated. Objective: Our study aims to investigate the FC changes of the cerebellum among patients with AD and MCI, compared to healthy controls (HC). Additionally, we explored the role of cerebellum FC changes in the cognitive performance of all subjects. Materials: Resting-state functional magnetic resonance imaging (rs-fMRI) data from three different groups (28 AD patients, 26 MCI patients, and 30 HC) was collected. We defined cerebellar crus II and lobule IX as seed regions to assess the intragroup differences of cortico-cerebellar connectivity. Bias correlational analysis was performed to investigate the relationship between changes in FC and neuropsychological performance. Results: Compared to HC, AD patients had decreased FC within the caudate, limbic lobe, medial frontal gyrus (MFG), middle temporal gyrus, superior frontal gyrus, parietal lobe/precuneus, inferior temporal gyrus, and posterior cingulate gyrus. Interestingly, MCI patients demonstrated increased FC within inferior parietal lobe, and MFG, while they had decreased FC in the thalamus, inferior frontal gyrus, and superior frontal gyrus. Further analysis indicated that FC changes between the left crus II and the right thalamus, as well as between left lobule IX and the right parietal lobe, were both associated with cognitive decline in AD. Disrupted FC between left crus II and right thalamus, as well as between left lobule IX and right parietal lobe, was associated with attention deficit among subjects with MCI. Conclusion: These findings indicate that cortico-cerebellar FC in MCI and AD patients was significantly disrupted with different distributions, particularly in the default mode networks (DMN) and fronto-parietal networks (FPN) region. Increased activity within the fronto-parietal areas of MCI patients indicated a possible compensatory role for the cerebellum in cognitive impairment. Therefore, alterations in the cortico-cerebellar FC represent a novel approach for early diagnosis and a potential therapeutic target for early intervention.
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Affiliation(s)
- Fanyu Tang
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Donglin Zhu
- Department of Neurology, Affiliated to Nanjing Medical University, Nanjing, China
| | - Wenying Ma
- Nanjing Medical University, Nanjing, China
| | - Qun Yao
- Department of Neurology, Affiliated to Nanjing Medical University, Nanjing, China
| | - Qian Li
- Nanjing Medical University, Nanjing, China
| | - Jingping Shi
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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21
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Kaur H, Malhotra N, Jacob JJ. Impact of subclinical hypothyroidism on cognitive functions among the elderly. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Bougea AM, Zikos P, Spanou I, Efthymiopoulou E. Clock-Drawing Tasks as Predictive Measurements for Disease Classification Among Patients With Parkinson's Disease and Essential Tremor. Cureus 2021; 13:e13239. [PMID: 33728188 PMCID: PMC7949632 DOI: 10.7759/cureus.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
Background Nonmotor cognitive symptoms are widely being recognized in both Parkinson's Disease (PD) and Essential Tremor (ET), the two most common movement disorders. Clock-drawing (CD) test seems to be impaired early in the process of cognitive (executive) decline in PD. However, the optimal measures for detecting cognitive changes in ET patients have not been established. Examining whether the CD test is a quick test could identify frontal and visuospatial deficits in patients with Parkinson's disease (PD) and essential tremor (ET). Methods Visuospatial performance was assessed in 58 consecutive patients with ET and 75 with PD and 22 healthy controls (HC) who visited two neurological clinics of Athens in Greece. The CD and copy (CC) items of the PD-Cognitive Rating Scale were used as a test of visuospatial function. Results Both CD and CC scores were lower for ET compared to PD patients and HC (p=<0.001 for both comparisons). A binomial logistic regression showed that both CD and CC items predict if participants had ET or PD with high sensitivity 94.7% and specificity 87.9% and an area under the curve (AUC) 0.980 (95% confidence interval, 0.962-0.997). The model explained 86.1% (Nagelkerke R2) of the variance in the disease variable (ET/PD) and correctly classified 91.7% of the cases. Conclusion Patients with ET have more visuospatial deficits compared to PD and HC. CD task may be an easy, useful tool to track cognitive changes in nondemented patients with ET in clinical practice.
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Affiliation(s)
- Anastasia M Bougea
- Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Ioanna Spanou
- Neurology, 251 Hellenic Air Force Hospital, Athens, GRC
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Lolekha P, Tangkanakul C, Saengchatri T, Kulkeartprasert P. The Six-item Clock-Drawing Scoring System: a rapid screening for cognitive impairment in Parkinson's disease. Psychogeriatrics 2021; 21:24-31. [PMID: 32875700 DOI: 10.1111/psyg.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive impairment, characterised by predominant executive dysfunction and visuospatial deficit, is frequently observed in Parkinson's disease (PD) and may lead to mild cognitive impairment (PD-MCI) and dementia (PD-D). The clock-drawing test (CDT) is a rapid cognitive evaluation that is appropriate for screening frontoparietal lobe dysfunction. This study aimed to evaluate the screening performance of the Six-item Clock-Drawing Scoring System (6-CDSS) in detecting cognitive impairment in PD patients. METHODS A retrospective analysis of free-drawn clocks from 136 PD patients was performed. The presence of cognitive impairment and dementia was documented by neurologists according to the standard diagnostic criteria. Diagnostic performance and the optimal screening cut-off scores for cognitive impairment and dementia using the 6-CDSS were determined. RESULTS One hundred and thirteen patients were documented as having PD with cognitive impairment (PD-CI). Of those, 39 were diagnosed as probable PD-D and 74 with PD-MCI. The optimal screening cut-off scores for PD-CI were 4/5 and 1/2 for probable PD-D. The area under the receiver operating characteristic curve was 0.88 and 0.91, respectively. Multiple regression analysis revealed that low education levels, poor activity of daily living, and older age were associated with low 6-CDSS scores. CONCLUSIONS CDT scoring using the 6-CDSS is a reliable system to screen cognitive impairment in PD and may serve as a simple screening tool for PD-D in clinical practice.
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Affiliation(s)
- Praween Lolekha
- Neurology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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24
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Comparison of Traditional Chinese Exercises and Nontraditional Chinese Exercise Modalities on Cognitive and Executive Function in Community Middle-Aged and Older Adults: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4380805. [PMID: 33299452 PMCID: PMC7704149 DOI: 10.1155/2020/4380805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/21/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
Background Current evidence indicates that regular exercise can have a positive impact on cognitive function in older adults, but whether different exercise modalities may induce differential protective effects in different cognitive domains is uncertain. Objective To compare the effect of traditional Chinese exercise (TCE) modalities and non-traditional Chinese exercise (non-TCE) modalities on cognitive and executive function in community middle-aged and older adults through a cross-sectional study. Methods A total of 350 community middle-aged and older adults aged over 55 years participated in this study. Information on demographic characteristics, lifestyle and behavioural habits, and regular exercise was collected by a self-designed questionnaire. Global cognitive ability and executive function were assessed using the Montreal Cognitive Assessment (MoCA) scale, the clock drawing test (CDT), the animal naming test (ANT), and the trail making test (TMT). Eligible subjects were categorized into the no regular exercise (no-RE), non-TCE, or TCE groups according to their self-reported exercise information. Comparisons of global cognitive and executive function among the three groups were conducted using ANOVA or the general linear model with adjustment for potential confounding factors. Results The results showed that for the non-TCE or TCE groups, the MoCA and CDT scores were significantly higher, and the TMT-A test time was significantly shorter than those in the no-RE group (all P < 0.05), but no significant difference was observed for the TMT-B and ANT tests. After adjustment for potential confounding factors, the MoCA, the CDT, and TMT-A scores in the TCE group were significant compared to those in the no-RE group. In addition, subgroup analysis showed that in the TCE group, the MoCA scores were significantly higher than those in the non-TCE group. Furthermore, in the TCE group, the CDT scores for those with an exercise duration of <5 years were higher and the TMT-A test time for those with an exercise duration of ≥5 years was shorter than those in the non-TCE group. Conclusions Both TCE and non-TCE have potential protective effects on global cognitive and executive function in community middle-aged and older adults. Compared to the non-TCE modality, the TCE modality may have a more positive association with these protective effects. Furthermore, prospective studies are needed to confirm these findings.
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25
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Jekel K, Wagner P. [Neuropsychological diagnostics of cognitive deficits : Focus on dementia]. Z Gerontol Geriatr 2020; 53:797-806. [PMID: 33146740 DOI: 10.1007/s00391-020-01800-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
Older people often report a decline in their cognitive functions - memory problems and difficulty finding words are frequently mentioned. In this context it is essential to differentiate between age-related cognitive decline and pathological processes as they occur in the context of dementia. Neuropsychological diagnostics make an important contribution to this distinction. Using cognitive tests, the quality and quantity of cognitive deficits can be determined. Moreover, the cognitive profile can be used to generate hypotheses about the etiology of the cognitive impairment. In order to avoid a misdiagnosis, factors such as drug side effects, loss of vision and hearing, the presence of depressive symptoms or states of delirium should be taken into account.
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Affiliation(s)
- Katrin Jekel
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
| | - Peter Wagner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Abteilung Gerontopsychiatrie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
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26
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Dong F, Shao K, Guo S, Wang W, Yang Y, Zhao Z, Feng R, Wang J. Clock-drawing test in vascular mild cognitive impairment: Validity of quantitative and qualitative analyses. J Clin Exp Neuropsychol 2020; 42:622-633. [PMID: 32700636 DOI: 10.1080/13803395.2020.1793104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The clock-drawing test (CDT) has been used as a screening tool to identify cognitive deficit in patients with dementia. However, it has not been extensively evaluated for categorizing patients with vascular mild cognitive impairment (vMCI). This study aimed to examine the discrimination of vMCI using various CDT scoring methods. METHOD A total of 120 vMCI patients and 119 normal control (NC) subjects were tested using three CDT quantitative scoring systems: the one from the Montreal Cognitive Assessment (MoCA) (CDT3) and the systems of Rouleau (CDT10) and Babins (CDT18). We used a revised scoring method to evaluate the effectiveness in differentiating vMCI patients from NC subjects, which combined the CDT10 quantitative score and three qualitative errors with a significantly higher prevalence in vMCI group (called hereinafter CDTcomb, including CDTcomb13 and CDTcomb16 based on different weights of the three error types). The sensitivity and specificity of the CDT methods were determined by the receiver operating characteristic (ROC) curve. The results of the scoring systems were compared with those of the Mini-Mental State Examination (MMSE). RESULTS The results of the ROC analyses with the CDT3, CDT10, and CDT18 systems produced a sensitivity of 71.1%, 81.8%, and 60.3%, and a specificity of 66.12%, 58.68%, and 73.55%, respectively, for the diagnosis of vMCI. Compared with the separate MMSE score, the combination of MMSE with the CDT3, CDT10 and CDT18 scores did not increase the sensitivity and specificity. When three qualitative errors were incorporated into the CDT10 quantitative score, CDTcomb13 and CDTcomb16 provided a sensitivity of 87.6% and 86.78%, and a specificity of 74.79% and 80.67%, respectively, in differentiating vMCI patients from the NC group. CONCLUSION Our findings suggest that the combination of CDT quantitative score with qualitative observations of the clock-drawing errors can provide a better discrimination between vMCI patients and cognitively normal subjects.
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Affiliation(s)
- Fangming Dong
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Kai Shao
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Shangzun Guo
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China.,Graduate School, Hebei North University , Zhangjiakou, China
| | - Wei Wang
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Yiming Yang
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China.,Graduate School, Hebei North University , Zhangjiakou, China
| | - Zhongmin Zhao
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Rongfang Feng
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Jianhua Wang
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China
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The Relationship between Plasma Al Levels and Multi-domain Cognitive Performance among In-service Aluminum-exposed Workers at the SH Aluminum Factory in China: A Cross-sectional Study. Neurotoxicology 2020; 76:144-152. [DOI: 10.1016/j.neuro.2019.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022]
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Wang D, Yao Q, Yu M, Xiao C, Fan L, Lin X, Zhu D, Tian M, Shi J. Topological Disruption of Structural Brain Networks in Patients With Cognitive Impairment Following Cerebellar Infarction. Front Neurol 2019; 10:759. [PMID: 31379713 PMCID: PMC6659410 DOI: 10.3389/fneur.2019.00759] [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: 02/28/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Cerebellar lesions can lead to a series of cognitive and emotional disorders by influencing cerebral activity via cerebro-cerebellar loops. To explore changes in cognitive function and structural brain networks in patients with posterior cerebellar infarction, we conducted the current study using diffusion-weighted MRI (32 cerebellar infarction patients, 29 controls). Moreover, a series of neuropsychological tests were used to assess the subject's cognitive performance. We found cognitive impairment following cerebellar infarction involving multiple cognitive domains, including memory, executive functions, visuospatial abilities, processing speed and language functions, and brain topological abnormalities, including changes in clustering coefficients, shortest path lengths, global efficiency, local efficiencies, betweenness centrality and nodal efficiencies. Our results indicated that measures of local efficiency, mainly in the precuneus, cingulate gyrus and frontal-temporal cortex, were significantly reduced with posterior cerebellar infarction. At the same time, The correlation analysis suggested thatthe abnormal alterations in the right PCG, bilateral DCG, right PCUN may play a core role in the cognitive impairment following cerebellar infarctions. The differences in topological features of the structural brain networks within the cerebro-cerebellar circuits may provide a new approach to explore the pathophysiological mechanisms of cognitive impairment following cerebellar infarction.
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Affiliation(s)
- Duohao Wang
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qun Yao
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Miao Yu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chaoyong Xiao
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Fan
- Department of Neurology, Taizhou People's Hospital, Taizhou, China
| | - Xingjian Lin
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Donglin Zhu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Minjie Tian
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingping Shi
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Shanhu X, Linhui C, Xiaoqing J, Jing Y, Saizhu X, Ying X, Caixia L, Yu J. Effects of age and education on clock-drawing performance by elderly adults in China. Clin Neuropsychol 2019; 33:96-105. [PMID: 31322036 DOI: 10.1080/13854046.2019.1640285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xu Shanhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chen Linhui
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Xiaoqing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yan Jing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Saizhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Ying
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Liu Caixia
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Yu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
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Gromisch ES, Beauvais J, Iannone LP, Marottoli RA. Optimizing Clock Drawing Scoring Criteria: Development of the West Haven–Yale Clock Drawing Test. J Am Geriatr Soc 2019; 67:2129-2133. [PMID: 31287923 DOI: 10.1111/jgs.16047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/03/2019] [Accepted: 05/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth S. Gromisch
- Mandell Center for Multiple Sclerosis Mount Sinai Rehabilitation Hospital, Trinity Health Of New England Hartford Connecticut
- Psychology Service VA Connecticut Healthcare System West Haven Connecticut
- Department of Neurology University of Connecticut School of Medicine Farmington Connecticut
| | - John Beauvais
- Psychology Service VA Connecticut Healthcare System West Haven Connecticut
- Department of Psychiatry Yale University School of Medicine New Haven Connecticut
| | - Lynne P. Iannone
- Department of Internal Medicine Yale University School of Medicine New Haven Connecticut
| | - Richard A. Marottoli
- Department of Internal Medicine Yale University School of Medicine New Haven Connecticut
- Geriatrics and Extended Care Section VA Connecticut Healthcare System West Haven Connecticut
- Cooperative Studies Program Clinical Epidemiology Research Center VA Connecticut Healthcare System West Haven Connecticut
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Meng H, Wang S, Guo J, Zhao Y, Zhang S, Zhao Y, Niu Q. Cognitive impairment of workers in a large-scale aluminium factory in China: a cross-sectional study. BMJ Open 2019; 9:e027154. [PMID: 31209090 PMCID: PMC6589001 DOI: 10.1136/bmjopen-2018-027154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of mild cognitive impairment and the relationship with plasma aluminium among aluminium workers. DESIGN This was a cross-sectional case-control study in the SH Aluminium Factory, China. SETTING The university and affiliated hospital cooperated in the study. PARTICIPANTS There were 910 aluminium workers on duty, among whom 853 participated in our study. Participants, such as those with cerebral vascular disease, epilepsy, brain trauma, Parkinson's and mental diseases, aluminium-containing drug and mental drug use, and any family history of dementia in first-degree relatives were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Blood samples were collected, and plasma aluminium was measured by inductively coupled plasma-mass spectrometry. For each case, four age-matched controls were evaluated to determine the relationship between aluminium exposure and mild cognitive impairment. Conditional logistic regression was used to explore influential factors in mild cognitive impairment. RESULTS Among 910 workers, 93.74% participated in stage 1; 53 cases were finally diagnosed. The crude prevalence of mild cognitive impairment among aluminium workers on duty was 6.21%. There was a significant difference in plasma aluminium concentration between the two groups. In the multivariate analysis, we found that a higher level of plasma aluminium was associated with a high risk of cognitive impairment when compared with a lower aluminium level (AOR=2.24, 95% CI=1.17 to 4.26), and a high education level was a protective factor (AOR=0.36, 95% CI=0.18 to 0.70). No other factor was statistically significant. CONCLUSIONS Mild cognitive impairment is no longer a disease specific to elderly people. High plasma aluminium exposure might be associated with an increased risk of cognitive impairment, but a reduced risk was observed with a high education level. The cognitive function of aluminium workers on duty must be considered seriously.
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Affiliation(s)
- Huaxing Meng
- School of Public Health, Shanxi Medical University, Taiyuan, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Shanshan Wang
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yarong Zhao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuhui Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yuqing Zhao
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Qiao Niu
- School of Public Health, Shanxi Medical University, Taiyuan, China
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Supasitthumrong T, Herrmann N, Tunvirachaisakul C, Shulman K. Clock drawing and neuroanatomical correlates: A systematic review. Int J Geriatr Psychiatry 2019; 34:223-232. [PMID: 30370637 DOI: 10.1002/gps.5013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/05/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The popular clock drawing test (CDT) is easy to administer, acceptable to patients, and has excellent psychometric properties. Although it has been used primarily as a cognitive screening test, many studies have attempted to establish the CDT's ability to localize specific brain lesions or pathology. This systematic review aimed to summarize the evidence on the neuroanatomical correlates of the CDT. METHODS Using PRISMA guidelines, the authors systematically reviewed the evidence on neuroanatomical correlates of clock drawing by a systematic search in six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science) until January 2018. Studies were included if they reported CDT correlations with anatomical brain lesions documented by neuroimaging. RESULTS Forty-five papers met inclusion criteria. Thirty-one studies identified distinct areas of neuroanatomical correlates of CDT utilizing different scoring methods and imaging techniques. Nine articles reported on the degree of white matter hyperintensities that correlated with lower scores on CDT and the severity of cognitive deficits. Five articles focused on postacute cerebrovascular accidents correlated with CDT performance. A variety of different anatomical lesions, located in all areas of the brain, were associated with abnormalities on the CDT. CONCLUSIONS The CDT, regardless of scoring method and population studied, was not associated with any consistent, specific brain localization. This systematic review supports the use of the CDT as a cognitive screening test rather than a method of localizing brain lesions.
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Affiliation(s)
- Thitiporn Supasitthumrong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Kenneth Shulman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems. Dement Neurocogn Disord 2018; 17:100-109. [PMID: 30906399 PMCID: PMC6428010 DOI: 10.12779/dnd.2018.17.3.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. Methods Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. Results On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. Conclusions The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.
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Potier F, Degryse JM, Bihin B, Debacq-Chainiaux F, Charlet-Renard C, Martens H, de Saint-Hubert M. Health and frailty among older spousal caregivers: an observational cohort study in Belgium. BMC Geriatr 2018; 18:291. [PMID: 30477431 PMCID: PMC6258488 DOI: 10.1186/s12877-018-0980-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/13/2018] [Indexed: 11/16/2022] Open
Abstract
Background Among older couples, spouses are first in line to provide care, and they are key elements in the home support of dependent older persons. In this context, ensuring the health of these older spousal caregivers should be an important issue for all of the providers who care for older adults. The aim of this study was to longitudinally assess the health of older spousal caregivers considering frailty, nutrition, cognition, physical performance and mood disorders. Methods In this longitudinal, observational cohort study, participants were assessed at home in Wallonia, Belgium. At baseline, 82 community-dwelling spouses of older patients with cognitive deficits or functional impairment were assessed; 78 caregivers were assessed at follow-up (16 months). The clinical instruments used included Frailty Phenotype (Fried), the Mini Nutritional Assessment-short form (MNA-SF), Short Physical Performance Battery (SPPB), Geriatric Depression Scale (GDS-15), clock drawing test, medications, Zarit Burden Index (ZBI), and Caregiver Reaction Assessment (CRA). Biological assessments included plasma interleukin-6 (IL-6), ultrasensitive C-reactive protein (CRP), cortisol, albumin and insulin growth factor-1 (IGF-1). Results Among caregivers, 54% were women, and the mean age was 80 years. Among care-receivers, 83% had cognitive impairment. Caregivers were more likely to be in a pre-frail stage. In one-third of the caregivers, the frailty status worsened. Transitions were observed between each of the states, except from frail to robust. In contrast to frailty, items including nutrition, cognitive status, SPPB and mood assessments were stable over time, with approximately 70% of the caregivers not experiencing significant change at follow-up. Caregiver experiences assessed with the Zarit Burden Interview and CRA were relatively stable over 16 months. Conclusion Many caregivers of geriatric patients are spouses who are old themselves. A failure in the health of the caregiver may anticipate an undesired care breakdown. Caregiver health and its determinants should be explored in future longitudinal studies that cover a longer time period. Electronic supplementary material The online version of this article (10.1186/s12877-018-0980-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Potier
- Department of Geriatrics, CHU Université Catholique de Louvain, 1, rue Dr G. Therasse, 5530 Mont-Godinne, Namur, Belgium. .,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.,Departments of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Benoit Bihin
- Scientific Support Unit, CHU Université Catholique de Louvain, Namur, Belgium
| | | | | | - Henri Martens
- GIGA Research Institute, University of Liège, Liège, Belgium
| | - Marie de Saint-Hubert
- Department of Geriatrics, CHU Université Catholique de Louvain, 1, rue Dr G. Therasse, 5530 Mont-Godinne, Namur, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Park J, Jeong E, Seomun G. The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy. J Adv Nurs 2018; 74:2742-2754. [DOI: 10.1111/jan.13810] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
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Knee Osteoarthritis Patients Can Provide Useful Estimates of Passive Knee Range of Motion: Development and Validation of the Copenhagen Knee ROM Scale. J Arthroplasty 2018; 33:2875-2883.e3. [PMID: 29887360 DOI: 10.1016/j.arth.2018.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/17/2018] [Accepted: 05/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Knee arthroplasty does not always require extensive long-term follow-up. If knee range of motion (ROM) could be assessed reliably by patients, some follow-up visits might be replaced by patient-reported outcome measures, and this additional information could be reported directly to registers. We developed and tested the validity and reliability of a simple scale for patients to self-report their passive knee ROM. METHODS Through an iterative process, we created a 2-item scale with 11 illustrations of knee motion in 15° increments. The validity and reliability was tested in knee osteoarthritis and arthroplasty patients at different treatment stages, many with poor ROM. Patient estimates were compared to passive goniometer measurements performed blindly by a physiotherapist and a junior orthopedic surgeon. RESULTS The mean difference between 100 patients' (70.9 years) estimates and goniometer measurements was -0.7° (standard deviation, 12.3°) for flexion and 1.1° (standard deviation, 11.6°) for extension, both not significant. Correlation was 0.79 and 0.63, and kappa values at retest were 0.84 and 0.66. For flexion < 110°, sensitivity of patient estimates was 88% and specificity was 88%. For a limit of 100°, values were 95% and 81%. For extension deficits >10°, sensitivity was 78% and specificity 70%. Values were 100% and 66% for a 15° limit. CONCLUSION The Copenhagen Knee ROM Scale is a patient-friendly and feasible alternative to passive ROM measurement for registers, research, and selected clinical use. This scale appears reliable and valid compared to reports of similar tools, and patient estimates are better correlated to goniometer measurements.
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Vergouw LJ, Salomé M, Kerklaan AG, Kies C, Roks G, van den Berg E, de Jong FJ. The Pentagon Copying Test and the Clock Drawing Test as Prognostic Markers in Dementia with Lewy Bodies. Dement Geriatr Cogn Disord 2018; 45:308-317. [PMID: 29996144 PMCID: PMC6159833 DOI: 10.1159/000490045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/14/2018] [Indexed: 01/18/2023] Open
Abstract
AIMS To determine whether the pentagon copying test (PCT) and the clock drawing test (CDT) are associated with nursing home admission or survival in dementia with Lewy bodies (DLB). METHODS The PCT and/or the CDT were retrospectively collected from 103 clinically diagnosed probable DLB patients at a university medical center and general hospital. Patients with high versus low scores on these tests were compared. RESULTS Kaplan-Meier analysis showed that patients with a low score on the PCT had a shorter time to nursing home admission than patients with a high score (log-rank χ2 = 6.1, p = 0.01). Patients with a low score on the PCT or the CDT had a shorter survival than patients with a high score (log-rank χ2 = 5.4, p = 0.02, and log-rank χ2 = 11.2, p < 0.001, respectively). Cox regression analyses showed the same associations with an HR of 2.2 (95% CI 1.2-4.1) for the PCT and an HR of 2.9 (95% CI 1.6-5.4) for the CDT. CONCLUSION The PCT and the CDT may function as prognostic markers in DLB. This finding is clinically relevant as these tests can be applied easily in the clinical setting and can provide valuable prognostic information. Furthermore, it may improve disease management and patient selection for research purposes.
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Affiliation(s)
- Leonie J.M. Vergouw
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariet Salomé
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Anke G. Kerklaan
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christiaan Kies
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
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Duro D, Tábuas-Pereira M, Freitas S, Santiago B, Botelho MA, Santana I. Validity and Clinical Utility of Different Clock Drawing Test Scoring Systems in Multiple Forms of Dementia. J Geriatr Psychiatry Neurol 2018; 31:114-122. [PMID: 29742972 DOI: 10.1177/0891988718774432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) has a known potential for the detection of cognitive impairment in populations with dementia, especially Alzheimer disease (AD). Our aim was to compare the clinical utility of 3 CDT scoring systems (Rouleau, Cahn, and Babins) in several pathologies with cognitive compromise from a tertiary center memory clinic. We selected patients with a clinical diagnosis of mild stage AD, behavioral variant frontotemporal dementia (FTD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and Parkinson disease with dementia (PDD). The results showed significant differences between the several diagnoses with the following pattern of results: AD, DLB < FTD, VaD, PDD. Qualitative analysis of clock drawing errors confirmed the stimulus-bound response as a hallmark of AD, while conceptual deficit was significantly more prevalent in patients with AD and DLB. Our results supported the CDT potential as a cognitive screening measure for mild dementia, particularly sensitive to AD and DLB, especially when we used the Cahn scoring system and its analysis of qualitative errors.
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Affiliation(s)
- Diana Duro
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Tábuas-Pereira
- 2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sandra Freitas
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Beatriz Santiago
- 2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Isabel Santana
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Is the Clock Drawing Test useful in the screening assessment of aged patients with chronic heart failure? Adv Med Sci 2018; 63:199-204. [PMID: 29197261 DOI: 10.1016/j.advms.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 06/21/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Cognitive impairment is one of the most common geriatric deficits in old patients with heart failure (HF), but there has been a lack of study on the utility of the Clock Drawing Test (CDT) when used with this group of patients. The aim of the study was to assess the usefulness of the CDT in the geriatric assessment of aged outpatients with chronic HF. PATIENTS AND METHODS A cross-sectional analysis of the results of the comprehensive geriatric assessment (CGA), including the CDT, of 92 aged outpatients with heart failure was conducted. RESULTS We found a high prevalence of five examined geriatric problems. The majority of the patients presented signs of cognitive deterioration of different patterns and severity on the Clock Drawing Test. All the CDT scoring systems correlated significantly with the Mini-Mental Test Examination results. CONCLUSIONS It seems reasonable to perform the routine CGA with the CDT examination in all aged heart failure patients.
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Vyhnálek M, Rubínová E, Marková H, Nikolai T, Laczó J, Andel R, Hort J. Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice. Int J Geriatr Psychiatry 2017; 32:933-939. [PMID: 27466038 DOI: 10.1002/gps.4549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The clock drawing test (CDT) is a commonly used brief cognitive measure. We evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. We further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. METHODS Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a "yes" (abnormal) versus "suspected" versus "no" (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. We also used a 17-point CDT rating system. RESULTS When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. CONCLUSIONS A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin Vyhnálek
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Rubínová
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Hana Marková
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Tomáš Nikolai
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jakub Hort
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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Makhani SS, Kim FY, Liu Y, Ye Z, Li JL, Revenig LM, Vaughan CP, Johnson TM, García PS, Ogan K, Master VA. Cognitive Impairment and Overall Survival in Frail Surgical Patients. J Am Coll Surg 2017; 225:590-600.e1. [PMID: 28826805 DOI: 10.1016/j.jamcollsurg.2017.07.1066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The definition of frailty, as modeled by the Fried criteria, has been limited primarily to the physical domain. The purpose of this study was to assess the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major operations. STUDY DESIGN A 4-level composite frailty scoring system was created via the combination of the Fried frailty score and the Emory Clock Draw Test to assess preoperative frailty and cognitive impairment, respectively. Overall survival was defined as months from date of operation to date of death or last follow-up. RESULTS This study included 330 patients undergoing major operations; mean age was 58 years and a total of 53 patient deaths occurred during 4-year follow-up. Among the robust cohort, 20 of 168 patients died (11.9%), and among those who were both physically frail and cognitively impaired, 11 of 26 patients died (42.3%). Multivariable analysis demonstrated the physically frail and cognitively impaired cohort to have a 3.92 higher risk of death (95% CI 1.66 to 9.26) compared with the cohort of robust patients (p = 0.002). Kaplan-Meier survival curves reveal an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment. CONCLUSIONS The use of a combined frailty and cognitive assessment score has a more powerful potential to predict adult patients at higher risk of overall survival than either measurement alone. The addition of cognitive assessment to physical frailty measure can lead to improved preoperative decision making and possibly early intervention, as well as more accurate patient counseling.
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Affiliation(s)
| | - Frances Y Kim
- Department of Urology, Emory University, Atlanta, GA
| | - Yuan Liu
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zixun Ye
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jessica L Li
- School of Medicine, Emory University, Atlanta, GA
| | | | - Camille P Vaughan
- Department of Medicine, Emory University, Atlanta, GA; Birmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Atlanta, GA
| | - Theodore M Johnson
- Department of Medicine, Emory University, Atlanta, GA; Department of Family and Preventative Medicine, Emory University, Atlanta, GA; Birmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Atlanta, GA
| | - Paul S García
- Department of Anesthesiology, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
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Chen PH, Sheu JJ. Clock-drawing test for cognitive assessment in an older adult with long-term benzodiazepine use. Geriatr Gerontol Int 2017; 17:1135-1137. [PMID: 28741883 DOI: 10.1111/ggi.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/15/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Garcia-Ptacek S, Modéer IN, Kåreholt I, Fereshtehnejad SM, Farahmand B, Religa D, Eriksdotter M. Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care: resultss from the Swedish Dementia Registry. Age Ageing 2017; 46:314-319. [PMID: 27810851 PMCID: PMC5859983 DOI: 10.1093/ageing/afw189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022] Open
Abstract
Background the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC). Design cross-sectional study. Subjects a total of, 9,625 patients diagnosed with AD registered 2011–14 in SveDem, the Swedish Dementia Registry. Methods descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication. Results a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC. Conclusion primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.
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Affiliation(s)
- Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
- Address correspondence to: S. Garcia-Ptacek, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Novum plan 5 SE141-83, Huddinge, Stockholm, Sweden. Tel: +46(0)8-58585408.
| | - Ingrid Nilsson Modéer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Neurology and Neurosurgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Bahman Farahmand
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
| | - Dorota Religa
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
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Spenciere B, Alves H, Charchat-Fichman H. Scoring systems for the Clock Drawing Test: A historical review. Dement Neuropsychol 2017; 11:6-14. [PMID: 29213488 PMCID: PMC5619209 DOI: 10.1590/1980-57642016dn11-010003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument
that is well accepted by patients and has solid psychometric properties. Several
different CDT scoring methods have been developed, but no consensus has been
reached regarding which scoring method is the most accurate. This article
reviews the literature on these scoring systems and the changes they have
undergone over the years. Historically, different types of scoring systems
emerged. Initially, the focus was on screening for dementia, and the methods
were both quantitative and semi-quantitative. Later, the need for an early
diagnosis called for a scoring system that can detect subtle errors, especially
those related to executive function. Therefore, qualitative analyses began to be
used for both differential and early diagnoses of dementia. A widely used
qualitative method was proposed by Rouleau et al. (1992). Tracing the historical
path of these scoring methods is important for developing additional scoring
systems and furthering dementia prevention research.
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Affiliation(s)
- Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | - Heloisa Alves
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
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Charernboon T. Diagnostic Accuracy of the Overlapping Infinity Loops, Wire Cube, and Clock Drawing Tests for Cognitive Impairment in Mild Cognitive Impairment and Dementia. Int J Alzheimers Dis 2017; 2017:5289239. [PMID: 28255496 PMCID: PMC5307133 DOI: 10.1155/2017/5289239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose. To investigate the diagnostic accuracy of the overlapping infinity loops, wire cube, and clock drawing tests (CDT) in the detection of mild cognitive impairment (MCI) and dementia. Method. The participants were 60 normal controls (NC), 35 patients with MCI, and 47 patients with mild dementia. Results. The results illustrate that infinity loops, cube, or CDT were not able to discriminate between NC and MCI groups. In dementia detection, the CDT had the highest diagnostic accuracy (sensitivity 76.6% and specificity 87.4%) followed by infinity loops (sensitivity 63.8% and specificity 91.6%) and cube (sensitivity 93.6% and specificity 46.3%). Conclusion. This study demonstrates that the three drawing tests are sensitive detectors of dementia but not MCI.
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Affiliation(s)
- Thammanard Charernboon
- Division of Clinical Epidemiology and Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Terwindt PW, Hubers AAM, Giltay EJ, van der Mast RC, van Duijn E. Screening for cognitive dysfunction in Huntington's disease with the clock drawing test. Int J Geriatr Psychiatry 2016; 31:1013-20. [PMID: 26766850 DOI: 10.1002/gps.4412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/22/2015] [Accepted: 12/03/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of the study is to investigate the performance of the clock drawing test as a screening tool for cognitive impairment in Huntington's disease (HD) mutation carriers. METHODS The performance of the clock drawing test was assessed in 65 mutation carriers using the Shulman and the Freund scoring systems. The mini-mental state examination, the Symbol Digit Modalities Test, the Verbal Fluency Test, and the Stroop tests were used as comparisons for the evaluation of cognitive functioning. Correlations of the clock drawing test with various cognitive tests (convergent validity), neuropsychiatric characteristics (divergent validity) and clinical characteristics were analysed using the Spearman's rank correlation coefficient. Receiver-operator characteristic analyses were performed for the clock drawing test against both the mini-mental state examination and against a composite variable for executive cognitive functioning to assess optimal cut-off scores. RESULTS Inter-rater reliability was high for both the Shulman and Freund scoring systems (ICC = 0.95 and ICC = 0.90 respectively). The clock drawing tests showed moderate to high correlations with the composite variable for executive cognitive functioning (mean ρ = 0.75) and weaker correlations with the mini-mental state examination (mean ρ = 0.62). Mean sensitivity of the clock drawing tests was 0.82 and mean specificity was 0.79, whereas the mean positive predictive value was 0.66 and the mean negative predictive value was 0.87. CONCLUSION The clock drawing test is a suitable screening instrument for cognitive dysfunction in HD, because it was shown to be accurate, particularly so with respect to executive cognitive functioning, and is easy and quick to use. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paul W Terwindt
- Center for Mental Health Care Delfland, Delft, the Netherlands
| | - Anna A M Hubers
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Rose C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik van Duijn
- Center for Mental Health Care Delfland, Delft, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Beber BC, Kochhann R, Matias B, Chaves MLF. The Clock Drawing Test: Performance differences between the free-drawn and incomplete-copy versions in patients with MCI and dementia. Dement Neuropsychol 2016; 10:227-231. [PMID: 29213459 PMCID: PMC5642419 DOI: 10.1590/s1980-5764-2016dn1003009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Clock Drawing Test (CDT) is a brief cognitive screening tool for dementia. Several different presentation formats and scoring methods for the CDT are available in the literature. OBJECTIVE In this study we aimed to compare performance on the free-drawn and "incomplete-copy" versions of the CDT using the same short scoring method in Mild Cognitive Impairment (MCI) and dementia patients, and healthy elderly participants. METHODS 90 participants (controlled for age, sex and education) subdivided into control group (n=20), MCI group (n=30) and dementia group (n=40) (Alzheimer's disease - AD=20; Vascular Dementia - VD=20) were recruited for this study. The participants performed the two CDT versions at different times and a blinded neuropsychologist scored the CDTs using the same scoring system. RESULTS The scores on the free-drawn version were significantly lower than the incomplete-copy version for all groups. The dementia group had significantly lower scores on the incomplete-copy version of the CDT than the control group. MCI patients did not differ significantly from the dementia or control groups. Performance on the free-drawn copy differed significantly among all groups. CONCLUSION The free-drawn CDT version is more cognitively demanding and sensitive for detecting mild/early cognitive impairment. Further evaluation of the diagnostic value (accuracy) of the free-drawn CDT in Brazilian MCI patients is needed.
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Affiliation(s)
- Bárbara Costa Beber
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
| | - Renata Kochhann
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
- Graduate Program in Psychology, Human Cognition, Pontifícia Universidade
Católica do Rio Grande do Sul (PUCRS), RS, Brazil
| | - Bruna Matias
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
| | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
- Department of Internal Medicine, Faculty of Medicine, Universidade
Federal do Rio Grande do Sul (UFRGS), RS, Brazil
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The clock-drawing test as a possible indicator of acute psychosis. Int Clin Psychopharmacol 2016; 31:155-8. [PMID: 26752620 DOI: 10.1097/yic.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clock-drawing test (CDT) is used widely to evaluate cognitive disorders, but its role in the assessment of psychotic disorders has not been studied. We sought to examine whether the CDT plays a role as an indicator of psychosis and to establish its sensitivity to clinical improvement of psychosis. The CDT was administered twice to 53 hospitalized patients without dementia but with psychosis: once at admission and again before discharge. The CDT scores were calculated in a random order by two independent senior psychiatrists who were blinded to the patients' status (admission or discharge). The inter-rater reliability was high (0.89 at admission, 0.85 at discharge, P<0.01 for both). The severity of psychosis was assessed by the Positive and Negative Syndrome Scale (PANSS). Patients had significantly lower CDT scores at admission than at discharge (2.87±1.39 vs. 3.91±1.08, respectively, P<0.01). The PANSS-total score of the patients showed a significant improvement (84.90±17.77 vs. 69.18±16.23, P<0.01). An inverse correlation was found between CDT performance and psychosis severity, as reflected by the PANSS-positive symptom subscale at admission (R=-0.279, P<0.05). Our findings suggest that the CDT may aid in the assessment of psychotic states and in their clinical monitoring.
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Persson K, Brækhus A, Selbæk G, Kirkevold Ø, Engedal K. Burden of Care and Patient's Neuropsychiatric Symptoms Influence Carer's Evaluation of Cognitive Impairment. Dement Geriatr Cogn Disord 2016; 40:256-67. [PMID: 26304633 DOI: 10.1159/000437298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore what effects the carer's burden and patient's neuropsychiatric symptoms have on carer's report on patient's cognitive functioning and instrumental activities of daily living (IADL). METHODS We included 1,832 patients, 742 with mild cognitive impairment and 1,090 with dementia [mean age 75.2 years (SD 9.5), 56% women]. The following scales were used: Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Lawton and Brody IADL Scale, Neuropsychiatric Inventory Questionnaire (NPI-Q), Relatives' Stress Scale (RSS), Mini-Mental State Examination (MMSE), and Clock Drawing Test (CDT). Correlation analyses and multiple linear regression analyses were carried out to explore which factors were associated with IQCODE and IADL. RESULTS Spouses scored lower on the IQCODE compared with non-spouses in spite of equivalent MMSE and CDT scores. In a multiple linear regression analysis using IQCODE as a dependent variable, beta for MMSE was -0.368 (p < 0.001) adjusted for demographic factors. After adjusting also for RSS and NPI-Q, MMSE beta was -0.279 (p < 0.001), RSS beta 0.294 (p < 0.001), and NPI beta 0.237 (p < 0.001). Similar results were found using IADL as the dependent variable. CONCLUSION Carer's burden and neuropsychiatric symptoms of the patient are important biasing factors when carers report on cognitive function and IADL.
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Affiliation(s)
- Karin Persson
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tx00F8;nsberg, Norway
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Mazancova AF, Nikolai T, Stepankova H, Kopecek M, Bezdicek O. The Reliability of Clock Drawing Test Scoring Systems Modeled on the Normative Data in Healthy Aging and Nonamnestic Mild Cognitive Impairment. Assessment 2016; 24:945-957. [DOI: 10.1177/1073191116632586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.
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Affiliation(s)
- Adela Fendrych Mazancova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomas Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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