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Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
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Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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2
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Zhang J, Wang A, Zhang X, Chen S, Wu S, Zhao X, Zhang Q. Association between tea consumption and cognitive impairment in middle-aged and older adults. BMC Geriatr 2020; 20:447. [PMID: 33148194 PMCID: PMC7640442 DOI: 10.1186/s12877-020-01848-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Biologic studies have suggested that tea may have neuroprotective activity. However, tea’s protective effect on cognitive function is controversial in human epidemiological studies, and no data, including the middle-aged, are available. The objective of this study was to investigate the association of habit, frequency, and types of tea consumption with incident cognitive impairment in middle-aged and older adults. Methods Data from the Asymptomatic Polyvascular Abnormalities in Community study were used (aged over 40y). We gathered information on tea consumption, including habit, frequency, and types, via a standardized questionnaire and assessed cognitive function by Mini-Mental State Examination (MMSE) and/or Montreal Cognitive Assessment (MoCA). Three thousand eight hundred sixty-eight and 806 participants were selected in MMSE and MoCA subgroups. Multivariate logistic regression models were utilized to examine associations between tea consumption and cognitive impairment in middle-aged and older participants. Results In MMSE analyses, after adjustment for potential confounding factors, habitual (odds ratio (OR) 0.47, [95% confidence interval (CI) 0.33–0.68], p < 0.001) and high frequency (p trend < 0.001) of tea intake were associated with a lower risk of cognitive impairment. The risk of cognitive impairment was lower in green tea consumption (OR 0.36, [95% CI 0.22–0.61], p < 0.001) than other types (OR 0.59, [95% CI 0.38–0.91], p = 0.017). In MoCA analyses, we got similar results. Conclusions Habitual tea consumption, especially high-frequency and green tea consumption, was significantly associated with a lower prevalence of cognitive impairment in middle-aged and older individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01848-6.
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Affiliation(s)
- Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, 063000, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Qian Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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3
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Benge JF, Kiselica AM. Rapid communication: Preliminary validation of a telephone adapted Montreal Cognitive Assessment for the identification of mild cognitive impairment in Parkinson's disease. Clin Neuropsychol 2020; 35:133-147. [PMID: 32779959 DOI: 10.1080/13854046.2020.1801848] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: In the current pandemic, tele-screening of neuropsychological status has become a necessity. Instruments developed for telephone screening are not as well validated as traditional neuropsychological measures. Therefore, the current study presents preliminary validation of a telephone version of the Montreal Cognitive Assessment (T-MoCA) in individuals with Parkinson's disease (PD).Method: Twenty-one persons with PD completed the T-MoCA along with a traditional neuropsychological battery. Diagnostic accuracy for the presence of PD-related mild cognitive impairment (MCI) and correlations with traditional neuropsychological measures are reported.Results: Individuals with MCI (n = 9) scored lower than individuals without cognitive impairment (17.56 vs. 19.50; t = -2.28, p = .03, d = -1.00). Diagnostic accuracy for MCI ranged from 76% to 81%, with sensitivity ranging from 0.56 to 0.67 and specificity ranging from 0.92 to 1.00. Correlations of T-MoCA derived scores with traditional neuropsychological measures were quite modest, with the exception of the memory impairment scale.Conclusions: This rapid communication presents preliminary validation of the T-MoCA for use in individuals with PD. Caveats and implications for practical use in the current pandemic are discussed.
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Affiliation(s)
- Jared F Benge
- Department of Neurology, Baylor Scott and White Health, Temple, TX, USA.,Plummer Movement Disorder Center, BSWH Health, Temple, TX, USA.,Texas A&M College of Medicine, Temple, TX, USA
| | - Andrew M Kiselica
- Department of Neurology, Baylor Scott and White Health, Temple, TX, USA
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4
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Lin C, Chen L. Effect of hemorrhagic cerebrospinal fluid drainage on cognitive function after intracranial aneurysm clipping. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.1177/2096595819896201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The effects of repeated lumbar puncture and continuous lumbar cistern drainage on the cognitive function of patients with aneurysmal subarachnoid hemorrhage were compared and analyzed. Methods: Retrospective analysis was performed on 59 patients with aneurysmal subarachnoid hemorrhage treated at our Neurosurgery Department between October 2017 and October 2018. According to the hemorrhagic cerebrospinal fluid drainage mode after aneurysm clipping, the patients were divided into the following two groups: the repeated lumbar puncture drainage (Group A, n = 28) and continuous lumbar cistern drainage (Group B, n = 31). Before and 1 month after surgery, the cognitive function of the patients was scored using the Montreal Cognitive Assessment Scale. Scores of 27~30 were defined as normal, and scores of < 27 as cognitive impairment. Results: The incidences of cognitive impairment were 46% (13/28) and 32% (10/31) for Groups A and B, respectively, before surgery, but the difference was not significant ( P > 0.05). The incidences of cognitive impairment were 35% (10/28) and 12% (4/31) for Groups A and B, respectively, at 1 month after surgery, with significant difference ( P < 0.05). Conclusion: Compared with repeated lumbar puncture, continuous lumbar cistern drainage for aneurysmal subarachnoid hemorrhage significantly reduced the incidence of cognitive impairment after aneurysm clipping.
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Affiliation(s)
- Chaoqun Lin
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu, China
| | - Lukui Chen
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu, China
- Department of Neurosurgery, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
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5
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Almeida KJ, Carvalho LCLDS, Monteiro THODH, Gonçalves Júnior PCDJ, Campos-Sousa RN. Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson’s disease. Dement Neuropsychol 2019; 13:210-215. [PMID: 31285796 PMCID: PMC6601300 DOI: 10.1590/1980-57642018dn13-020010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Movement Disorder Society has published some recommendations for dementia
diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment
(MOCA) as a cognitive screening tool in these patients. However, few studies
have been conducted assessing the Portuguese version of this test in Brazil
(MOCA-BR).
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Affiliation(s)
- Kelson James Almeida
- Universidade de São Paulo, Brazil; Ringgold standard institution, Brazil; Universidade Federal do Piaui, Brazil
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6
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Cognitive Problems in Parkinson Disease: Perspectives and Priorities of Patients and Care Partners. Cogn Behav Neurol 2019; 32:16-24. [DOI: 10.1097/wnn.0000000000000184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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7
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Lin C, Chen L. Effect of hemorrhagic cerebrospinal fluid drainage on cognitive function after intracranial aneurysm clipping. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.26599/bsa.2019.9050006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Badrkhahan SZ, Sikaroodi H, Sharifi F, Kouti L, Noroozian M. Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:431-439. [PMID: 30821505 DOI: 10.1080/23279095.2019.1565762] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parkinson's disease (PD) is a progressive multifactorial degenerative disorder that has both motor and nonmotor features. Among the nonmotor features of PD, cognitive impairment; Mild Cognitive Impairment (MCI) and dementia, poses one of the most significant implications for disability. Because of the high possibility of developing Dementia in PD, it is essential to obtain a reliable cognitive screen. Two commonly used cognitive measures include the Mini Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The MoCA is a more sensitive tool for the detection of MCI in compared to the MMSE. Because of the cultural differences, in this study, we evaluated the psychometric properties of the Persian version of the MoCA (MoCA-P) in a group of participants with PD in Iran. Participants were assessed by MMSE, Geriatric Depression Scale (GDS), and Functional Assessment Staging Test (FAST). If they met study eligibility, the MoCA-P scale was administered. Receiver Operating Characteristic (ROC) curve analyses showed that the MoCA-P scale produced significant discrimination of PD with Dementia (PDD) from PD with MCI (PD-MCI). It seems that the MoCA-P has adequate psychometric properties as a screening instrument for the detection of PD-MCI and PDD in Iranian patients. As near to 30% of patients with PD go on to develop dementia, the MoCA-P can be useful in the detection of cognitive impairment in patients with PD and is suitable for executive function assessment.
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Affiliation(s)
- Seyedeh Zahra Badrkhahan
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajir Sikaroodi
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Kouti
- Clinical Pharmacy Department, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Maryam Noroozian
- Cognitive Neurology & Neuropsychiatry Division, Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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9
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Brown DS, Barrett MJ, Flanigan JL, Sperling SA. Clinical and demographic correlates of apathy in Parkinson's disease. J Neurol 2019; 266:507-514. [PMID: 30604055 DOI: 10.1007/s00415-018-9166-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To better understand the demographic, neuropsychiatric, cognitive, and motor predictors of apathy in Parkinson's disease (PD). METHOD 112 participants (Mage = 68.53 years; Mdisease duration = 6.17 years) were administered the Apathy Scale (AS), Beck Depression Inventory-II (BDI-II), Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Trail Making Test (TMT), Wechsler Adult Intelligence Scale-IV Matrix Reasoning subtest, letter (F-A-S) and category (Animals) fluency, and Hopkins Verbal Learning Test-Revised. Psychosis was assessed. A stepwise logistic regression analysis was performed to investigate the ability of demographic factors and clinical assessments to predict nonapathetic (AS ≤ 13) versus apathetic (AS > 13) group membership. RESULTS The regression analysis yielded a robust model in which older age, less education, elevated BDI-II, current psychosis, higher MDS-UPDRS Part III (motor score), and slower TMT-B performance predicted membership in the apathetic group, with a correct classification rate of 77.5% (Nagelkerke R2 = 0.48, p < .001). Depression (OR = 9.20, p < .001) and education (OR = 0.66, p = 0.002) contributed significantly to the overall model. A linear regression with AS score as the outcome variable was similar, but TMT-B additionally contributed significantly (p = 0.02) to the overall model, F(6, 86) = 12.02, p < .001, adjusted R2 = 0.42. CONCLUSIONS Of the factors examined, depression, education, and executive functioning were the strongest correlates of apathy in PD. These results support the idea that common underlying frontosubcortical disruptions in this population contribute to apathy, depression, and executive dysfunction.
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Affiliation(s)
- Daniel S Brown
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Matthew J Barrett
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA.
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10
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Pugh EA, Kemp EC, van Dyck CH, Mecca AP, Sharp ES. Effects of Normative Adjustments to the Montreal Cognitive Assessment. Am J Geriatr Psychiatry 2018; 26:1258-1267. [PMID: 30314940 PMCID: PMC6779033 DOI: 10.1016/j.jagp.2018.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate optimal cutoff scores and the effects of normative adjustments on the performance of the Montreal Cognitive Assessment (MoCA) as a screening instrument for Mild Cognitive Impairment (MCI) and dementia due to Alzheimer's disease (AD-dementia). METHODS 499 adults 48 to 91 years-old enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) and were administered the MoCA during baseline. Participants were classified as either cognitively normal (CN), MCI, or AD-dementia by clinical assessment. Receiver operating characteristic (ROC) analyses were performed using raw MoCA scores, education-adjusted MoCA scores, and a regression-based adjustment derived from the National Alzheimer's Coordinating Center data (NACC). Test performance characteristics were calculated for various cutoffs after each normative correction method. RESULTS Areas under the curve (AUC) were similar for raw, education-adjusted, and NACC-adjusted MoCA scores, and demonstrated minimal improvement when adjustments of increasing complexity were applied. Our results suggest that the optimal cutoff score for distinguising MCI is 24 and for distinguising AD-dementia is 22. CONCLUSIONS This study adds to the understanding of how normative adjustments affect the sensitivity and specificity of the MoCA. Suggested corrections based on education alone do not yield improved test characteristics, but small improvements are attained when a regression-based correction that accounts for age, sex, and education is applied. Furthermore, optimal cutoffs for distinguishing CN from MCI or CN from AD-dementia were lower than previously reported. Optimal cutoffs to detect MCI and AD-dementia may vary in different populations, and further study is needed to determine appropriate use of the MoCA as a screening tool.
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Affiliation(s)
- Erika A. Pugh
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Corresponding Author: Erika A. Pugh, M.A., One Church Street, 8th Floor, New Haven, CT 06510, (203) 764-8100 (phone), (203) 764-8111 (fax),
| | - Emily C. Kemp
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher H. van Dyck
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Adam P. Mecca
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Emily S. Sharp
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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11
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Ewert V, Pelletier S, Alarcon R, Nalpas B, Donnadieu-Rigole H, Trouillet R, Perney P. Determination of MoCA Cutoff Score in Patients with Alcohol Use Disorders. Alcohol Clin Exp Res 2017; 42:403-412. [DOI: 10.1111/acer.13547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Valérie Ewert
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
| | - Stéphanie Pelletier
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Inserm U1018; Paris France
| | - Régis Alarcon
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
| | - Bertrand Nalpas
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Département d'Information Scientifique et de Communication (DISC); Inserm; Paris France
| | - Hélène Donnadieu-Rigole
- Service Addictologie; Hôpital Saint-Eloi; CHU Montpellier; Montpellier France
- Inserm, U1183, IRMB; Hôpital Saint-Eloi; CHU Montpellier; Montpellier France
| | | | - Pascal Perney
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Inserm U1018; Paris France
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12
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Benge JF, Balsis S, Madeka T, Uhlman C, Lantrip C, Soileau MJ. Factor structure of the Montreal Cognitive Assessment items in a sample with early Parkinson's disease. Parkinsonism Relat Disord 2017; 41:104-108. [DOI: 10.1016/j.parkreldis.2017.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
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13
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Kopecek M, Bezdicek O, Sulc Z, Lukavsky J, Stepankova H. Montreal Cognitive Assessment and Mini-Mental State Examination reliable change indices in healthy older adults. Int J Geriatr Psychiatry 2017; 32:868-875. [PMID: 27352935 DOI: 10.1002/gps.4539] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive tests are used repeatedly to assess the treatment response or progression of cognitive disorders. The Montreal Cognitive Assessment (MoCA) is a valid screening test for mild cognitive impairment. The aim of our study was to establish 90% reliable change indices (RCI) for the MoCA together with the Mini-Mental State Examination (MMSE) in cognitively healthy older adults. METHOD We analyzed 197 cognitively healthy and functional independent volunteers aged 60-94 years, who met strict inclusion criteria for four consecutive years. The RCI methods by Chelune and Hsu were used. RESULTS For 1, 2, and 3 years, the 90% RCI for MoCA using Chelune's formula were -4 ≤, ≥4; -4 ≤, ≥4 and -5 ≤, ≥4 points, respectively, and -3 ≤, ≥3 for the MMSE each year. Ninety percent RCI for MoCA using Hsu's formula ranged from -6 to 0, respectively, and +3 to +8 dependent on the baseline MoCA. CONCLUSION Our study demonstrated RCI for the MoCA and MMSE in a 3-year time period that can be used for the estimation of cognitive decline or improvement in clinical settings. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Ondrej Bezdicek
- National Institute of Mental Health, Klecany, Czech Republic.,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
| | - Zdenek Sulc
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jiri Lukavsky
- National Institute of Mental Health, Klecany, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
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14
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Lin VYW, Chung J, Callahan BL, Smith L, Gritters N, Chen JM, Black SE, Masellis M. Development of cognitive screening test for the severely hearing impaired: Hearing-impaired MoCA. Laryngoscope 2017; 127 Suppl 1:S4-S11. [PMID: 28409842 DOI: 10.1002/lary.26590] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To develop a version of the Montreal Cognitive Assessment (MoCA) to be administered to the severely hearing impaired (HI-MoCA), and to assess its performance in two groups of cognitively intact adults over the age of 60. STUDY TYPE Test development followed by prospective subject recruitment. METHODS The MoCA was converted into a timed PowerPoint (Microsoft Corp., Redmond, WA) presentation, and verbal instructions were converted into visual instructions. Two groups of subjects over the age of 60 were recruited. All subjects passed screening questionnaires to eliminate those with undiagnosed mild cognitive impairment. The first group had normal hearing (group 1). The second group was severely hearing impaired (group 2). Group 1 received either the MoCA or HI-MoCA test (T1). Six months later (T2), subjects were administered the test (MoCA or HI-MoCA) they had not received previously to determine equivalency. Group 2 received the HI-MoCA at T1 and again at T2 to determine test-retest reliability. RESULTS One hundred and three subjects were recruited into group 1, with a score of 26.66 (HI-MoCA) versus 27.14 (MoCA). This was significant (P < 0.05), but scoring uses whole numerals and the 0.48 difference was found not clinically significant using post hoc sensitivity analyses. Forty-nine subjects were recruited into group 2. They scored 26.18 and 26.49 (HI-MoCA at T1 and T2). No significance was noted (P > 0.05), with a test-retest coefficient of 0.66. CONCLUSION The HI-MoCA is easy to administer and reliable for screening cognitive impairment in the severely hearing impaired. No conversion factor is required in our prospectively tested cohort of cognitively intact subjects. LEVEL OF EVIDENCE 1b. Laryngoscope, 127:S4-S11, 2017.
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Affiliation(s)
- Vincent Y W Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet Chung
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brandy L Callahan
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leah Smith
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nils Gritters
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mario Masellis
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Bentvelzen A, Aerts L, Seeher K, Wesson J, Brodaty H. A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite. J Am Med Dir Assoc 2017; 18:826-837. [PMID: 28283381 DOI: 10.1016/j.jamda.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The diagnosis of dementia and the management of its associated symptoms are aided by high-quality assessment tools. However, there is disagreement on the optimal tools among abundant alternatives and lack of consistent quality standards across the different domains of dementia-related change (ie, cognition, severity, function, behavioral and psychological symptoms, delirium, quality of life). Standardization is difficult because the relevance of a measurement tool for health professionals may depend on the clinical setting and on the dementia type and severity. To address this need, we conducted a comprehensive and clinically relevant evidence-based review of dementia-related tools and present a set of recommended tools, the Dementia Outcomes Measurement Suite. The review revealed that considerable development has occurred in terms of assessment of persons with mild cognitive impairment, executive dysfunction, cognitively mediated functional change, and apathy. More research is needed to develop and validate tools to assess health-related quality of life and specific symptoms of dementia including anxiety, wandering, and repetitive vocalizations. This extensive overview of the quality of different measures may serve as a guide for health professionals clinically and for researchers developing new or improved dementia assessment tools.
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Affiliation(s)
- Adam Bentvelzen
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Liesbeth Aerts
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Katrin Seeher
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Jacqueline Wesson
- Aging Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia; Center for Healthy Brain Aging (CHeBA), University of New South Wales Australia, Sydney, Australia.
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Van Liew C, Santoro MS, Goldstein J, Gluhm S, Gilbert PE, Corey-Bloom J. Evaluating Recall and Recognition Memory Using the Montreal Cognitive Assessment: Applicability for Alzheimer's and Huntington's Diseases. Am J Alzheimers Dis Other Demen 2016; 31:658-663. [PMID: 27678491 PMCID: PMC10852695 DOI: 10.1177/1533317516668573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We sought to investigate whether the Montreal Cognitive Assessment (MoCA) could provide a brief assessment of recall and recognition using Huntington disease (HD) and Alzheimer disease (AD) as disorders characterized by different memory deficits. This study included 80 participants with HD, 64 participants with AD, and 183 community-dwelling control participants. Random-effects hierarchical logistic regressions were performed to assess the relative performance of the normal control (NC), participants with HD, and participants with AD on verbal free recall, cued recall, and multiple-choice recognition on the MoCA. The NC participants performed significantly better than participants with AD at all the 3 levels of assessment. No difference existed between participants with HD and NC for cued recall, but NC participants performed significantly better than participants with HD on free recall and recognition. The participants with HD performed significantly better than participants with AD at all the 3 levels of assessment. The MoCA appears to be a valuable, brief cognitive assessment capable of identifying specific memory deficits consistent with known differences in memory profiles.
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Affiliation(s)
- Charles Van Liew
- Department of Neurosciences, University of California, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Maya S Santoro
- Joint Doctoral Program in Clinical Psychology, University of California, San Diego/San Diego State University, San Diego, CA, USA
| | - Jody Goldstein
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Shea Gluhm
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Paul E Gilbert
- Joint Doctoral Program in Clinical Psychology, University of California, San Diego/San Diego State University, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
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Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, Ding G, Wen G, Namba H, Xia Y. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev 2016; 68:741-772. [PMID: 27375277 DOI: 10.1016/j.neubiorev.2016.06.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan; Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan.
| | - Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, Shanghai, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Katsuaki Suzuki
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Norio Mori
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Yilin Yang
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Fei Hua
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Guanghong Ding
- Shanghai Key laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
| | - Guoqiang Wen
- Department of Neurology, Hainan General Hospital, Haikou, Hainan, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Ying Xia
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, TX 77030, USA.
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