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Sheppard PAS, Oomen CA, Bussey TJ, Saksida LM. The Granular Retrosplenial Cortex Is Necessary in Male Rats for Object-Location Associative Learning and Memory, But Not Spatial Working Memory or Visual Discrimination and Reversal, in the Touchscreen Operant Chamber. eNeuro 2024; 11:ENEURO.0120-24.2024. [PMID: 38844347 PMCID: PMC11208985 DOI: 10.1523/eneuro.0120-24.2024] [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: 03/18/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
The retrosplenial cortex (RSC) is a hub of diverse afferent and efferent projections thought to be involved in associative learning. RSC shows early pathology in mild cognitive impairment and Alzheimer's disease (AD), which impairs associative learning. To understand and develop therapies for diseases such as AD, animal models are essential. Given the importance of human RSC in object-location associative learning and the success of object-location associative paradigms in human studies and in the clinic, it would be of considerable value to establish a translational model of object-location learning for the rodent. For this reason, we sought to test the role of RSC in object-location learning in male rats using the object-location paired-associates learning (PAL) touchscreen task. First, increased cFos immunoreactivity was observed in granular RSC following PAL training when compared with extended pretraining controls. Following this, RSC lesions following PAL acquisition were used to explore the necessity of the RSC in object-location associative learning and memory and two tasks involving only one modality: trial-unique nonmatching-to-location for spatial working memory and pairwise visual discrimination/reversal. RSC lesions impaired both memory for learned paired-associates and learning of new object-location associations but did not affect performance in either the spatial or visual single-modality tasks. These findings provide evidence that RSC is necessary for object-location learning and less so for learning and memory involving the individual modalities therein.
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Affiliation(s)
- Paul A S Sheppard
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Charlotte A Oomen
- Department of Experimental Psychology, University of Cambridge, Cambridge CB2 1TN, United Kingdom
- MRC and Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge CB2 1TN, United Kingdom
| | - Timothy J Bussey
- Department of Experimental Psychology, University of Cambridge, Cambridge CB2 1TN, United Kingdom
- MRC and Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge CB2 1TN, United Kingdom
| | - Lisa M Saksida
- Department of Experimental Psychology, University of Cambridge, Cambridge CB2 1TN, United Kingdom
- MRC and Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge CB2 1TN, United Kingdom
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2
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Calandrelli R, Panfili M, Onofrj V, Tran HE, Piludu F, Guglielmi V, Colosimo C, Pilato F. Brain atrophy pattern in patients with mild cognitive impairment: MRI study. Transl Neurosci 2022; 13:335-348. [PMID: 36250040 PMCID: PMC9518661 DOI: 10.1515/tnsci-2022-0248] [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: 04/28/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
We evaluated the accuracy of the quantitative and semiquantitative analysis in detecting regional atrophy patterns and differentiating mild cognitive impairment patients who remain stable (aMCI-S) from patients who develop Alzheimer’s disease (aMCI-AD) at clinical follow-up. Baseline magnetic resonance imaging was used for quantitative and semiquantitative analysis using visual rating scales. Visual rating scores were related to gray matter thicknesses or volume measures of some structures belonging to the same brain regions. Receiver operating characteristic (ROC) analysis was performed to assess measures’ accuracy in differentiating aMCI-S from aMCI-AD. Comparing aMCI-S and aMCI-AD patients, significant differences were found for specific rating scales, for cortical thickness belonging to the middle temporal lobe (MTL), anterior temporal (AT), and fronto-insular (FI) regions, for gray matter volumes belonging to MTL and AT regions. ROC curve analysis showed that middle temporal atrophy, AT, and FI visual scales showed better diagnostic accuracy than quantitative measures also when thickness measures were combined with hippocampal volumes. Semiquantitative evaluation, performed by trained observers, is a fast and reliable tool in differentiating, at the early stage of disease, aMCI patients that remain stable from those patients that may progress to AD since visual rating scales may be informative both about early hippocampal volume loss and cortical thickness reduction.
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Affiliation(s)
- Rosalinda Calandrelli
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo A. Gemelli, 1 , 00168 Rome , Italy
| | - Marco Panfili
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo A. Gemelli, 1 , 00168 Rome , Italy
| | - Valeria Onofrj
- Department of Medical Imaging, Cliniques Universitaires Saint-Luc , Brussels , Belgium
| | - Huong Elena Tran
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo A. Gemelli, 1 , 00168 Rome , Italy
| | - Francesca Piludu
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute , Via Elio Chianesi 53 , 00144 Rome , Italy
| | - Valeria Guglielmi
- Institute of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo A. Gemelli, 1 , 00168 Rome , Italy
| | - Cesare Colosimo
- Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo A. Gemelli, 1 , 00168 Rome , Italy
| | - Fabio Pilato
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University , Rome 00128 , Italy
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Smith KM, Starr JM, Escudero J, Ibañez A, Parra MA. Abnormal Functional Hierarchies of EEG Networks in Familial and Sporadic Prodromal Alzheimer's Disease During Visual Short-Term Memory Binding. FRONTIERS IN NEUROIMAGING 2022; 1:883968. [PMID: 37555153 PMCID: PMC10406202 DOI: 10.3389/fnimg.2022.883968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 08/10/2023]
Abstract
Alzheimer's Disease (AD) shows both complex alterations of functional dependencies between brain regions and a decreased ability to perform Visual Short-Term Memory Binding (VSTMB) tasks. Recent advances in network neuroscience toward understanding the complexity of hierarchical brain function here enables us to establish a link between these two phenomena. Here, we study data on two types of dementia at Mild Cognitive Impairment (MCI) stage-familial AD patients (E280A mutation of the presenilin-1 gene) and elderly MCI patients at high risk of sporadic AD, both with age-matched controls. We analyzed Electroencephalogram (EEG) signals recorded during the performance of Visual Short-Term Memory (VSTM) tasks by these participants. Functional connectivity was computed using the phase-lag index in Alpha and Beta; and network analysis was employed using network indices of hierarchical spread (degree variance) and complexity. Hierarchical characteristics of EEG functional connectivity networks revealed abnormal patterns in familial MCI VSTMB function and sporadic MCI VSTMB function. The middle-aged familial MCI binding network displayed a larger degree variance in lower Beta compared to healthy controls (p = 0.0051, Cohen's d = 1.0124), while the elderly sporadic MCI binding network displayed greater hierarchical complexity in Alpha (p = 0.0140, Cohen's d = 1.1627). Characteristics in healthy aging were not shown to differ. These results indicate that activity in MCI exhibits cross-frequency network reorganization characterized by increased heterogeneity of node roles in the functional hierarchy. Aging itself is not found to cause VSTM functional hierarchy differences.
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Affiliation(s)
- Keith M. Smith
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John M. Starr
- Alzheimer Scotland Dementia Research Centre, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Javier Escudero
- School of Engineering, Institute for Digital Communications, University of Edinburgh, Edinburgh, United Kingdom
| | - Agustin Ibañez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute, UCSF, San Francisco, CA, United States
- Trinity College Institute of Neuroscience, Trintity College Dublin, Dublin, Ireland
| | - Mario A. Parra
- Trinity College Institute of Neuroscience, Trintity College Dublin, Dublin, Ireland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
- Neuroprogressive and Dementia Network, NHS Scotland, Glasgow, United Kingdom
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Pettigrew C, Soldan A, Brichko R, Zhu Y, Wang MC, Kutten K, Bilgel M, Mori S, Miller MI, Albert M. Computerized paired associate learning performance and imaging biomarkers in older adults without dementia. Brain Imaging Behav 2022; 16:921-929. [PMID: 34686968 PMCID: PMC9012682 DOI: 10.1007/s11682-021-00583-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/21/2023]
Abstract
This cross-sectional study examined whether performance on the computerized Paired Associate Learning (PAL) task from the Cambridge Neuropsychological Test Automated Battery is associated with amyloid positivity as measured by Positron Emission Tomography, regional volume composites as measured by Magnetic Resonance Imaging, and cognitive impairment. Participants from the BIOCARD Study (N = 73, including 62 cognitively normal and 11 with mild cognitive impairment; M age = 70 years) completed the PAL task, a comprehensive clinical and neuropsychological assessment, and neuroimaging as part of their annual study visit. In linear regressions covarying age, sex, years of education and diagnosis, higher PAL error scores were associated with amyloid positivity but not with medial temporal or cortical volume composites. By comparison, standard neuropsychological measures of episodic memory and global cognition were unrelated to amyloid positivity, but better performance on the verbal episodic memory measures was associated with larger cortical volume composites. Participants with mild cognitive impairment demonstrated worse cognitive performance on all of the cognitive measures, including the PAL task. These findings suggest that this computerized visual paired associate learning task may be more sensitive to amyloid positivity than standard neuropsychological tests, and may therefore be a promising tool for detecting amyloid positivity in non-demented participants.
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Affiliation(s)
- Corinne Pettigrew
- Department of Neurology, Division of Cognitive Neuroscience, Johns Hopkins University School of Medicine, 1620 McElderry Street, Reed Hall West - 1, Baltimore, MD, 21205, USA.
| | - Anja Soldan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Rostislav Brichko
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuxin Zhu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
| | - Kwame Kutten
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute On Aging, Baltimore, MD, 21224, USA
| | - Susumu Mori
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Marilyn Albert
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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5
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Pathways linking abdominal obesity to poor memory function: Explore the mediating role of hypertension and depressive symptoms. J Affect Disord 2021; 295:492-497. [PMID: 34509063 DOI: 10.1016/j.jad.2021.08.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The negative effect of abdominal obesity on cognitive function has been widely reported, especially on memory function, however, it is unclear how the effect is mediated. We aim to investigate the mediating role of hypertension and depressive symptoms. METHODS Data were collected from wave 6 (2012-2013) of the English Longitudinal Study of Ageing (ELSA). Abdominal obesity was defined as a waist circumference (WC) ≥88cm for women and ≥102cm for men. Hypertension was determined on the basis of objective blood pressure measurement and previous physician diagnosis. Depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies (CESD) scale. Memory function was measured with the 10-word immediate and delayed recall tests. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were used to examine the mediating effect. RESULTS A total of 7,448 participants aged ≥50 years were included in this study. We found a negative effect of abdominal obesity on memory function (β=-0.047, p=0.031). KHB method identified significant mediating effect of hypertension and depressive symptoms on the relationship between abdominal obesity and memory function, they explained 16.92 and 6.32% of the total effect of abdominal obesity on memory function, respectively. LIMITATIONS This study was limited by its cross-sectional design and possibility of residual confounding. CONCLUSIONS Hypertension and depressive symptoms might be possible pathways linking abdominal obesity and poor memory function, suggesting that collaborative interventions of abdominal obesity, hypertension and depressive symptoms are beneficial in maintaining memory function.
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LaPlume AA, Paterson TSE, Gardner S, Stokes KA, Freedman M, Levine B, Troyer AK, Anderson ND. Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment. J Clin Exp Neuropsychol 2021; 43:796-812. [PMID: 34556008 DOI: 10.1080/13803395.2021.1982867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mean cognitive performance is worse in amnestic mild cognitive impairment (aMCI) compared to control groups. However, studies on variability of cognitive performance in aMCI have yielded inconclusive results, with many differences in variability measures and samples from one study to another. METHODS We examined variability in aMCI using an existing older adult sample (n = 91; 51 with aMCI, 40 with normal cognition for age), measured with an online self-administered computerized cognitive assessment (Cogniciti's Brain Health Assessment). Our methodology extended past findings by using pure measures of variability (controlling for confounding effects of group performance or practice), and a clinically representative aMCI sample (reflecting the continuum of cognitive performance between normal cognition and aMCI). RESULTS Between-group t-tests showed significantly greater between-person variability (interindividual variability or diversity) in overall cognitive performance in aMCI than controls, although the effect size was with a small to moderate effect size, d = 0.44. No significant group differences were found in within-person variability (intraindividual variability) across cognitive tasks (dispersion) or across trials of a response time task (inconsistency), which may be because we used a sample measuring the continuum of cognitive performance. Exploratory correlation analyses showed that a worse overall score was associated with greater inter- and intraindividual variability, and that variability measures were correlated with each other, indicating people with worse cognitive performance were more variable. DISCUSSION The current study demonstrates that self-administered online tests can be used to remotely assess different types of variability in people at risk of Alzheimer`s. Our findings show small but significantly more interindividual differences in people with aMCI. This diversity is considered as "noise" in standard assessments of mean performance, but offers an interesting and cognitively informative "signal" in itself.
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Affiliation(s)
- Annalise A LaPlume
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria, Canada.,Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada
| | - Sandra Gardner
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kathryn A Stokes
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Division of Neurology, Baycrest, Toronto, Canada.,Department of Medicine, Division of Neurology, Mt. Sinai Hospital, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Brian Levine
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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7
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Gwinnutt JM, Toyoda T, Jeffs S, Flanagan E, Chipping JR, Dainty JR, Mioshi E, Hornberger M, MacGregor A. Reduced cognitive ability in people with rheumatoid arthritis compared with age-matched healthy controls. Rheumatol Adv Pract 2021; 5:rkab044. [PMID: 34350373 PMCID: PMC8329472 DOI: 10.1093/rap/rkab044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objective The aim was to compare the cognitive ability of people with RA with healthy controls (HCs). Methods People with RA were recruited from the Norfolk Arthritis Register (NOAR), a population-based cohort study of people with inflammatory arthritis. Data on aged-matched HCs (people with no cognitive impairment) came from the comparison arm of The Dementia Research and Care Clinic Study (TRACC). People with RA and HCs performed a range of cognitive ability tasks to assess attention, memory, verbal fluency, language, visuospatial skills, emotional recognition, executive function and theory of mind. A score of <88 on the Addenbrooke’s Cognitive Examination III was considered cognitive impairment. Scores were compared using linear regression adjusting for age, sex, smoking status, education, BMI, anxiety and depression. Results Thirty-eight people with RA [mean (S.D.) age: 69.1 (8.0) years; 25 (65.8%) women] were matched with 28 HCs [mean (S.D.) age: 68.2 (6.4) years; 15 (53.6%) women]. Twenty-three (60.5%) people with RA were considered to have mild cognitive impairment [mean (S.D.) Addenbrooke’s Cognitive Examination III: RA = 85.2 (7.4), HC = 96.0 (2.5)]. People with RA had impairments in memory, verbal fluency, visuospatial functioning, executive function and emotional recognition in faces compared with HCs, after adjustment for confounders. Conclusion People with RA had cognitive impairments in a range of domains. People with RA might benefit from cognitive impairment screening to allow for early administration of appropriate interventions.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - Task Toyoda
- Norwich Medical School, University of East Anglia
| | | | | | - Jacqueline R Chipping
- Norwich Medical School, University of East Anglia.,Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust
| | | | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Alex MacGregor
- Norwich Medical School, University of East Anglia.,Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust
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Bozhinovska M, Jenko M, Stupica GT, Klokočovnik T, Kšela J, Jelenc M, Podbregar M, Fabjan A, Šoštarič M. Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study. J Cardiothorac Surg 2021; 16:142. [PMID: 34030698 PMCID: PMC8142614 DOI: 10.1186/s13019-021-01509-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. Methods Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure. Results A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). Conclusion There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. Trial registry number clinicaltrials.gov, NCT02697786 14. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01509-8.
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Affiliation(s)
- Marija Bozhinovska
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Matej Jenko
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Gordana Taleska Stupica
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Tomislav Klokočovnik
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Juš Kšela
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Jelenc
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Podbregar
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Department of Internal Intensive Medicine, General and Teaching Hospital, Celje, Slovenia
| | - Andrej Fabjan
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Šoštarič
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia. .,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
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9
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Schmidtke D. Age affects procedural paired-associates learning in the grey mouse lemur (Microcebus murinus). Sci Rep 2021; 11:1252. [PMID: 33442034 PMCID: PMC7806666 DOI: 10.1038/s41598-021-80960-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/29/2020] [Indexed: 01/12/2023] Open
Abstract
The ability to associate memorized objects with their location in space gradually declines during normal aging and can drastically be affected by neurodegenerative diseases. This study investigates object-location paired-associates learning (PAL) in the grey mouse lemur (Microcebus murinus), a nonhuman primate model of brain aging. Touchscreen-based testing of 6 young adults (1–5 years) and 6 old adults (> 7 years) in the procedural rodent dPAL-task revealed significant age-related performance decline, evident in group differences in the percentage of correct decision during learning and the number of sessions needed to reach a predefined criterion. Response pattern analyses suggest decreased susceptibility to relative stimulus-position biases in young animals, facilitating PAL. Additional data from a subset of “overtrained” individuals (n = 7) and challenge sessions using a modified protocol (sPAL) further suggest that learning criteria routinely used in animal studies on PAL can underestimate the endpoint at which a stable performance is reached and that more conservative criteria are needed to improve construct validity of the task. To conclude, this is the first report of an age effect on dPAL and corroborates the role of mouse lemurs as valuable natural nonhuman primate models in aging research.
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Affiliation(s)
- Daniel Schmidtke
- Institute of Zoology, University of Veterinary Medicine Hannover, Hannover, Germany.
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10
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Glynn K, O'Callaghan M, Hannigan O, Bruce I, Gibb M, Coen R, Green E, A Lawlor B, Robinson D. Clinical utility of mild cognitive impairment subtypes and number of impaired cognitive domains at predicting progression to dementia: A 20-year retrospective study. Int J Geriatr Psychiatry 2021; 36:31-37. [PMID: 32748438 DOI: 10.1002/gps.5385] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the utility of mild cognitive impairment (MCI) subtypes and number of impaired cognitive domains on initial assessment at predicting progression to dementia in a sample of memory clinic patients over a 20-year period. METHODS A retrospective analysis was conducted of those presenting to a memory clinic with MCI from 1 January 1999 to 31 December 2018 inclusive. Those with MCI were broken down into one of the four subtypes using recommended cut-off scores on the Cambridge Cognitive Assessment (CAMCOG). Binomial logistic regression analysis was used to determine the utility of MCI subtypes and number of impaired cognitive domains as predictors for dementia. RESULTS Overall 1188 individuals with MCI diagnosis were identified, with 378 (32%) progressing to dementia, with median [range] time to diagnosis of 2 years [1-8.4]. Six hundred and forty-nine (55%) were identified as amnestic MCI and 539 (45%) as non-amnestic MCI. Amnestic MCI was a significant predictor of progression compared to non-amnestic MCI (OR = 1.85, df = 1, P < .001). Number of cognitive domains impaired was also a significant predictor of progression to dementia (OR = 1.07, df = 1, P = .01) but the single-/multi-domain distinction was not (OR = 1.29, df = 1, P = .36). CONCLUSION This study shows that approximately 32% of those diagnosed with MCI in a memory clinic progressed to dementia, with a median time to progression of 2 years. Those with amnestic MCI are almost twice as likely to progress to dementia than non-amnestic MCI and that therefore this is a useful distinction. However, the utility of the single- and multi-domain MCI distinction is called into question by our findings.
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Affiliation(s)
- Kevin Glynn
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | | | - Oisin Hannigan
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Irene Bruce
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Mathew Gibb
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Robert Coen
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Elaine Green
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian A Lawlor
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - David Robinson
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
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11
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López ME, Turrero A, Cuesta P, Rodríguez-Rojo IC, Barabash A, Marcos A, Maestú F, Fernández A. A multivariate model of time to conversion from mild cognitive impairment to Alzheimer's disease. GeroScience 2020; 42:1715-1732. [PMID: 32886293 PMCID: PMC7732920 DOI: 10.1007/s11357-020-00260-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
The present study was aimed at determining which combination of demographic, genetic, cognitive, neurophysiological, and neuroanatomical factors may predict differences in time to progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). To this end, a sample of 121 MCIs was followed up during a 5-year period. According to their clinical outcome, MCIs were divided into two subgroups: (i) the "progressive" MCI group (n = 46; mean time to progression 17 ± 9.73 months) and (ii) the "stable" MCI group (n = 75; mean time of follow-up 31.37 ± 14.58 months). Kaplan-Meier survival analyses were applied to explore each variable's relationship with the progression to AD. Once potential predictors were detected, Cox regression analyses were utilized to calculate a parsimonious model to estimate differences in time to progression. The final model included three variables (in order of relevance): left parahippocampal volume (corrected by intracranial volume, LP_ ICV), delayed recall (DR), and left inferior occipital lobe individual alpha peak frequency (LIOL_IAPF). Those MCIs with LP_ICV volume, DR score, and LIOL_IAPF value lower than the defined cutoff had 6 times, 5.5 times, and 3 times higher risk of progression to AD, respectively. Besides, when the categories of the three variables were "unfavorable" (i.e., values below the cutoff), 100% of cases progressed to AD at the end of follow-up. Our results highlighted the relevance of neurophysiological markers as predictors of conversion (LIOL_IAPF) and the importance of multivariate models that combine markers of different nature to predict time to progression from MCI to dementia.
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Affiliation(s)
- María Eugenia López
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain.
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Polytechnic University of Madrid, Madrid, Spain.
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain.
| | - Agustín Turrero
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Department of Statistics and Operational Research, Complutense University of Madrid, Madrid, Spain
| | - Pablo Cuesta
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Polytechnic University of Madrid, Madrid, Spain
| | - Inmaculada Concepción Rodríguez-Rojo
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Polytechnic University of Madrid, Madrid, Spain
- Psychology Faculty, Centro Universitario Villanueva, Madrid, Spain
- Physiotherapy and Nursing Faculty, University of Castilla-La Mancha, Toledo, Spain
| | - Ana Barabash
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Laboratory of Psychoneuroendocrinology and Genetics, San Carlos University Hospital, Madrid, Spain
| | - Alberto Marcos
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Neurology Department, San Carlos University Hospital, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Polytechnic University of Madrid, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
| | - Alberto Fernández
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Polytechnic University of Madrid, Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid, Spain
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12
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Musaeus CS, Nielsen MS, Musaeus JS, Høgh P. Electroencephalographic Cross-Frequency Coupling as a Sign of Disease Progression in Patients With Mild Cognitive Impairment: A Pilot Study. Front Neurosci 2020; 14:790. [PMID: 32848563 PMCID: PMC7431634 DOI: 10.3389/fnins.2020.00790] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
Mild cognitive impairment (MCI) refers to mild objective cognitive deficits and is associated with the later development of Alzheimer’s disease (AD). However, not all patients with MCI convert to AD. EEG spectral power has shown promise as a marker of progression, but brain oscillations in different frequencies are not isolated entities. Coupling between different frequency bands, so-called cross-frequency coupling (CFC), has been associated with memory function and may further contribute to our understanding of what characterizes patients with MCI who progress to AD. In the current study, we wanted to investigate the changes in gamma/theta CFC in patients with AD and MCI compared to HC and in patients with pMCI compared to patients with sMCI. Furthermore, we wanted to investigate the association with cognitive test scores. EEGs were included at baseline for 15 patients with AD, 25 patients with MCI, and 36 older HC, and the participants were followed for up to 3 years. To investigate CFC, we calculated the modulation index (MI), which has been shown to be less affected by noisy data compared to other techniques. We found that patients with pMCI showed a significantly lower global gamma/theta CFC compared to patients with sMCI. In addition, global gamma/theta CFC was significantly correlated with Addenbrooke’s Cognitive Examination (ACE) score (p-value = 0.030, rho = 0.527). Although not significant, patients with AD and MCI showed a lower gamma/theta CFC compared to HC. These findings suggest that gamma/theta CFC is important for proper cognitive functioning and that a decrease in gamma/theta CFC in patients with MCI may be a sign of progression. Gamma/theta CFC may therefore serve as a progression marker in MCI, but larger studies are needed to validate these findings.
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Affiliation(s)
- Christian Sandøe Musaeus
- Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Malene Schjønning Nielsen
- Department of Neurology, Regional Dementia Research Centre, Zealand University Hospital, Roskilde, Denmark
| | | | - Peter Høgh
- Department of Neurology, Regional Dementia Research Centre, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Lee SH, Lee JH, Byun MS, Yi D, Jung G, Park JE, Lee DY. Comparison of Amyloid Positivity Rate and Accumulation Pattern between Amnestic and Non-Amnestic Type Mild Cognitive Impairment. Psychiatry Investig 2020; 17:603-607. [PMID: 32517418 PMCID: PMC7324742 DOI: 10.30773/pi.2020.0063] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to compare cerebral beta-amyloid protein (Aβ) positivity rate and amyloid accumulation pattern on amyloid positron emission tomography (PET) between mild cognitive impairment (MCI) subtypes, i.e. amnestic mild cognitive impairment (aMCI) and non-amnestic mild cognitive impairment (naMCI). METHODS The study participants were 34 naMCI patients and age-, sex- and education-matched 68 aMCI patients (1:2 ratio) who visited the Dementia and Age-Associated Cognitive Decline Clinic of the Seoul National University Hospital. All participants received comprehensive clinical and neuropsychological assessments and [18F] florbetaben PET. RESULTS Aβ positivity rate of naMCI group (26.5%) was significantly lower than that of aMCI group (64.7%). Among Aβ positive individuals, there was no difference in Aβ accumulation pattern between naMCI and aMCI. CONCLUSION The findings suggest that MCI subtypes based on impaired cognitive domains have a differential association with brain Aβ deposition, a core pathology of AD. Amnestic subtype of MCI are more closely associated with cerebral Aβ deposition compared to nonamnestic subtype. In contrast, the pattern of amyloid deposition does not appear to have any difference between the subtypes.
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Affiliation(s)
- Sun Hyung Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Neuropsychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Gijung Jung
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Nursing, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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14
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Belleville S, LeBlanc AC, Kergoat MJ, Calon F, Gaudreau P, Hébert SS, Hudon C, Leclerc N, Mechawar N, Duchesne S, Gauthier S. The Consortium for the early identification of Alzheimer's disease-Quebec (CIMA-Q). ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:787-796. [PMID: 31788534 PMCID: PMC6880140 DOI: 10.1016/j.dadm.2019.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction The Consortium for the early identification of Alzheimer's disease–Quebec (CIMA-Q) created a research infrastructure to recruit, characterize, and track disease progression in individuals at risk of dementia. Methods CIMA-Q established standardized clinical, neuropsychological, neuroimaging, blood (plasma, serum, RNA, genomic DNA), cryopreserved peripheral blood mononuclear cells, and cerebrospinal fluid collection protocols. These data and biological materials are available to the research community. Results In phase 1, 115 persons with subjective cognitive decline, 88 with mild cognitive impairment, 31 with early probable Alzheimer's disease, and 56 older adults with no worries nor impairments received detailed clinical and cognitive evaluations as well as blood and peripheral blood mononuclear cells collections. Among them, 142 underwent magnetic resonance imaging, 29 a 18fluorodeoxyglucose positron emission tomography, and 60 a lumbar puncture. Discussion CIMA-Q provides procedures and resources to identify early biomarkers and novel therapeutic targets, and holds promise for detecting cognitive decline in Alzheimer's disease. Well-ascertained cohort of 290 community-dwelling elderly individuals in Quebec. Large number of individuals with subjective cognitive decline studied longitudinally. Clinical, neuropsychology, neuroimaging, and biomaterials available for Alzheimer's disease studies.
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Affiliation(s)
- Sylvie Belleville
- Psychology Department, Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Andréa C LeBlanc
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Marie-Jeanne Kergoat
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Department of Geriatric, Université de Montréal, Montreal, Canada
| | - Frédéric Calon
- Faculty of Pharmacy, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Pierrette Gaudreau
- Department of Medicine, Université de Montréal, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal Research Center, Montreal, Canada
| | - Sébastien S Hébert
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Québec, Canada
| | - Carol Hudon
- School of Psychology, Université Laval, Québec, Canada.,Centre de recherche CERVO, Institut Universitaire en Santé Mentale de Québec, Quebec, Canada
| | - Nicole Leclerc
- Centre Hospitalier de l'Université de Montréal Research Center, Montreal, Canada.,Department of Neurosciences, Université de Montréal, Montreal, Canada
| | - Naguib Mechawar
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Canada
| | - Simon Duchesne
- Centre de recherche CERVO, Institut Universitaire en Santé Mentale de Québec, Quebec, Canada.,Department of Radiology and Nuclear Medicine, Université Laval, Québec, Canada
| | - Serge Gauthier
- Department of Psychiatry, McGill University, Montreal, Canada.,McGill Center for Studies in Aging, Montreal, Canada
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15
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Schneider LS, Geffen Y, Rabinowitz J, Thomas RG, Schmidt R, Ropele S, Weinstock M. Low-dose ladostigil for mild cognitive impairment: A phase 2 placebo-controlled clinical trial. Neurology 2019; 93:e1474-e1484. [PMID: 31492718 DOI: 10.1212/wnl.0000000000008239] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/10/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Ladostigil reduces oxidative stress and microglial activation in aging rats. We assessed its safety and potential efficacy in a 3-year, randomized, double-blind, placebo-controlled phase 2 clinical trial in patients with mild cognitive impairment (MCI) and medial temporal lobe atrophy. METHODS Patients 55 to 85 years of age with MCI, Clinical Dementia Rating (CDR) score of 0.5, Mini-Mental State Examination (MMSE) score >24, Wechsler Memory Scale-Revised Verbal Paired Associates I score ≤18, and Medial Temporal Lobe Atrophy Scale score >1 were stratified by APOE ε4 genotype and randomly assigned (1:1) to ladostigil 10 mg/d or placebo. Primary outcomes were safety and onset of Alzheimer disease dementia. Secondary endpoints were Neuropsychological Test Battery (NTB) composite, Disability Assessment in Dementia (DAD), and Geriatric Depression Scale (GDS) scores. Exploratory outcomes were NTB component, CDR, and MMSE scores. Biomarkers included MRI-derived whole-brain, hippocampus, and entorhinal cortex volumes. RESULTS Two hundred ten patients from 15 sites in Austria, Germany, and Israel were randomly allocated to placebo (107 patients) or ladostigil (103 patients). After 36 months, 21 of 103 patients on placebo and 14 of 99 patients receiving ladostigil progressed to Alzheimer disease (log-rank test p = 0.162). There were no significant effects on the NTB composite, DAD, or GDS score. Whole-brain and hippocampus volumes decreased more in the placebo than in the ladostigil group (whole brain, p = 0.025, Cohen d = 0.43; hippocampus, p = 0.043, d = 0.43). Serious adverse events were reported by 28 of 107 patients treated with placebo and 26 of 103 with ladostigil. CONCLUSION Ladostigil was safe and well tolerated but did not delay progression to dementia. Its association with reduced brain and hippocampus volume loss suggests a potential effect on atrophy. CLINICALTRIALSGOV IDENTIFIER NCT01429623. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with MCI and medial temporal lobe atrophy, ladostigil did not significantly decrease the risk of the development of Alzheimer disease.
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Affiliation(s)
- Lon S Schneider
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel.
| | - Yona Geffen
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
| | - Jonathan Rabinowitz
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
| | - Ronald G Thomas
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
| | - Reinhold Schmidt
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
| | - Stefan Ropele
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
| | - Marta Weinstock
- From the Keck School of Medicine of the University of Southern California (L.S.S.), Los Angeles; Avraham Pharmaceuticals, Ltd (Y.G.), Yavne; Bar Ilan University (J.R.), Ramat Gan, Israel; University of California (R.G.T.), San Diego; Department of Neurology (R.S., S.R.), Medical University, Graz, Austria; and Hebrew University (M.W.), Jerusalem, Israel
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16
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Tam A, Dansereau C, Iturria-Medina Y, Urchs S, Orban P, Sharmarke H, Breitner J, Bellec P. A highly predictive signature of cognition and brain atrophy for progression to Alzheimer's dementia. Gigascience 2019; 8:giz055. [PMID: 31077314 PMCID: PMC6511068 DOI: 10.1093/gigascience/giz055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/07/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clinical trials in Alzheimer's disease need to enroll patients whose cognition will decline over time, if left untreated, in order to demonstrate the efficacy of an intervention. Machine learning models used to screen for patients at risk of progression to dementia should therefore favor specificity (detecting only progressors) over sensitivity (detecting all progressors), especially when the prevalence of progressors is low. Here, we explore whether such high-risk patients can be identified using cognitive assessments and structural neuroimaging by training machine learning tools in a high-specificity regime. RESULTS A multimodal signature of Alzheimer's dementia was first extracted from the ADNI1 dataset. We then validated the predictive value of this signature on ADNI1 patients with mild cognitive impairment (N = 235). The signature was optimized to predict progression to dementia over 3 years with low sensitivity (55.1%) but high specificity (95.6%), resulting in only moderate accuracy (69.3%) but high positive predictive value (80.4%, adjusted for a "typical" 33% prevalence rate of true progressors). These results were replicated in ADNI2 (N = 235), with 87.8% adjusted positive predictive value (96.7% specificity, 47.3% sensitivity, 85.1% accuracy). CONCLUSIONS We found that cognitive measures alone could identify high-risk individuals, with structural measurements providing a slight improvement. The signature had comparable receiver operating characteristics to standard machine learning tools, yet a marked improvement in positive predictive value was achieved over the literature by selecting a high-specificity operating point. The multimodal signature can be readily applied for the enrichment of clinical trials.
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Affiliation(s)
- Angela Tam
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Centre for the Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute Research Centre, 6875 Lasalle Boulevard, Montréal, QC, H4H 1R3, Canada
| | - Christian Dansereau
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Département d'informatique et de recherche opérationnelle, Université de Montréal, 2920 chemin de la Tour, Montréal, QC, H3T 1J4, Canada
| | - Yasser Iturria-Medina
- Montreal Neurological Institute, McGill University, 3801 University Street, Montréal, QC, H3A 2B4, Canada
| | - Sebastian Urchs
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Montreal Neurological Institute, McGill University, 3801 University Street, Montréal, QC, H3A 2B4, Canada
| | - Pierre Orban
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, H1N 3V2, Canada
- Département de psychiatrie, Université de Montréal, 2900 boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Hanad Sharmarke
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
| | - John Breitner
- Centre for the Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute Research Centre, 6875 Lasalle Boulevard, Montréal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC, H3A 1A1, Canada
| | - Pierre Bellec
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, QC, H3W 1W4, Canada
- Département de psychologie, Université de Montréal, 90 avenue Vincent d'Indy, Montréal, QC, H3C 3J7, Canada
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17
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Oltra-Cucarella J, Sánchez-SanSegundo M, Lipnicki DM, Sachdev PS, Crawford JD, Pérez-Vicente JA, Cabello-Rodríguez L, Ferrer-Cascales R. Using Base Rate of Low Scores to Identify Progression from Amnestic Mild Cognitive Impairment to Alzheimer's Disease. J Am Geriatr Soc 2018; 66:1360-1366. [PMID: 29745971 DOI: 10.1111/jgs.15412] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the implications of obtaining one or more low scores on a battery of cognitive tests on diagnosing mild cognitive impairment (MCI). DESIGN Observational longitudinal study. SETTING Alzheimer's Disease Neuroimaging Initiative. PARTICIPANTS Normal controls (NC, n = 280) and participants with MCI (n = 415) according to Petersen criteria were reclassified using the Jak/Bondi criteria and number of impaired tests (NIT) criteria. MEASUREMENTS Diagnostic statistics and hazard ratios of progression to Alzheimer's disease (AD) were compared according to diagnostic criteria. RESULTS The NIT criteria were a better predictor of progression to AD than the Petersen or Jak/Bondi criteria, with optimal sensitivity, specificity, and positive and negative predictive value. CONCLUSION Considering normal variability in cognitive test performance when diagnosing MCI may help identify individuals at greatest risk of progression to AD with greater certainty.
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Affiliation(s)
- Javier Oltra-Cucarella
- Department of Health Psychology, University of Alicante, Campus de San Vicente del Raspeig, Alicante, Spain.,Unit of Cognitive Impairments and Movement Disorders, Hospital Universitario Santa María del Rosell, Cartagena, Murcia, Spain
| | - Miriam Sánchez-SanSegundo
- Department of Health Psychology, University of Alicante, Campus de San Vicente del Raspeig, Alicante, Spain
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Medicine, Randwick, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Medicine, Randwick, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Medicine, Randwick, Australia
| | - José A Pérez-Vicente
- Unit of Cognitive Impairments and Movement Disorders, Hospital Universitario Santa María del Rosell, Cartagena, Murcia, Spain
| | - Luis Cabello-Rodríguez
- Unit of Cognitive Impairments and Movement Disorders, Hospital Universitario Santa María del Rosell, Cartagena, Murcia, Spain
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, University of Alicante, Campus de San Vicente del Raspeig, Alicante, Spain
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18
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Belleville S, Fouquet C, Hudon C, Zomahoun HTV, Croteau J. Neuropsychological Measures that Predict Progression from Mild Cognitive Impairment to Alzheimer's type dementia in Older Adults: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2017; 27:328-353. [PMID: 29019061 PMCID: PMC5754432 DOI: 10.1007/s11065-017-9361-5] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/04/2017] [Indexed: 11/28/2022]
Abstract
This study aimed to determine the extent to which cognitive measures can predict progression from mild cognitive impairment (MCI) to Alzheimer’s type dementia (AD), assess the predictive accuracy of different cognitive domain categories, and determine whether accuracy varies as a function of age and length of follow-up. We systematically reviewed and meta-analyzed data from longitudinal studies reporting sensitivity and specificity values for neuropsychological tests to identify individuals with MCI who will develop AD. We searched articles in Medline, Cochrane, EMBASE, PsycINFO, and the Web of Science. Methodological quality was assessed using the STARDem and QUADAS standards. Twenty-eight studies met the eligibility criteria (2365 participants) and reported predictive values from 61 neuropsychological tests with a 31-month mean follow-up. Values were pooled to provide combined accuracy for 14 cognitive domains. Many domains showed very good predictive accuracy with high sensitivity and specificity values (≥ 0.7). Verbal memory measures and many language tests yielded very high predictive accuracy. Other domains (e.g., executive functions, visual memory) showed better specificity than sensitivity. Predictive accuracy was highest when combining memory measures with a small set of other domains or when relying on broad cognitive batteries. Cognitive tests are excellent at predicting MCI individuals who will progress to dementia and should be a critical component of any toolkit intended to identify AD at the pre-dementia stage. Some tasks are remarkable as early indicators, whereas others might be used to suggest imminent progression.
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Affiliation(s)
- Sylvie Belleville
- Research Center of the Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, Québec, H3W 1W5, Canada. .,Université de Montréal, CP 6128 Succ. Centre Ville, Montréal, Québec, H3C-1J7, Canada.
| | - Céline Fouquet
- Research Center of the Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, Québec, H3W 1W5, Canada
| | - Carol Hudon
- Université Laval, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Local 1546, Québec, Québec, G1V 0A6, Canada.,CERVO Brain Research Center, 2601, de la Canardiere, Québec, Québec, G1J 2G3, Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Québec, Québec, G1L 2E8, Canada.,Population Health and Practice-Changing Research Group, Research Centre of CHU de Québec- Université Laval, Québec, Québec, G1L 2E8, Canada
| | - Jordie Croteau
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Québec, Québec, G1L 2E8, Canada.,Population Health and Practice-Changing Research Group, Research Centre of CHU de Québec- Université Laval, Québec, Québec, G1L 2E8, Canada
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19
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Ten Kate M, Barkhof F, Visser PJ, Teunissen CE, Scheltens P, van der Flier WM, Tijms BM. Amyloid-independent atrophy patterns predict time to progression to dementia in mild cognitive impairment. ALZHEIMERS RESEARCH & THERAPY 2017; 9:73. [PMID: 28899429 PMCID: PMC5596472 DOI: 10.1186/s13195-017-0299-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/22/2017] [Indexed: 12/19/2022]
Abstract
Background Amyloid pathology in subjects with mild cognitive impairment (MCI) is an important risk factor for progression to dementia due to Alzheimer’s disease. Predicting the onset of dementia is challenging even in the presence of amyloid, as time to progression varies considerably among patients and depends on the onset of neurodegeneration. Survival analysis can account for variability in time to event, but has not often been applied to MRI measurements beyond singular predefined brain regions such as the hippocampus. Here we used a voxel-wise survival analysis to identify in an unbiased fashion brain regions where decreased gray matter volume is associated with time to dementia, and assessed the effects of amyloid on these associations. Methods We included 276 subjects with MCI (mean age 67 ± 8, 41% female, mean Mini-Mental State Examination 26.6 ± 2.4), baseline 3D T1-weighted structural MRI, baseline cerebrospinal fluid (CSF) biomarkers, and prospective clinical follow-up. We fitted for each voxel a proportional Cox hazards regression model to study whether decreased gray matter volume predicted progression to dementia in the total sample, and stratified for baseline amyloid status. Results Dementia at follow-up occurred in 122 (44%) subjects over an average follow-up period of 2.5 ± 1.5 years. Baseline amyloid positivity was associated with progression to dementia (hazard ratio 2.4, p < 0.001). Within amyloid-positive subjects, decreased gray matter volume in the hippocampal, temporal, parietal, and frontal regions was associated with more rapid progression to dementia (median (interquartile range) hazard ratio across significant voxels 1.35 (1.32–1.40)). Repeating the analysis in amyloid-negative subjects revealed similar patterns (median (interquartile range) hazard ratio 1.76 (1.66–1.91)). Conclusions In subjects with MCI, both abnormal amyloid CSF and decreased gray matter volume were associated with future progression to dementia. The spatial pattern of decreased gray matter volume associated with progression to dementia was consistent for amyloid-positive and amyloid-negative subjects. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0299-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mara Ten Kate
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands. .,Alzheimer Center & Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Pieter Jelle Visser
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, VU University Medical Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Betty M Tijms
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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20
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Díaz-Mardomingo MDC, García-Herranz S, Rodríguez-Fernández R, Venero C, Peraita H. Problems in Classifying Mild Cognitive Impairment (MCI): One or Multiple Syndromes? Brain Sci 2017; 7:brainsci7090111. [PMID: 28862676 PMCID: PMC5615252 DOI: 10.3390/brainsci7090111] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022] Open
Abstract
As the conceptual, methodological, and technological advances applied to dementias have evolved the construct of mild cognitive impairment (MCI), one problem encountered has been its classification into subtypes. Here, we aim to revise the concept of MCI and its subtypes, addressing the problems of classification not only from the psychometric point of view or by using alternative methods, such as latent class analysis, but also considering the absence of normative data. In addition to the well-known influence of certain factors on cognitive function, such as educational level and cultural traits, recent studies highlight the relevance of other factors that may significantly affect the genesis and evolution of MCI: subjective memory complaints, loneliness, social isolation, etc. The present work will contemplate the most relevant attempts to clarify the issue of MCI categorization and classification, combining our own data with that from recent studies which suggest the role of relevant psychosocial factors in MCI.
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Affiliation(s)
| | - Sara García-Herranz
- Department of Basic Psychology I, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - Raquel Rodríguez-Fernández
- Department of Behavioural Sciences Methodology, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - César Venero
- Department of Psychobiology, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
| | - Herminia Peraita
- Department of Basic Psychology I, National University of Distance Education, Juan del Rosal 10, 28040 Madrid, Spain.
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21
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Clarnette R, O'Caoimh R, Antony DN, Svendrovski A, Molloy DW. Comparison of the Quick Mild Cognitive Impairment (Qmci) screen to the Montreal Cognitive Assessment (MoCA) in an Australian geriatrics clinic. Int J Geriatr Psychiatry 2017; 32:643-649. [PMID: 27427212 DOI: 10.1002/gps.4505] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Montreal Cognitive Assessment (MoCA) accurately differentiates mild cognitive impairment (MCI) from mild dementia and normal controls (NC). While the MoCA is validated in multiple clinical settings, few studies compare it with similar tests also designed to detect MCI. We sought to investigate how the shorter Quick Mild Cognitive Impairment (Qmci) screen compares with the MoCA. METHODS Consecutive referrals presenting with cognitive complaints to a teaching hospital geriatric clinic (Fremantle, Western Australia) underwent a comprehensive assessment and were classified as MCI (n = 72) or dementia (n = 109). NC (n = 41) were a sample of convenience. The Qmci and MoCA were scored by trained geriatricians, in random order, blind to the diagnosis. RESULTS Median Qmci scores for NC, MCI and dementia were 69 (+/-19), 52.5 (+/-12) and 36 (+/-14), respectively, compared with 27 (+/-5), 22 (+/-4) and 15 (+/-7) for the MoCA. The Qmci more accurately identified cognitive impairment (MCI or dementia), area under the curve (AUC) 0.97, than the MoCA (AUC 0.92), p = 0.04. The Qmci was non-significantly more accurate in distinguishing MCI from controls (AUC 0.91 vs 0.84, respectively = 0.16). Both instruments had similar accuracy for differentiating MCI from dementia (AUC of 0.91 vs 0.88, p = 0.35). At the optimal cut-offs, calculated from receiver operating characteristic curves, the Qmci (≤57) had a sensitivity of 91% and specificity of 93% for cognitive impairment, compared with 87% sensitivity and 80% specificity for the MoCA (≤23). CONCLUSION While both instruments are accurate in detecting MCI, the Qmci is shorter and arguably easier to complete, suggesting that it is a useful instrument in an Australian geriatric outpatient population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Roger Clarnette
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia.,Department of Community and Geriatric Medicine, Fremantle Hospital and Health Service, Perth, Western Australia, Australia
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland.,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Deanna N Antony
- Department of Community and Geriatric Medicine, Fremantle Hospital and Health Service, Perth, Western Australia, Australia
| | | | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
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22
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Mazzeo S, Santangelo R, Bernasconi MP, Cecchetti G, Fiorino A, Pinto P, Passerini G, Falautano M, Comi G, Magnani G. Combining Cerebrospinal Fluid Biomarkers and Neuropsychological Assessment: A Simple and Cost-Effective Algorithm to Predict the Progression from Mild Cognitive Impairment to Alzheimer’s Disease Dementia. J Alzheimers Dis 2016; 54:1495-1508. [DOI: 10.3233/jad-160360] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Salvatore Mazzeo
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Roberto Santangelo
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Maria Paola Bernasconi
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giordano Cecchetti
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Agnese Fiorino
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Patrizia Pinto
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Monica Falautano
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
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23
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Pietto M, Parra MA, Trujillo N, Flores F, García AM, Bustin J, Richly P, Manes F, Lopera F, Ibáñez A, Baez S. Behavioral and Electrophysiological Correlates of Memory Binding Deficits in Patients at Different Risk Levels for Alzheimer’s Disease. J Alzheimers Dis 2016; 53:1325-40. [DOI: 10.3233/jad-160056] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marcos Pietto
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Unidad de Neurobiología Aplicada, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Consejo Nacional de Investigaciones Científicas y Técnicas CONICET, Buenos Aires, Argentina
| | - Mario A. Parra
- School of Life Sciences, Psychology, Heriot-Watt University, UK
- Human Cognitive Neuroscience and Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre and Scottish Dementia Clinical Research Network, UK
- Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Natalia Trujillo
- School of Public Health, University of Antioquia (UDEA), Medellin, Colombia
- Neuroscience Group, Faculty of Medicine, University of Antioquia (UDEA), Medellin
| | - Facundo Flores
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Adolfo M. García
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- ACR Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | - Julian Bustin
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Pablo Richly
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Facundo Manes
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Sobremonte 74, C5500, Mendoza, Argentina
| | - Francisco Lopera
- Neuroscience Group, Faculty of Medicine, University of Antioquia (UDEA), Medellin
| | - Agustín Ibáñez
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Sobremonte 74, C5500, Mendoza, Argentina
| | - Sandra Baez
- Instituto de Neurociencia Cognitiva y Traslacional (INCyT), Laboratorio de Psicología Experimental y Neurociencias (LPEN), Fundación INECO, Universidad de Favaloro, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Grupo de Investigación Cerebro y Cognición Social, Bogotá, Colombia
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24
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Hawkins KM, Sergio LE. Adults at Increased Alzheimer's Disease Risk Display Cognitive-Motor Integration Impairment Associated with Changes in Resting-State Functional Connectivity: A Preliminary Study. J Alzheimers Dis 2016; 53:1161-72. [PMID: 27340846 DOI: 10.3233/jad-151137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many neuroimaging parameters have demonstrated utility as biomarkers in preclinical AD, including resting-state functional connectivity in the default mode network. However, neuroimaging is not a practical, cost effective screening instrument. OBJECTIVE Here we investigate the relationship between performance on a cognitive-motor integration assessment and alterations in resting-state functional connectivity in an at-risk population. METHODS Three groups of ten adults (young: mean age = 26.6 ± 2.7, low AD risk: mean age = 58.7 ± 5.6, and high AD risk: mean age = 58.5 ± 6.9) performed a simple cognitive-motor integration task using a dual-touchscreen laptop and also underwent functional magnetic resonance imaging at rest. RESULTS We found poorer cognitive-motor integration performance in high AD risk participants, as well as an association with lower resting-state functional connectivity in this group. CONCLUSION These findings provide novel insight into underlying AD-related brain alterations associated with a behavioral assessment that can be easily administered clinically.
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25
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Spaan PE. Episodic and semantic memory impairments in (very) early Alzheimer’s disease: The diagnostic accuracy of paired-associate learning formats. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2015.1125076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Pauline E.J. Spaan
- Department of Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry & Medical Psychology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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26
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Barnett JH, Blackwell AD, Sahakian BJ, Robbins TW. The Paired Associates Learning (PAL) Test: 30 Years of CANTAB Translational Neuroscience from Laboratory to Bedside in Dementia Research. Curr Top Behav Neurosci 2016; 28:449-74. [PMID: 27646012 DOI: 10.1007/7854_2015_5001] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The origins and rationale of the Cambridge Neuropsychological Test Automated Battery (CANTAB) as a cross-species translational instrument suitable for use in human neuropsychopharmacological studies are reviewed. We focus on its use for the early assessment and detection of Alzheimer's disease, in particular the Paired Associates Learning (PAL) test. We consider its psychometric properties, neural validation, and utility, including studies on large samples of healthy volunteers, patients with mild cognitive impairment (MCI), and Alzheimer's disease. We demonstrate how it can be applied in cross-species studies using experimental animals to bridge the cross-species translational 'gap'. We also show how the CANTAB PAL has bridged a second translational 'gap' through its application to the early detection of memory problems in primary care clinics, using iPad technology.
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Affiliation(s)
- Jennifer H Barnett
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Cambridge Cognition, Cambridge, UK.
| | - Andrew D Blackwell
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge Cognition, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Medical Research Council/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | - Trevor W Robbins
- Medical Research Council/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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27
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Intzandt B, Black SE, Lanctôt KL, Herrmann N, Oh P, Middleton LE. Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment? Can Geriatr J 2015; 18:65-72. [PMID: 26180562 PMCID: PMC4487738 DOI: 10.5770/cgj.18.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Exercise is a promising strategy to prevent dementia, but no clinically supervised exercise program is widely available to people with mild cognitive impairment (MCI). The objective was to survey health professionals to assess the feasibility of using cardiac rehabilitation exercise programs for MCI populations. Methods We distributed surveys to: 1) health professionals working in cardiac rehabilitation exercise programs (36/72 responded); and 2) physicians who treat MCI (22/32 responded). Questions addressed clinician and clinic characteristics and feasibility of referring and accommodating people with MCI. Results Most cardiac rehabilitation exercise programs currently treat people with MCI (61.1%). Nearly all were willing and able to accept people with MCI and comorbid vascular risk (91.7%), though only a minority could accept MCI without vascular risk (16.7%). Although most physicians recommend exercise to people with MCI (63.6%), few referred patients with MCI to programs or people to guide exercise (27.3%). However, all physicians (100%) would refer patients with MCI to a cardiac rehabilitation exercise program. Conclusions Our study supports cardiac rehabilitation exercise programs as a feasible model of exercise for patients with MCI with vascular risk. Patients with and without vascular risk could likely be accommodated if program mandates were expanded.
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Affiliation(s)
| | - Sandra E Black
- Division of Cognitive Neurology, Sunnybrook Health Sciences Centre, Toronto; ; Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Department of Medicine (Neurology), University of Toronto
| | - Krista L Lanctôt
- Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Neuropsychopharmacology Research Group, Sunnybrook Research Institute; ; Department of Psychiatry, Sunnybrook Health Sciences Centre; ; Department of Psychiatry, University of Toronto
| | - Nathan Herrmann
- Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Neuropsychopharmacology Research Group, Sunnybrook Research Institute; ; Department of Psychiatry, Sunnybrook Health Sciences Centre; ; Department of Psychiatry, University of Toronto
| | - Paul Oh
- Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Cardiac Rehab and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network; ; Clinical Pharmacology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site)
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28
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Howieson DB, Mattek N, Dodge HH, Erten-Lyons D, Zitzelberger T, Kaye JA. Memory Complaints in Older Adults: Prognostic Value and Stability in Reporting over Time. SAGE Open Med 2015; 3. [PMID: 26064522 PMCID: PMC4459758 DOI: 10.1177/2050312115574796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this longitudinal study was to examine the prognostic value of subjective memory complaints in 156 cognitively intact community-dwelling older adults with a mean age of 83 years. Methods: Participants were assessed for subjective memory complaints, cognitive performance, functional status, and mood at annual evaluations with a mean follow-up of 4.5 years. Results: Subjective memory complaint at entry (n = 24) was not associated with impaired memory performance and did not predict memory decline or progression to incipient dementia. Memory complaints were inconsistent across examinations for 62% of participants who reported memory problems. Conclusion: Memory complaints by older adults are inconsistent over time. Memory complaints’ value as a research criterion for selecting people at risk of dementia is weak among community-dwelling older adults. Age, length of follow-up, and other population characteristics may affect the implication of self-reported memory problems.
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Affiliation(s)
- Diane B Howieson
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA ; Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Deniz Erten-Lyons
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Tracy Zitzelberger
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey A Kaye
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, USA
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29
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Influence of controlled encoding and retrieval facilitation on memory performance in patients with different profiles of mild cognitive impairment. J Neurol 2015; 262:938-48. [DOI: 10.1007/s00415-015-7662-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 11/26/2022]
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30
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Acosta-Cabronero J, Nestor PJ. Diffusion tensor imaging in Alzheimer's disease: insights into the limbic-diencephalic network and methodological considerations. Front Aging Neurosci 2014; 6:266. [PMID: 25324775 PMCID: PMC4183111 DOI: 10.3389/fnagi.2014.00266] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022] Open
Abstract
Glucose hypometabolism and gray matter atrophy are well known consequences of Alzheimer's disease (AD). Studies using these measures have shown that the earliest clinical stages, in which memory impairment is a relatively isolated feature, are associated with degeneration in an apparently remote group of areas—mesial temporal lobe (MTL), diencephalic structures such as anterior thalamus and mammillary bodies, and posterior cingulate. These sites are thought to be strongly anatomically inter-connected via a limbic-diencephalic network. Diffusion tensor imaging or DTI—an imaging technique capable of probing white matter tissue microstructure—has recently confirmed degeneration of the white matter connections of the limbic-diencephalic network in AD by way of an unbiased analysis strategy known as tract-based spatial statistics (TBSS). The present review contextualizes the relevance of these findings, in which the fornix is likely to play a fundamental role in linking MTL and diencephalon. An interesting by-product of this work has been in showing that alterations in diffusion behavior are complex in AD—while early studies tended to focus on fractional anisotropy, recent work has highlighted that this measure is not the most sensitive to early changes. Finally, this review will discuss in detail several technical aspects of DTI both in terms of image acquisition and TBSS analysis as both of these factors have important implications to ensure reliable observations are made that inform understanding of neurodegenerative diseases.
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Affiliation(s)
- Julio Acosta-Cabronero
- Brain Plasticity and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Germany
| | - Peter J Nestor
- Brain Plasticity and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Germany
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31
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Juncos-Rabadán O, Facal D, Pereiro AX, Lojo-Seoane C. Visual memory profiling with CANTAB in mild cognitive impairment (MCI) subtypes. Int J Geriatr Psychiatry 2014; 29:1040-8. [PMID: 24633821 DOI: 10.1002/gps.4095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/24/2014] [Accepted: 02/03/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although visual memory has been shown to be impaired in amnestic mild cognitive impairment (aMCI), the differences between MCI subtypes are not well defined. The current study attempted to investigate visual memory profiles in different MCI subtypes. METHODS One hundred and seventy volunteers aged older than 50 years performed several visual memory tests included in the CANTAB battery. Participants were classified into four groups: (1) multiple domain aMCI (mda-MCI) (32 subjects); (2) single domain aMCI (sda-MCI)(57 subjects); (3) multiple domain non amnestic MCI (mdna-MCI) (32 subjects); and (4) controls (54 healthy individuals without cognitive impairment). Parametric and non parametric analyses were performed to compare the groups and to obtain their corresponding memory profiles. RESULTS The mda-MCI group exhibited impairments in both dimensions of episodic memory (recognition and recollection/recall), and also in learning and working memory, whereas the sda-MCI only showed impairment in recollection-delayed recall and learning. The mdna-MCI group displayed impairment in working memory but good preservation of learning and episodic memory. CONCLUSION The CANTAB visual memory profiles may contribute to better cognitive characterization of patients with different MCI subtypes, allowing comparison across several processes involved in visual memory such as attention, recognition, recollection and working memory.
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Affiliation(s)
- Onésimo Juncos-Rabadán
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Abstract
BACKGROUND An association between metabolic syndrome (MetS) and disturbances in neurocognitive function has been identified in Caucasians but the nature and extent of impaired cognition in Asian MetS patients, who may be at greater risk of degenerative cognitive decline, remains unspecified. METHODS A cross-sectional study was conducted at the National University Hospital of Singapore. Participants were recruited from a diabetes clinic at the National University Hospital. Fifty-three patients who met MetS criteria and 44 clinical controls were recruited. All participants were 55 years and above and community ambulant. Neurocognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). CANTAB performances between MetS and control groups were examined with analysis of variance (ANOVA) and the relative contributions of vascular risk, and intrademographic factors on CANTAB scores were dilineated with stepwise regression analyses. RESULTS Participants with MetS consistently performed significantly worse than controls across all CANTAB subtests. Education and Chinese race were found to be potential protective factors. CONCLUSIONS Executive and memory impairment is present in Asian patients with midlife MetS who may be particularly vulnerable to the detrimental impact of MetS in midlife.
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Klekociuk SZ, Summers JJ, Vickers JC, Summers MJ. Reducing false positive diagnoses in mild cognitive impairment: the importance of comprehensive neuropsychological assessment. Eur J Neurol 2014; 21:1330-6, e82-3. [PMID: 24943259 DOI: 10.1111/ene.12488] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/05/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Longitudinal studies of mild cognitive impairment (MCI) report that a sizeable proportion of MCI cases revert to normal levels of functioning over time. The rate of recovery from MCI indicates that existing MCI diagnostic criteria result in an unacceptably high rate of false positive diagnoses and lack adequate sensitivity and specificity. METHODS The aim of the present study was to identify a set of neuropsychological measures able to differentiate between true positive cases of MCI from those who were unimpaired at 11 months' follow-up. RESULTS A discriminant function analysis identified that a combination of measures of complex sustained attention, semantic memory, working memory, episodic memory and selective attention correctly classified outcome in more than 80% of cases. The rate of false positive diagnoses (5.93%) was considerably lower than is evident in previously published MCI studies. CONCLUSIONS The results of the present study indicate that the rate of false positive MCI diagnoses can be significantly reduced through the use of sensitive and specific neuropsychological measures of memory and non-memory functions.
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Affiliation(s)
- S Z Klekociuk
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Juncos-Rabadán O, Pereiro AX, Facal D, Reboredo A, Lojo-Seoane C. Do the Cambridge Neuropsychological Test Automated Battery episodic memory measures discriminate amnestic mild cognitive impairment? Int J Geriatr Psychiatry 2014; 29:602-9. [PMID: 24150876 DOI: 10.1002/gps.4042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/02/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although visual recognition memory and visuospatial paired associates learning has been shown to be impaired in amnestic mild cognitive impairment (aMCI), the sensitivity and specificity of the visual memory tests used to identify aMCI are not well defined. The current study attempted to analyze the sensitivity and specificity of three visual episodic memory tests (Pattern Recognition Memory [PRM], Delayed Matching to Sample [DMS], and Paired Associated Learning [PAL]) from the CANTAB, in differentiating aMCI patients from control healthy participants. METHODS Seventy seven aMCI patients and 85 cognitive normal controls aged over 50 years performed the PRM, DMS, and PAL tests. Univariate and multivariate logistic regression and receiver operating characteristic curve analyses were used to study the relationships between aMCI and visual memory measures. RESULTS The three Cambridge Neuropsychological Test Automated Battery measures significantly predicted aMCI. The optimal predictive model combined the total percent correct responses for PRM and DMS with the PAL total errors (six shapes adjusted), with a sensitivity of 72%, specificity of 83%, and achieved predictive accuracy of 80%. CONCLUSION Visual episodic memory tasks such as those involved in the PRM, DMS, and PAL tests (included in the Cambridge Neuropsychological Test Automated Battery) may sensitively discriminate aMCI patients from normal controls. These tests may be useful for correct diagnosis of aMCI.
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Affiliation(s)
- Onésimo Juncos-Rabadán
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Meta-analysis of the endogenous N200 latency event-related potential subcomponent in patients with Alzheimer’s disease and mild cognitive impairment. Clin Neurophysiol 2014; 125:1145-51. [DOI: 10.1016/j.clinph.2013.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/15/2013] [Accepted: 10/19/2013] [Indexed: 11/20/2022]
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Klekociuk SZ, Summers MJ. The learning profile of persistent mild cognitive impairment (MCI): a potential diagnostic marker of persistent amnestic MCI. Eur J Neurol 2013; 21:470-7, e23-4. [DOI: 10.1111/ene.12333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/18/2013] [Indexed: 11/26/2022]
Affiliation(s)
- S. Z. Klekociuk
- School of Psychology; University of Tasmania; Launceston TAS Australia
| | - M. J. Summers
- School of Psychology; University of Tasmania; Launceston TAS Australia
- Wicking Dementia Research and Education Centre; School of Medicine; University of Tasmania; Hobart TAS Australia
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The value of hippocampal and temporal horn volumes and rates of change in predicting future conversion to AD. Alzheimer Dis Assoc Disord 2013; 27:168-73. [PMID: 22760170 PMCID: PMC4154837 DOI: 10.1097/wad.0b013e318260a79a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hippocampal pathology occurs early in Alzheimer disease (AD), and atrophy, measured by volumes and volume changes, may predict which subjects will develop AD. Measures of the temporal horn (TH), which is situated adjacent to the hippocampus, may also indicate early changes in AD. Previous studies suggest that these metrics can predict conversion from amnestic mild cognitive impairment (MCI) to AD with conversion and volume change measured concurrently. However, the ability of these metrics to predict future conversion has not been investigated. We compared the abilities of hippocampal, TH, and global measures to predict future conversion from MCI to AD. TH, hippocampi, whole brain, and ventricles were measured using baseline and 12-month scans. Boundary shift integral was used to measure the rate of change. We investigated the prediction of conversion between 12 and 24 months in subjects classified as MCI from baseline to 12 months. All measures were predictive of future conversion. Local and global rates of change were similarly predictive of conversion. There was evidence that the TH expansion rate is more predictive than the hippocampal atrophy rate (P=0.023) and that the TH expansion rate is more predictive than the TH volume (P=0.036). Prodromal atrophy rates may be useful predictors of future conversion to sporadic AD from amnestic MCI.
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Age-related decline in associative learning in healthy Chinese adults. PLoS One 2013; 8:e80648. [PMID: 24265834 PMCID: PMC3827181 DOI: 10.1371/journal.pone.0080648] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 10/04/2013] [Indexed: 12/16/2022] Open
Abstract
Paired associates learning (PAL) has been widely used in aging-related research, suggesting an age-related decline in associative learning. However, there are several cognitive processes (attention, spatial and recognition memory, strategy, and associative learning) involved in PAL. It is unclear which component contributes to the decline in PAL performance associated with age effects. The present study determines whether age effects on associative learning are independent of other cognitive processes involved in PAL. Using a validated computerized cognitive program (CANTAB), we examined cognitive performance of associative learning, spatial and recognition memory, attention and strategy use in 184 Singaporean Chinese adults aged from 21 to 80 years old. Linear regression revealed significant age-related decline in associative learning, spatial and recognition memory, and the level of strategy use. This age-related decline in associative learning remains even after adjusting for attention, spatial and recognition memory, and strategy use. These results show that age effects on associative learning are independent of other cognitive processes involved in PAL.
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Comparison of the Montreal Cognitive Assessment and the Mini-Mental State Examination in detecting multi-domain mild cognitive impairment in a Chinese sub-sample drawn from a population-based study. Int Psychogeriatr 2013; 25:1831-8. [PMID: 23870281 DOI: 10.1017/s1041610213001129] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND We examined the discriminant validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in detecting multiple-domain mild cognitive impairment (md-MCI) in a Chinese sub-sample drawn from elderly population-based study. METHODS This study included Chinese participants from the Epidemiology of Dementia in Singapore (EDIS) study aged ≥ 60 years who underwent cognitive screening with the Abbreviated Mental Test and Progressive Forgetfulness Questionnaire. Screen-positive participants subsequently underwent MoCA, MMSE, and a comprehensive formal neuropsychological battery. MCI was defined by Petersen's criteria and further classified into single-domain MCI (sd-MCI) and md-MCI. Area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs) was computed for the MoCA and the MMSE in detecting md-MCI. RESULTS A total of 300 participants were recruited: 128 (42.7%) were diagnosed with no cognitive impairment (NCI), 47 (15.7%) with sd-MCI, and 83 (28.0%) with md-MCI. Forty-one participants were excluded, 7 (2.3%) had dementia, and 34 (11.3%) had only objective cognitive impairment without subjective complaints. Although the MoCA had a significantly larger AUC than the MMSE (0.94 (95% CI = 0.91-0.97) vs. 0.91 (95% CI = 0.86-0.95), p= 0.04), at optimal cut-off points, the MoCA (19/20) was equivalent to the MMSE (25/26) in detecting md-MCI (sensitivity: 0.80 vs. 0.87, specificity: 0.92 vs. 0.80). CONCLUSION Both screening tests had good discriminant validity and can be used in detecting md-MCI in a sub-sample of Chinese drawn from a population-based study.
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Wang L, Li H, Liang Y, Zhang J, Li X, Shu N, Wang YY, Zhang Z. Amnestic mild cognitive impairment: topological reorganization of the default-mode network. Radiology 2013; 268:501-14. [PMID: 23481166 DOI: 10.1148/radiol.13121573] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the topologic reorganization of the default-mode network (DMN) in patients with mild cognitive impairment (MCI) and whether, relative to healthy control subjects, patients with MCI would be more likely to show disrupted functional connectivity and altered topological configuration of the DMN during the memory task compared with that observed during the resting state. MATERIALS AND METHODS This study was approved by the institutional review board of Beijing Normal University Imaging Center for Brain Research. Written informed consent was obtained from each participant. Healthy control subjects (n = 26) and patients with amnestic MCI (aMCI) (n = 25) performed an episodic memory task and also rested while undergoing functional magnetic resonance imaging. Task-induced deactivations were identified and parcellated into different regions associated with the DMN. Functional connectivity across all pairs of regions was computed to construct the DMN architecture. Graph theoretical approaches were used to characterize topological properties of this network. RESULTS Patients with aMCI showed similar deactivation in the DMN to that observed in healthy control subjects (P > .05) but showed significantly decreased anterior-to-posterior functional connectivity only during the task (P < .05). Significant increases in local efficiency (P < .05), but not in global efficiency (P > .05), were observed in aMCI only during the task. Decreased functional connectivity was predictive of increased local efficiency (r = -0.35, P = .015). Significant correlations between these network measures and cognitive performance (P < .05) indicated their potential use as early markers to assess the risk of Alzheimer disease (AD). CONCLUSION This study suggests the early onset functional reorganization of the DMN toward a nonoptimized regularity configuration in aMCI and expands the understanding of dynamic functional reorganization in brain networks along the continuum from normal aging to AD dementia.
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Affiliation(s)
- Liang Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, 19 Xinjiekouwai St, Beijing 100875, P.R. China
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Junkkila J, Oja S, Laine M, Karrasch M. Applicability of the CANTAB-PAL computerized memory test in identifying amnestic mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Disord 2013; 34:83-9. [PMID: 22922741 DOI: 10.1159/000342116] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 11/19/2022] Open
Abstract
AIM To compare the diagnostic accuracy of a computerized test, the CANTAB paired associate learning (PAL) to that of an established and validated noncomputerized test, the CERAD Wordlist Learning task in differentiating between normal aging, aMCI and AD in a cross-sectional design. METHODS 58 participants were assessed (19 with mild probable AD, 17 aMCI, 22 healthy controls). RESULTS The variables found to best discriminate between the three groups were the CANTAB PAL total errors adjusted (p < 0.0001, 81.0% of the cases correctly classified), and CERAD Wordlist Learning Delayed Recall (p < 0.0001, 77.6% of the cases correctly classified). Using both PAL total errors adjusted and Wordlist Learning Delayed Recall, 84.5% of the cases were correctly classified. DISCUSSION The results suggest that the CANTAB could be used for screening of AD-typical memory impairment.
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Affiliation(s)
- Jenny Junkkila
- Abo Akademi University, Department of Psychology and Logopedics, Åbo, Finland.
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Pietrzak RH, Scott JC, Harel BT, Lim YY, Snyder PJ, Maruff P. A process-based approach to characterizing the effect of acute alprazolam challenge on visual paired associate learning and memory in healthy older adults. Hum Psychopharmacol 2012; 27:549-58. [PMID: 23027677 DOI: 10.1002/hup.2263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 09/02/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Alprazolam is a benzodiazepine that, when administered acutely, results in impairments in several aspects of cognition, including attention, learning, and memory. However, the profile (i.e., component processes) that underlie alprazolam-related decrements in visual paired associate learning has not been fully explored. METHODS In this double-blind, placebo-controlled, randomized cross-over study of healthy older adults, we used a novel, "process-based" computerized measure of visual paired associate learning to examine the effect of a single, acute 1-mg dose of alprazolam on component processes of visual paired associate learning and memory. RESULTS Acute alprazolam challenge was associated with a large magnitude reduction in visual paired associate learning and memory performance (d = 1.05). Process-based analyses revealed significant increases in distractor, exploratory, between-search, and within-search error types. Analyses of percentages of each error type suggested that, relative to placebo, alprazolam challenge resulted in a decrease in the percentage of exploratory errors and an increase in the percentage of distractor errors, both of which reflect memory processes. CONCLUSIONS Results of this study suggest that acute alprazolam challenge decreases visual paired associate learning and memory performance by reducing the strength of the association between pattern and location, which may reflect a general breakdown in memory consolidation, with less evidence of reductions in executive processes (e.g., working memory) that facilitate visual paired associate learning and memory.
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Affiliation(s)
- Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA.
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Memory and Executive Screening (MES): a brief cognitive test for detecting mild cognitive impairment. BMC Neurol 2012; 12:119. [PMID: 23050770 PMCID: PMC3492138 DOI: 10.1186/1471-2377-12-119] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/26/2012] [Indexed: 11/20/2022] Open
Abstract
Background Mild cognitive impairment (MCI), defined as a transitional zone between normal cognition and dementia, requires a battery of formal neuropsychological tests administered by a trained rater for its diagnosis. The objective of this study was to develop a screening tool for MCI. Methods One hundred ninety seven cognitively normal controls (NC), one hundred sixteen patients with amnestic MCI –single domain (aMCI-sd), one hundred ninety five patients with amnestic MCI-multiple domain (aMCI-md), and two hundred twenty eight patients with mild Alzheimer’s disease (AD) were evaluated by comprehensive neuropsychological tests and by the Memory and Executive Screening (MES). Results Correlation analysis showed that the three indicators of the MES were significantly negatively related with age (P<0.05), yet not related with education (P>0.05). There was no ceiling or floor effect. Test completion averaged seven minutes (421.14±168.31 seconds). The receiver operating characteristics (ROC) analyses performed on the aMCI-sd group yielded 0.89 for the area under the curve (AUC) (95% CI, 0.85–0.92) for the MES-total score, with sensitivity of 0.795 and specificity of 0.828. There was 81% correct classification rate when the cut-off was set at less than 75. Meanwhile, the aMCI-md group yielded 0.95 for the AUC (95% CI, 0.93–0.97) for the MES-total score, with sensitivity of 0.87 and specificity of 0.91, and 90% correct classification rate when the cut-off was set at less than 72. Conclusion The MES, minimally time-consuming, may be a valid and easily administered cognitive screening tool with high sensitivity and specificity for aMCI, with single or multiple domain impairment.
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Dementia time to death: a systematic literature review on survival time and years of life lost in people with dementia. Int Psychogeriatr 2012; 24:1034-45. [PMID: 22325331 DOI: 10.1017/s1041610211002924] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Life expectancy with dementia directly influences rates of prevalence and service needs and is a common question posed by families and patients. As well as years of survival, it is useful to consider years of life lost after a diagnosis of dementia. METHODS We systematically reviewed the literature on mortality and survival with dementia which were compared to estimated life expectancies in the general population. Both were then compared by age (under 65 years vs. 65+ years), gender, dementia type, severity, and two epochs (prior to and after introduction of cholinesterase inhibitors in 1997). RESULTS Survival after a diagnosis of dementia varies considerably and depends on numerous factors and their complex interaction. Relative loss of life expectancy decreases with age at diagnosis across varying gender, dementia subtypes (except for frontotemporal dementia and dementia with Lewy bodies), and severity stages. Numerous study deficiencies precluded a meta-analysis of survival in dementia. CONCLUSION Estimates of years of life lost through dementia may be helpful for patients and their families. Recommendations for future research methods are proposed.
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Crawford S, Whitnall L, Robertson J, Evans JJ. A systematic review of the accuracy and clinical utility of the Addenbrooke's Cognitive Examination and the Addenbrooke's Cognitive Examination-Revised in the diagnosis of dementia. Int J Geriatr Psychiatry 2012; 27:659-69. [PMID: 22068971 DOI: 10.1002/gps.2771] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/04/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To review the evidence relating to the diagnostic accuracy and clinical utility of the Addenbrooke's Cognitive Examination (ACE) and its updated version, the Addenbrooke's Cognitive Examination-Revised (ACE-R) in relation to the diagnosis of dementia. DESIGN A systematic search of relevant databases was conducted, covering the period 2000 to April 2010. Specific journals and reference lists were hand searched. Identified studies that fulfilled the inclusion criteria were reviewed using a tailored, methodological quality rating checklist. RESULTS The systematic search process identified nine studies for review (seven relating to the ACE, two on the ACE-R). Strengths and weaknesses across studies are considered, and diagnostic accuracy measures are presented for six out of the nine studies. CONCLUSION The evidence suggests that the ACE/ACE-R is capable of providing information on a range of cognitive domains and of differentiating well between those with and those without cognitive impairment. Further research examining how the tools distinguish between dementia subtypes and mild cognitive impairment will further benefit the evidence base.
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Ballard C, Jones E, Gauge N, Aarsland D, Nilsen OB, Saxby BK, Lowery D, Corbett A, Wesnes K, Katsaiti E, Arden J, Amoako D, Prophet N, Purushothaman B, Green D. Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial. PLoS One 2012; 7:e37410. [PMID: 22719840 PMCID: PMC3376123 DOI: 10.1371/journal.pone.0037410] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 04/18/2012] [Indexed: 11/19/2022] Open
Abstract
Background The study determined the one year incidence of post operative cognitive decline (POCD) and evaluated the effectiveness of an intra-operative anaesthetic intervention in reducing post-operative cognitive impairment in older adults (over 60 years of age) undergoing elective orthopaedic or abdominal surgery. Methods and Trial Design The design was a prospective cohort study with a nested randomised, controlled intervention trial, using intra-operative BiSpectral index and cerebral oxygen saturation monitoring to enable optimisation of anaesthesia depth and cerebral oxygen saturation in older adults undergoing surgery. Results In the 52 week prospective cohort study (192 surgical patients and 138 controls), mild (χ2 = 17.9 p<0.0001), moderate (χ2 = 7.8 p = 0.005) and severe (χ2 = 5.1 p = 0.02) POCD were all significantly higher after 52 weeks in the surgical patients than among the age matched controls. In the nested RCT, 81 patients were randomized, 73 contributing to the data analysis (34 intervention, 39 control). In the intervention group mild POCD was significantly reduced at 1, 12 and 52 weeks (Fisher’s Exact Test p = 0.018, χ2 = 5.1 p = 0.02 and χ2 = 5.9 p = 0.015), and moderate POCD was reduced at 1 and 52 weeks (χ2 = 4.4 p = 0·037 and χ2 = 5.4 p = 0.02). In addition there was significant improvement in reaction time at all time-points (Vigilance Reaction Time MWU Z = −2.1 p = 0.03, MWU Z = −2.7 p = 0.004, MWU Z = −3.0 p = 0.005), in MMSE at one and 52 weeks (MWU Z = −2.9 p = 0.003, MWU Z = −3.3 p = 0.001), and in executive function at 12 and 52 weeks (Trail Making MWU Z = −2.4 p = .0.018, MWU Z = −2.4 p = 0.019). Conclusion POCD is common and persistent in older adults following surgery. The results of the nested RCT indicate the potential benefits of intra-operative monitoring of anaesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment. Trial Registration Controlled-Trials.com ISRCTN39503939
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom.
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Mild worry symptoms predict decline in learning and memory in healthy older adults: a 2-year prospective cohort study. Am J Geriatr Psychiatry 2012; 20:266-75. [PMID: 22354117 PMCID: PMC3285262 DOI: 10.1097/jgp.0b013e3182107e24] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Theoretical models of cognitive aging are increasingly recognizing the importance of anxiety and depressive symptoms in predicting age-related cognitive changes and early dementia. This study examined the association between mild worry and depressive symptoms, and cognitive function in healthy, community-dwelling older adults. METHOD : A total of 263 healthy older adults participated in an observational prospective cohort study that assessed worry and depression symptoms, and a broad range of cognitive functions over a 2-year period. RESULTS : Older adults with mildly elevated worry symptoms at baseline performed worse than older adults with minimal worry symptoms on measures of visual and paired associate learning. They were also more likely to show clinically significant (> 1.5 standard deviation) decline in visual learning and memory at a 2-year follow-up assessment (9.4% versus 2.5%; odds ratio = 3.8). CONCLUSION : Assessment of worry symptoms, even mild levels, may have utility in predicting early cognitive decline in healthy, community-dwelling older adults.
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Abstract
Decline in executive function has been noted in the prodromal stage of Alzheimer's disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia.
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Redel P, Bublak P, Sorg C, Kurz A, Förstl H, Müller H, Schneider W, Perneczky R, Finke K. Deficits of spatial and task-related attentional selection in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2012; 33:195.e27-42. [DOI: 10.1016/j.neurobiolaging.2010.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 04/29/2010] [Accepted: 05/14/2010] [Indexed: 10/19/2022]
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Validation of the revised Addenbrooke's Cognitive Examination (ACE-R) for detecting mild cognitive impairment and dementia in a Japanese population. Int Psychogeriatr 2012; 24:28-37. [PMID: 21843399 DOI: 10.1017/s1041610211001190] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early detection of dementia will be important for implementation of disease-modifying treatments in the near future. We aimed to investigate the diagnostic validity and reliability of the Japanese version of the revised Addenbrooke's Cognitive Examination (ACE-R J) for identifying mild cognitive impairment (MCI) and dementia. METHODS We translated and adapted the original ACE-R for use with a Japanese population. Standard tests for evaluating cognitive decline and dementing disorders were applied. A total of 242 subjects (controls = 73, MCI = 39, dementia = 130) participated in this study. RESULTS The optimal cut-off scores of ACE-R J for detecting MCI and dementia were 88/89 (sensitivity 0.87, specificity 0.92) and 82/83 (sensitivity 0.99, specificity 0.99) respectively. ACE-R J was superior to the Mini-Mental State Examination in the detection of MCI (area under the curve (AUC): 0.952 vs. 0.868), while the accuracy of the two instruments did not differ significantly in identifying dementia (AUC: 0.999 vs. 0.993). The inter-rater reliability (ICC = 0.999), test-retest reliability (ICC = 0.883), and internal consistency (Cronbach's α = 0.903) of ACE-R J were excellent. CONCLUSION ACE-R J proved to be an accurate cognitive instrument for detecting MCI and mild dementia. Further neuropsychological evaluation is required for the differential diagnosis of dementia subtypes.
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