"Mini-mental state". A practical method for grading the cognitive state of patients for the clinician

CSL-CTEA: a systematic method for evaluating novel intelligent cognitive assessment tools

With the intensification of global population aging, the incidence of cognitive disorders such as dementia continues to rise. The Mini-Mental State Examination (MMSE) and other alternative tools can help doctors detect subtle changes in cognitive function at an early stage. These assessment tools can make a diagnosis before symptoms become severe, providing opportunities for early intervention, which is crucial for delaying disease progression and improving the quality of life of patients. However, traditional cognitive assessment methods are overly complex and affected by various factors. With the development of artificial intelligence technology, many new assessment tools are constantly being developed and improved. How to evaluate the effectiveness of intelligent electronic cognitive assessment tools is particularly important. We have proposed the Correlation and Supervised Learning-based Cognitive Tool Effectiveness Assessment Method (CSL-CTEA) to evaluate the effectiveness of intelligent electronic cognitive assessment tools, including: (1) experimental design and data collection based on traditional scales and intelligent electronic assessment tools, (2) consistency and correlation tests; (3) accuracy analysis of assessment results based on supervised learning. We used CSL-CTEA to explore the effectiveness of a certain electronic assessment. This intelligent electronic cognitive assessment tool includes voice tests, orientation tests, and picture recognition tests to assess cognitive abilities from multiple perspectives. The results show that the electronic assessment is in good agreement with traditional cognitive assessment methods. The various indicators of the electronic assessment can explain the changes in MMSE scores to some extent. The study also found that the electronic assessment performs well in determining whether the subject is at cognitive risk. To some extent, the electronic assessment can replace traditional cognitive assessment methods such as MMSE to help people judge whether they are at risk of cognitive decline.

Experiences of insomnia among older people living in nursing homes A qualitative study

PURPOSE

The study aimed to explore older people's experiences of insomnia in nursing homes.

METHOD

This qualitative study used an inductive approach with semi-structured interviews involving 19 older people (aged 67-101 years) from nine nursing homes in southwestern Sweden. The older people were purposively selected based on insomnia criteria according to the International Classification of Diseases (ICD-10, G47.0) and cognitive competence according to the Standardized Mini-Mental State Examination (S-MMSE). The interviews were analysed using qualitative content analysis.

RESULTS

Two categories were identified: Valuing good sleep and Disruptive influence on sleep, with the subcategories of internal and external disturbances. Older people expressed that sleep was crucial to their well-being, and poor sleep quality negatively influenced their mood and physical health. They experienced internal disturbances, such as anxiety and physical discomfort, as causing sleep disturbances, but also external aspects that included environmental disturbances, reduced activity levels, loneliness, and worry about which nursing staff was on duty.

CONCLUSION

This study highlights the critical role of sleep in maintaining energy, coping with daily life, and ensuring overall well-being for older people in nursing homes.

Effects of multidomain lifestyle intervention on frailty among older men and women - a secondary analysis of a randomized clinical trial

BACKGROUND

Frailty is a common geriatric syndrome associated with poor clinical outcomes. Effectiveness of lifestyle intervention programmes among frail older people has been examined earlier, but effects of interventions on prevention of frailty have been rarely studied. The aim of this study was to investigate to what extent the multidomain lifestyle intervention in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) affected changes in frailty status among older men and women at risk of cognitive disorders.

METHODS

The 2-year multidomain lifestyle intervention trial including simultaneous nutritional counseling, physical exercise, cognitive training and social activity, and management of metabolic and vascular risk factors, was conducted among 1259 older people (mean age 68.9 years). A modified Fried's frailty phenotype (weight loss, exhaustion, weakness, slowness, and low physical activity) was used to assess frailty at baseline and after the 2-year intervention. Participants with one or more components of the frailty phenotype were classified as pre-frail or frail. A multinomial regression model was applied to investigate efficacy of the intervention on frailty.

RESULTS

We observed a favorable trend in reversing frailty among older men with the intervention. Pre-frail or frail men in the intervention group had higher probability of being non-frail after the intervention (44%) than pre-frail or frail men in the control group (30%) (p = 0.040). Among men, the intervention was especially beneficial in terms of increasing physical activity. Among women, multidomain lifestyle intervention did not affect the frailty status.

CONCLUSION

Modifying lifestyle-related factors may have potential to reverse first signs of frailty among older men. However, the intervention lasted only two years, therefore, research with longer follow-up is needed to see possible long-term effects of lifestyle management on the development of frailty.

Risk factors influencing fall risk in geriatric patients with type 2 diabetes: a comprehensive analysis

BACKGROUND AND OBJECTIVES

Type 2 diabetes mellitus (T2DM) is a common chronic disease in the elderly. Comorbidities, especially neuropathy and retinopathy, significantly increase fall risk in this group. This study aimed to identify fall risk factors in older adults with T2DM.

MATERIALS AND METHODS

From January to June 2024, 242 T2DM patients aged 65 and older were followed at the internal medicine outpatient clinic. Fall risk was assessed using the Performance Oriented Mobility Assessment (POMA), Hendrich II Fall Risk Model (HIIFRM), Barthel Activities of Daily Living Index, and Clinical Frailty Scale (CFS).

RESULTS

Among the patients (median age = 70 years), 41.3% had experienced at least one fall in the previous year. Factors, such as age and diabetes duration were associated with falls. Notably, hypoglycemia (aPR: 1.90, p = 0.017), polypharmacy (aPR: 2.39, p = 0.004), osteoarthritis (aPR: 2.48, p = 0.017), (aPR: 1.70, p = 0.025), and malnutrition (aPR: 1.90, p = 0.007) were independently associated with fall risk.

CONCLUSIONS

Fall risk in elderly outpatients with T2DM was linked to various factors, including hospitalization, malnutrition, osteoarthritis, polypharmacy, neuropathy, and hypoglycemia. To mitigate this risk, patient-specific care plans are recommended.

Storage time affects the level and diagnostic efficacy of plasma biomarkers for neurodegenerative diseases

JOURNAL/nrgr/04.03/01300535-202508000-00027/figure1/v/2024-09-30T120553Z/r/image-tiff Several promising plasma biomarker proteins, such as amyloid-β (Aβ), tau, neurofilament light chain, and glial fibrillary acidic protein, are widely used for the diagnosis of neurodegenerative diseases. However, little is known about the long-term stability of these biomarker proteins in plasma samples stored at -80°C. We aimed to explore how storage time would affect the diagnostic accuracy of these biomarkers using a large cohort. Plasma samples from 229 cognitively unimpaired individuals, encompassing healthy controls and those experiencing subjective cognitive decline, as well as 99 patients with cognitive impairment, comprising those with mild cognitive impairment and dementia, were acquired from the Sino Longitudinal Study on Cognitive Decline project. These samples were stored at -80°C for up to 6 years before being used in this study. Our results showed that plasma levels of Aβ42, Aβ40, neurofilament light chain, and glial fibrillary acidic protein were not significantly correlated with sample storage time. However, the level of total tau showed a negative correlation with sample storage time. Notably, in individuals without cognitive impairment, plasma levels of total protein and tau phosphorylated protein threonine 181 (p-tau181)also showed a negative correlation with sample storage time. This was not observed in individuals with cognitive impairment. Consequently, we speculate that the diagnostic accuracy of plasma p-tau181 and the p-tau181 to total tau ratio may be influenced by sample storage time. Therefore, caution is advised when using these plasma biomarkers for the identification of neurodegenerative diseases, such as Alzheimer's disease. Furthermore, in cohort studies, it is important to consider the impact of storage time on the overall results.

Effect of perampanel in reducing depression in patients with focal epilepsy

Background

High prevalence of depression is very common in epilepsy. This study aimed to discover the effect of perampanel on depression in patients with focal epilepsy.

Methods

This is a prospective observational study. We included a total of 68 patients with focal EP, which were treated with perampanel. We analyzed data before perampanel treatment and at 6 and 12 months of follow-up of the optimal dose. Using the Beck Depression Inventory-II (BDI-II) scale to evaluate depression, the Mini-Mental State Examination (MMSE) to assess the cognitive function, and the Quality of Life in Epilepsy-31 items (QOLIE-31) to estimate the quality of life of EP patients.

Results

The BDI-II score improved significantly compared to before treatment and at 6 and 12 months of follow-up (P < 0.001). The mean total QOLIE-31 score significantly increased from 82.9 ± 20.4 to 88.7 ± 21.2 at the 12-month follow-up (P < 0.001). In addition, seizure control was improved significantly at 12 months: 32.1 % of patients were seizure-free, and 73.2 % were responsive. Moreover, there was statistical relationship between improvement in depression and seizure control. The MMSE score was not different before and after treatment (P > 0.05). Multiple Regression Analysis was found that annual family income, etiology, the frequency of attacks in recent years, types of ASMs and the age were the influence factors of pirampanel in reducing depression (P＜0.05).

Conclusion

Perampanel reduced depression symptoms in patients with focal epilepsy, although the lack of a control group or the relatively small sample size.

Aging modulates large-scale neural network interactions during speech comprehension

Speech comprehension in noisy environments constitutes a critical challenge in everyday life and affects people of all ages. This challenging listening situation can be alleviated using semantic context to predict upcoming words (i.e., predictability gain)-a process associated with the domain-specific semantic network. When no such context can be used, speech comprehension in challenging listening conditions relies on cognitive control functions, underpinned by domain-general networks. Most previous studies focused on regional activity of pre-selected cortical regions or networks in healthy young listeners. Thus, it remains unclear how domain-specific and domain-general networks interact during speech comprehension in noise and how this may change across the lifespan. Here, we used correlational psychophysiological interaction (cPPI) to investigate functional network interactions during sentence comprehension under noisy conditions with varying predictability in healthy young and older listeners. Relative to young listeners, older adults showed increased task-related activity in several domain-general networks but reduced between-network connectivity. Across groups, higher predictability was associated with increased positive coupling between semantic and attention networks and increased negative coupling between semantic and control networks. These results highlight the complex interplay between the semantic network and several domain-general networks underlying the predictability gain. The observed differences in connectivity profiles with age inform the current debate on whether age-related changes in neural activity and functional connectivity reflect compensation or dedifferentiation.

Connected Speech Alterations and Progression in Patients With Primary Progressive Aphasia Variants

BACKGROUND AND OBJECTIVES

Diagnosing the different variants of primary progressive aphasia (PPA) is challenging, but more accurate characterization can improve patient management and treatment outcomes. This study aimed to identify the following: (1) which speech features, alone or combined with language assessment and gray matter volumes (GMVs), best distinguish PPA variants and (2) how connected speech evolves in PPA.

METHODS

This prospective study was conducted at IRCCS San Raffaele Hospital in Milan, Italy, between 2010 and 2021. We included patients with PPA who underwent neuropsychological assessments, including standard evaluation of language and the "Picnic Scene" speech test, and, when available, brain structural MRI. Clinical and language assessments were also performed at follow-up in a subgroup. Sequential feature selection models identified speech parameters that best differentiated groups, incorporating age, sex, education, standard language tests, and GMVs. In each PPA group, linear mixed-effect models analyzed speech changes over time.

RESULTS

We included 95 patients with PPA (mean age 69 ± 9 years, 55 women [58%]; 40 with nonfluent variant PPA [nfvPPA], 35 with semantic variant PPA [svPPA], 20 with logopenic variant PPA [lvPPA]), of whom 82 underwent brain MRI and 34 had a follow-up visit after 10.2 months. Each model distinguished svPPA from the other PPA groups with high accuracy (R2 range 0.93-1.00; p < 0.001). No differences in accuracy were observed among models for this distinction. In differentiating nfvPPA and lvPPA groups, the models incorporating speech parameters (R2 = 0.92; p < 0.001), GMVs (R2 = 0.95; p < 0.001), and their combination (speech + GMVs; R2 = 0.97; p < 0.001) outperformed those using only standard language scores (R2 = 0.75; p = 0.01). Over time, patients with nfvPPA showed more phonological errors, the svPPA group exhibited more semantic and morphosyntactic errors along with difficulties in naming and syntax production, and patients with lvPPA exhibited reduced number of words per second and fewer words per sentence.

DISCUSSION

All models were equally effective in distinguishing the svPPA group from the other 2 PPA subtypes. However, compared with using standard measures alone, incorporating speech measures from the "Picnic Scene" speech test, GMVs, or their combination into the models significantly improved accuracy in differentiating nfvPPA and lvPPA groups. The PPA variants showed distinct speech trajectories. These variables can aid in understanding disease progression, predicting patient outcomes, and planning speech therapy interventions in clinical practice.

Role of sacubitril/valsartan in modulating diabetes mediated cognitive and neuronal impairment

Earlier investigations had established that Diabetes mellitus (DM) caused significant damage in the central nervous system, bringing about diabetic encephalopathy and increasing the risk of cognitive-related problems. Nonetheless, the inherent pathophysiology of cognitive dysfunctions in DM is not well understood. The current study aimed to examine the possible influences of sacubitril/valsartan (SAC/VAL), an angiotensin receptor blocker/neprilysin inhibitor (ARNI), on cognitive dysfunction associated with streptozotocin (STZ)-induced diabetic rats. SAC/VAL and VAL treatments were initiated three days after the diabetic condition was established and continued daily for eight weeks. Normal, non-diabetic rats were reserved as a control group. Both SAC/VAL and VAL treatment in diabetic rats ameliorated diabetes induced oxidative stress as indicated by reduced malondialdehyde (MDA), increased total antioxidant capacity (TAO) in hippocampal tissue and decreased serum advanced glycation end products (AGEs), also inflammatory and apoptotic changes were observed and proved by the reduction of tumor necrosis factor alpha (TNF-α) and caspase -3 in rat hippocampus. SAC/VAL administration to diabetic rats also improved neuronal damages as reflected by restored cAMP response element-binding protein (CREB), brain derived neurotrophic factor (BDNF) and pre-synaptic phosphoproteins, synapsin I and growth associated protein-43 (GAP-43) in the hippocampus of diabetic rats. Additionally, SAC/VAL treated diabetic rats markedly reduced signs of cognitive deterioration during the Morris water maze test. Collectively, these findings suggested that SAC/VAL might play a vital role in improvement of the cognitive impairment observed in diabetic rats through antioxidant, anti-inflammatory and anti-apoptotic actions.

An integrated approach to understanding the effects of exposome on neuroplasticity

Anthropogenic factors are those that occur due to human activities. The exposome is proposed to complement the genome, wherein an individual's exposure begins before birth. The range of exposures includes physical, chemical, dietary, lifestyle, biological, and occupational sources. Exposome has a positive or negative influence on neuroplasticity during different stages of life. A comprehensive study of the exposome is thus necessary to incorporate these factors and their influence on the individual, community, and the population as a whole. Exposomic research and global health present significant opportunities for interdisciplinary research. This review gives an overview of the exposome and its influence on neuroplasticity. It proposes methods to study the exposome on neuroplasticity across the lifespan of the individual. This is possible with the use of self-reported data, large-scale cohort formation, physiological sensors, neuroimaging, omics, molecular biology, and systems approaches. These approaches aim to provide a holistic understanding of an individual's neurological well-being and its implications for the population at large. This will also enable the designing of novel preventive and treatment strategies for managing neurological disorders.

A digital reminiscence intervention program using a time-traveling road map for community-dwelling older adults with subjective cognitive decline

BACKGROUND

Subjective cognitive decline (SCD) is a common concern among older adults in the South Korean population. Thus, non-pharmacological interventions are needed to reduce cognition, communication, and mood complaints.

OBJECTIVE

This study evaluated the effects of a Roadmap Time-Traveling Intervention program (RMTI), a digital reminiscence therapy intervention, on cognitive measurements, communication, and mood in older adults with SCD.

METHODS

Fifty participants were randomly assigned to the experimental or control group. Cognitive function, communication difficulties, quality of life (QoL), depression, and anxiety were assessed at baseline (T0), immediately after the intervention (T1), and four weeks post-intervention (T2). Generalized estimation equations were utilized to analyze the program's effectiveness over time (T0-T1) between groups. A repeated measures ANOVA and the Friedman/Wilcoxon signed-rank tests examined changes across the three time points (T0-T1-T2) within the experimental group. The study followed the Consolidated Standards of Reporting Trials guidelines.

RESULTS

The experimental group exhibited significant improvements in the Korean version of the Mini-Mental State Examination (MMSE-K) scores (p < .001) and QoL (p < .001) compared with the control group: MMSE-K scores (Ⲭ² = 9.55, p = .008), communication difficulties (Ⲭ² = 8.57, p = .014), and QoL (Ⲭ² = 3.35, p = .046) improved significantly across the three time points (T0-T1-T2).

CONCLUSIONS

The RMTI effectively enhanced MMSE-K scores, reduced communication difficulties, and enhanced the QoL in older adults with SCD. This program shows promise for broader implementation in community settings for older adults with SCD.

DCARD checklist: A simple screening tool for Lewy body disease-related early symptoms in memory clinic

OBJECTIVE

Despite the relatively high prevalence of Lewy body disease (LBD) in over middle-aged people, physicians and patients show poor awareness of early symptoms. We examined the clinical utility of a simple checklist for screening for the early symptoms of LBD.

METHODS

We administered a 7-item screening checklist assessing the five representative early symptoms of LBD (dizziness, constipation, anosmia, REM sleep behavior disorder, and depression: the acronym is "DCARD") to 450 consecutive individuals who visited the memory clinic at our university hospital. The aim of this retrospective study was to evaluate the usefulness of the DCARD checklist in differentiating neurocognitive disorders (NCD) due to LBD (i.e., NCD with Lewy bodies and NCD due to Parkinson's disease) from NCD due to non-LBD (e.g., Alzheimer's disease). We also associated the DCARD score with current depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15).

RESULTS

Fifty-five participants (12.2 %) had a higher DCARD score (≥4 out of 7 points) regardless of the global cognitive level. The subgroup with higher DCARD scores had higher GDS-15 scores than the subgroup with lower DCARD scores (p < 0.001). With a DCARD cut-off score of 3/4, the sensitivity and specificity were 65 % and 95 %, respectively, for diagnosing NCD due to LBDs. Receiver operating characteristic curve analysis showed good discriminatory ability (area under the curve: 0.89).

CONCLUSIONS

This simple LBD screening checklist may be useful as a diagnostic tool for the early diagnosis of LBD in memory clinics.

CLINICAL TRIAL REGISTRY

None.

Risk factors and prognosis of acute ischemic stroke related restless legs syndrome

BACKGROUND

Recent studies suggest that stroke may be associated with an increased prevalence of restless legs syndrome (RLS) as a comorbidity or a risk factor. We aimed to explore the association between acute ischemic stroke (AIS) and RLS, and the possible pathogenesis of acute ischemic stroke related restless legs syndrome (AIS-RLS), for guiding its diagnosis and treatment.

METHODS

In this single-center, prospective study, we identified consecutive AIS patients and segregated into AIS-RLS group and non-AIS-RLS group based on the diagnostic criteria of RLS. The differences in baseline data, clinical features, examination results, stroke etiology, stroke location, and clinical prognosis (functional disability, cognitive and mood disorders) of the two groups were analyzed. Logistic regression analysis was used to evaluate the risk factors for RLS.

RESULTS

A total of 201 AIS patients were included in our study, and 21 (10.45 %) demonstrated RLS. Compared with non-AIS-RLS group, AIS-RLS group patients had higher systolic blood pressure (SBP) at admission (P < 0.05), higher mean 24-h SBP (P < 0.01), higher mean 24-h diastolic blood pressure (DBP) (P < 0.01), higher mean daytime SBP (P < 0.01), higher mean daytime DBP (P < 0.01), higher mean nocturnal SBP (P < 0.01), higher mean nocturnal DBP (P < 0.05), smaller variation coefficient of 24-h SBP (P < 0.05). The distribution of AIS-RLS and non-AIS-RLS was not different for each subtype according to the cortical and subcortical classification of lesion sites. The NIHSS score, GAD-7 score and PHQ-9 score were higher at 7 days (P < 0.05), and the modified Rankin scale (mRS) was higher at 3 months follow-up (P < 0.05) in the AIS-RLS group. In the logistic regression, the higher SBP at admission had a statistically significant effect on AIS-RLS(OR = 1.030,P = 0.016)even after adjusting for age and gender(OR = 1.030,P = 0.014).

CONCLUSION

Stroke anatomy did not differ between AIS-RLS and non-AIS-RLS groups. AIS-RLS group patients tend to experience higher blood pressure. Moreover, AIS-RLS patients had worse clinical prognosis (functional disability and mood disorders) compared with non-AIS-RLS patients.

Questionable utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment in individuals with comorbid PTSD and SUD

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69-.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.

Performance validity of the Dot Counting Test in a dementia clinic setting

OBJECTIVE

This study examined the utility of a performance validity test (PVT), the Dot Counting Test (DCT), in individuals undergoing neuropsychological evaluations for dementia. We investigated specificity rates of the DCT Effort Index score (E-Score) and various individual DCT scores (based on completion time/errors) to further establish appropriate cutoff scores.

METHOD

This cross-sectional study included 56 non-litigating, validly performing older adults with no/minimal, mild, or major cognitive impairment. Cutoffs associated with ≥90% specificity were established for 7 DCT scoring methods across impairment severity subgroups.

RESULTS

Performance on 5 of 7 DCT scoring methods significantly differed based on impairment severity. Overall, more severely impaired participants had significantly higher E-Scores and longer completion times but demonstrated comparable errors to their less impaired counterparts. Contrary to the previously established E-Score cutoff of ≥17, a cutoff of ≥22 was required to maintain adequate specificity in our total sample, with significantly higher adjustments required in the Mild and Major Neurocognitive Disorder subgroups (≥27 and ≥40, respectively). A cutoff of >3 errors achieved adequate specificity in our sample, suggesting that error scores may produce lower false positive rates than E-Scores and completion time scores, both of which overemphasize speed and could inadvertently penalize more severely impaired individuals.

CONCLUSIONS

In a dementia clinic setting, error scores on the DCT may have greater utility in detecting non-credible performance than E-Scores and completion time scores, particularly among more severely impaired individuals. Future research should establish and cross-validate the sensitivity and specificity of the DCT for assessing performance validity.

A simple method to evaluate the pentagon copy test of the Mini-Mental State Examination for the differentiation of dementia with Lewy bodies

There are many commonalities between the clinical symptoms of dementia with Lewy bodies (DLB) and those of Alzheimer's disease (AD). The accurate differentiation of these two diseases is an important neuropsychological issue. The Mini-Mental State Examination (MMSE) is often used as a screening test for dementing disorders. We created evaluation items for the pentagon copy test of MMSE and developed a simple, highly accurate evaluation method for differentiating DLB in combination with conventional evaluation items such as the Qualitative Scoring MMSE Pentagon Test (QSPT). Subjects were divided into three groups: DLB (n = 119), AD (n = 50), and Normal (n = 26). The severities of DLB and AD ranged from mild cognitive impairment (MCI) to mild dementia. We compared the results of the pentagon copy test. We found that the rates of patients with abnormalities in "motor incoordination" and "gestalt destruction" were higher in the DLB group than the AD group. Furthermore, receiver operating characteristic curve analysis suggested the differentiation of DLB with high accuracy (sensitivity: 0.70, specificity: 0.78) using the criterion of patients meeting one of the following three characteristics: "the number of angles on QSPT: scores other than 4," "major tremor (Parkinsonism-related tremor) is present," and "gestalt destruction (distortion in overall coherence) is present." This evaluation method may be clinically useful for evaluating MCI to mild DLB patients because the burden on patients is low.

Use of vortioxetine in different neurological fields: a systematic review and future perspectives

INTRODUCTION

Vortioxetine is a multimodal antidepressant with a high tolerability profile. Recent evidence suggests a role for vortioxetine in improving cognitive function and reducing functional disability linked to depression. We conducted a systematic review on the use of vortioxetine in different neurological disorders.

METHODS

PubMed was searched for articles published from inception until June 2024. Article reference lists were screened, and relevant articles were retrieved for consultation. Clinical trials focused on the use of vortioxetine in cerebrovascular diseases, movement disorders and cognitive impairments were included. The systematic review protocol was developed using guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Our search identified 236 citations, 8 of which ultimately met the criteria for inclusion in the synthesis. The included studies consisted of 3 randomized controlled trials, 1 nonrandomized clinical trial and 4 single-arm observational studies. Subsequently, we grouped these articles into three sections of neurological interest (cerebrovascular diseases, movement disorders and cognitive dysfunction).

CONCLUSIONS

Through its multimodal mechanism of action, the antidepressant vortioxetine shows potential benefit in improving depressive symptoms in patients with depression and different, comorbid neurological condition. In addition, the pro-cognitive effect of this agent may represent a possible indication for its use in the treatment of adults with depression and/or neurological cognitive impairment. Future research is needed to explore and clarify other possible implications for a rational administration of this molecule in other neurological fields.

Parasomnia induced by lemborexant: a case report

Lemborexant, an orexin receptor antagonist, is effective not only for sleep disorders but also for preventing and treating delirium. To date, no complex sleep-related behaviors due to lemborexant have been reported. Herein, we present the case of a 69-year-old male patient who was hospitalized for oral floor and tongue cancer and developed delirium after surgery; however, upon lemborexant dosage increase, used to treat insomnia, he developed abnormal nocturnal behavior. This symptom rapidly improved when lemborexant was discontinued. Distinguishing parasomnia from delirium is important because the treatment of these two conditions differs. Although rapid eye movement sleep behavior or sleepwalking was the cause of this parasomnia, a definitive diagnosis could not be established. If qualitatively distinct abnormal behavior is observed compared to delirium after increasing lemborexant dosage, the possibility of parasomnia should be considered.

Age-related disturbances in rest-activity rhythms and integrity of the hippocampal network: An exploratory study

To better understand the relationship between the rest-activity rhythms and cognitive impairments during aging, we assessed the longitudinal changes in the rest-activity rhythms in an elderly population and their possible detrimental effect on the hippocampal network. This was done longitudinally in a rural cohort with two actigraphic assessments and brain imaging examinations, seven years apart. A segmentation of the hippocampus and its related structures was used to assess volumes and functional connectivity in this network based on anatomical and resting state functional data. Regression models were carried out to investigate the potential association of the evolution of sleep and rest-activity rhythms parameters with the structural and functional integrity of the hippocampal network. Our sample was composed of 33 subjects aged 75.2 ± 2.4 years old at the first time point with 40% of women. After seven years, the sleep of our participants did not change but their rest-activity rhythms did (p < 0.05), with a decrease in relative amplitude (∂RA = -0.021) and stability (∂IS = -0.044) as well as an increase in fragmentation (∂IV = +0.072). The deterioration of rest-activity rhythms was correlated with a lower anterior hippocampal volume (p corrected <0.05) while no correlation with functional connectivity was observed. These findings suggest that a degradation of rest-activity rhythms in people over 70 years old could constitute a factor of hippocampal vulnerability. Preventive interventions should consider rest-activity rhythms in the oldest-old population.

Needs expressed by people with subjective cognitive decline during amyloid PET disclosure consultations: An observational study

OBJECTIVES

We disclosed amyloid PET results to people with subjective cognitive decline (SCD) and analysed audiotaped consultations. The aim was to examine the needs expressed by people with SCD and their care partners during amyloid PET disclosure consultations, and to explore neurologists' communication behaviours surrounding these expressions of need.

METHODS

53 persons with SCD (65 ± 7.6 yrs, 18(34 %) female, MMSE 29 ± 1.4, 14(26 %) amyloid-positive, 10(18.9 %) attended with care partner) who wished to learn their amyloid PET results were included. We audiotaped disclosure consultations (54.7 % face-to-face, 45.3 % telephone). Systematic coding using inductive and deductive elements was performed and followed by thematic analysis by two independent researchers.

RESULTS

We observed 1434 needs expressions, on average 27(±23) per consultation. The needs expressed could be categorized into two main overarching themes: the need to feel known and understood (44 %) and the need to know and understand (56 %). Amyloid-positive persons expressed significantly more needs (t (14.3)= -2.249, p = 0.041), especially regarding the need to know and understand. Neurologists frequently responded with 'providing space' reactions (68.6 %), which often led to continued discussions about people's needs.

CONCLUSION

This study shows that people with SCD receiving their amyloid PET-scan results have a considerable number and variety of needs. Despite of the large variation in the content of these needs, we identified two main themes implying that people with SCD do not only want information, but also want to feel known and understood. Although the average number of expressed needs was higher among people with an amyloid positive scan, people with a negative scan also expressed a variety of needs. Further research is needed to inform guidelines for tailoring amyloid PET disclosure consultations to individual needs, thereby enhancing person-centred care in memory clinic settings.

IMPLICATIONS

People with SCD, care partners, and neurologists can use these results to prepare for amyloid PET disclosure consultations.

Caregiver burden in mild cognitive impairment due to Alzheimer's disease-a longitudinal study

BACKGROUND

Caregivers of people with mild forms of cognitive decline, namely mild cognitive impairment (MCI), are subjected to caregiver burden. In recent years, a major breakthrough was the possibility of diagnosing Alzheimer's disease (AD) reliably in patients that present with MCI, as required for the use of the recently approved anti-amyloid therapies. We aimed to examine the caregiver burden in caregivers of patients with MCI due to AD, describe how caregiver burden evolves with time, and determine caregiver baseline factors that might predict the progression of burden.

METHODS

Twenty-five dyads of community-dwelling patients and caregivers were consecutively recruited from a memory outpatient clinic, after receiving the diagnosis of MCI due to AD. Caregiver burden was measured with the Zarit Burden Inventory (ZBI), life satisfaction with Satisfaction With Life Scale, depressive symptoms with the Centre for Epidemiological Studies-Depression Scale (CES-D), anxiety symptoms with the State Anxiety Subscale of the State-Trait Anxiety Inventory (STAI) and patient neuropsychiatric symptoms with the Neuropsychiatric Inventory (NPI).

RESULTS

At baseline, the mean ZBI score was 24.5 ± 15.2 and correlated positively with caregiver CES-D and STAI scores and with patient neuropsychiatric symptoms (NPI-frequency × severity) and distress felt by the caregiver (NPI-distress). At follow-up (17.7 ± 9.4 months) the mean ZBI score increased to 31.4 ± 16.3 (P < 0.001); however, no baseline caregiver or patient characteristics were identified associated with the evolution of caregiver burden.

CONCLUSIONS

Caregivers of patients who received a diagnosis of MCI due to AD report substantial burden, that increased with time. Future studies should investigate caregiver characteristics that may predict burden progression and help delineate strategies to minimise it.

Longitudinal associations between late-life depression, cerebrovascular disease and cognition

BACKGROUND

Depression and vascular disease can both be risk factors for cognitive decline. This study assessed whether indicators of vascular disease are associated with depression over time, and whether depression is associated with cognition independent of vascular disease.

METHODS

Participants were 1032 community-dwelling, older adults from the Sydney Memory and Ageing Study. Depressive symptoms were measured on the 15-item Geriatric Depression Scale, and depression trajectories were classified using latent class growth modelling. Global cognition and individual cognitive domains were assessed. Indicators of vascular disease were history of stroke or transient ischaemic attack (TIA) and total white matter hyperintensities (TWMH). Generalised linear mixed modelling assessed whether vascular markers were associated with change in depressive symptoms over time. Linear mixed modelling examined relationships between depression, vascular disease indicators, and cognition.

RESULTS

History of stroke/TIA or TWMH did not predict depression over time (p = 0.11 and p = 0.70). Baseline stroke/TIA history was associated with a decline in attention over time (b = -0.05, p = 0.04). Significant differences between latent depression trajectories classes in cognitive decline were observed, with participants who became depressed over time experiencing decline in global cognition (b = -0.04, p < 0.001), attention (b = -0.05, p < 0.001) and executive function (b = -0.05, p < 0.001), compared to the non-depressed group.

CONCLUSION

Our findings suggest that depression in later life may not precede cognitive decline. Instead, depressive symptoms and cognitive decline, particularly in attention and executive function, may evolve in tandem over time. This reinforces the importance of early identification and treatment of depression in older adults to potentially mitigate cognitive deterioration.

Profile of Independence in Activities of Daily Living Among Patients With Parkinson's Disease: A Retrospective Observational Study

IMPORTANCE

Persons with Parkinson's disease (PD) become more dependent in activities of daily living (ADL) as the disease progresses. Occupational therapy practitioners aware of the stages of PD can design interventions to promote and maintain occupational performance.

OBJECTIVE

To evaluate the ADL independence and dependence profiles of patients with PD on the basis of disease stages.

DESIGN

Retrospective observational study.

SETTING

Hospital in Japan.

PARTICIPANTS

Patients with PD (N = 209; 75 men and 134 women), with a mean age of 73.3 yr (SD = 7.7).

OUTCOMES AND MEASURES

The Hoehn and Yahr (H-Y) stage was used to determine patients' disease severity. The Barthel Index (BI) was used to determine independence in performing ADLs.

RESULTS

In the H-Y Stage 2 group, the prevalence of independence in mobility and stairs was low, whereas that in other ADLs was high. In the H-Y Stage 3 group, more than half of the patients had limitations in bathing, mobility, and navigating stairs, although most patients remained independent in other ADLs. In the H-Y Stage 4 group, more than half of the patients required assistance with most ADLs, except feeding and bowel control. In the H-Y Stage 5 group, the prevalence of independence during feeding and grooming was relatively high.

CONCLUSIONS AND RELEVANCE

Dependence in ADL domains differs by PD stage, with direct implications for occupational therapy intervention. Plain-Language Summary: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms and nonmotor symptoms. The disease progression can gradually affect activities of daily living (ADLs), which can lead to decreased independence and quality of life as well as increased caregiver distress. This study evaluated the ADL independence and dependence of patients with PD based on each patient's disease stage. The study found that ADL dependence differs based on the PD stage (mild, moderate, severe), with direct implications for occupational therapy intervention. Occupational therapists can design interventions to improve and maintain the occupational performance of people with PD. Interventions that target ADLs should be based on the patient's PD stage.

Screening properties of the updated normative framework for the Italian MMSE in MCI and dementia

BACKGROUND

This study aimed to assess the screening properties of Foderaro et al.s' updated normative framework for the Italian MMSE in detecting mild cognitive impairment (MCI) and dementia due to neurodegenerative, chronic cerebrovascular, and mixed etiologies, as well as in differentiating between these two syndromes.

METHODS

Data on 234 patients with either MCI (N = 83) or dementia (N = 151) due to Alzheimer's disease (N = 112), Lewy body disease (N = 11), frontotemporal lobar degeneration (N = 20), chronic cerebrovascular disease (N = 39), or mixed (N = 47) etiologies having been administered Foderaro et al.'s version of the MMSE were retrospectively recruited. Moreover, N = 247 healthy controls (HCs) with a normal Montreal Cognitive Assessment performance were prospectively recruited. Receiver-operating characteristics analyses were run to test the capability of both raw and demographically adjusted MMSE scores to discriminate both HCs from MCI/dementia and MCI from dementia. For these comparisons, screening metrics were also computed at Foderaro et al.'s cut-off (<26.02).

RESULTS

The capability of demographically adjusted MMSE scores to discriminate both HCs from dementia and MCI from dementia was excellent (AUC = 0.91 and 0.93, respectively), whilst good for MCI case-finding (AUC = 0.85). Consistently, the screening metrics associated with the cut-off at hand were optimal-to-excellent for dementia case-finding (sensitivity = 0.95; specificity = 0.99) and for the differentiation between MCI and dementia (sensitivity = 0.95; specificity = 0.64), whilst imbalanced for detecting MCI (sensitivity = 0.35; specificity = 0.99).

DISCUSSION

Foderaro et al.'s updated normative framework for the Italian MMSE has optimal screening properties for both dementia case-finding and the discrimination between MCI and dementia, being at variance unbalanced towards specificity when it comes to detecting MCI.

Pattern-VEP findings in individuals with mild cognitive impairment

BACKGROUND

Visual evoked potential (VEP) is a technique used to evaluate the electrical response of the brain to visual stimuli. This study aimed to examine neural transmission in the visual pathway by VEP test in individuals with mild cognitive impairment (MCI) and compare it with age-appropriate controls and also investigate for a correlation between VEP parameters and cognitive test domains.

METHODS

The groups consisted of 56 MCI and 50 healthy volunteers, aged 60-80 years, matched for age and education. Mini-Mental State Examination (MMSE) was applied to the participants for cognitive assessment. Patients were also subjected to other dementia screening tests and other treatable causes were excluded. In addition, groups were formed from those who completed the test. The pattern-reversal VEP method was used in this study.

RESULTS

The mean MMSE score in the MCI group was 21.42 ± 1.55 points. Our findings showed that individuals with MCI had a longer left P100 latency compared to controls (p = 0.027). In addition, right N75-P100 and right P100-N145 amplitudes of VEP parameters were found to be positively correlated with the recall test, which is one of the MMSE domains (p < 0.05, rho: 0.399,0.314).

CONCLUSION

The evidence provided by this study supports the possibility of using pattern VEP with clinical parameters to evaluate MCI patients. In addition, a positive correlation between interpeak amplitudes and the recall test highlights the importance of the VEP test in these patients.

Construction of a risk prediction model for postoperative cognitive dysfunction in colorectal cancer patients

BACKGROUND

Colorectal cancer (CRC) is one of the most prevalent and lethal malignant tumors worldwide. Currently, surgical intervention was the primary treatment modality for CRC. However, increasing studies have revealed that CRC patients may experience postoperative cognitive dysfunction (POCD).

AIM

To establish a risk prediction model for POCD in CRC patients and investigate the preventive value of dexmedetomidine (DEX).

METHODS

A retrospective analysis was conducted on clinical data from 140 CRC patients who underwent surgery at the People’s Hospital of Qian Nan from February 2020 to May 2024. Patients were allocated into a modeling group (n = 98) and a validation group (n = 42) in a 7:3 ratio. General clinical data were collected. Additionally, in the modeling group, patients who received DEX preoperatively were incorporated into the observation group (n = 54), while those who did not were placed in the control group (n = 44). The incidence of POCD was recorded for both cohorts. Data analysis was performed using statistical product and service solutions 20.0, with t-tests or χ² tests employed for group comparisons based on the data type. Least absolute shrinkage and selection operator regression was applied to identify influencing factors and reduce the impact of multicollinear predictors among variables. Multivariate analysis was carried out using Logistic regression. Based on the identified risk factors, a risk prediction model for POCD in CRC patients was developed, and the predictive value of these risk factors was evaluated.

RESULTS

Significant differences were observed between the cognitive dysfunction group and the non-cognitive dysfunction group in diabetes status, alcohol consumption, years of education, anesthesia duration, intraoperative blood loss, intraoperative hypoxemia, use of DEX during surgery, intraoperative use of vasoactive drugs, surgical time, systemic inflammatory response syndrome (SIRS) score (P < 0.05). Multivariate Logistic regression analysis identified that diabetes [odds ratio (OR) = 4.679, 95% confidence interval (CI) = 1.382-15.833], alcohol consumption (OR = 5.058, 95%CI: 1.255-20.380), intraoperative hypoxemia (OR = 4.697, 95%CI: 1.380-15.991), no use of DEX during surgery (OR = 3.931, 95%CI: 1.383-11.175), surgery duration ≥ 90 minutes (OR = 4.894, 95%CI: 1.377-17.394), and a SIRS score ≥ 3 (OR = 4.133, 95%CI: 1.323-12.907) were independent risk factors for POCD in CRC patients (P < 0.05). A risk prediction model for POCD was constructed using diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score as factors. A receiver operator characteristic curve analysis of these factors revealed the model’s predictive sensitivity (88.56%), specificity (70.64%), and area under the curve (AUC) (AUC = 0.852, 95%CI: 0.773-0.919). The model was validated using 42 CRC patients who met the inclusion criteria, demonstrating sensitivity (80.77%), specificity (81.25%), and accuracy (80.95%), and AUC (0.805) in diagnosing cognitive impairment, with a 95%CI: 0.635-0.896.

CONCLUSION

Logistic regression analysis identified that diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score vigorously influenced the occurrence of POCD. The risk prediction model based on these factors demonstrated good predictive performance for POCD in CRC individuals. This study offers valuable insights for clinical practice and contributes to the prevention and management of POCD under CRC circumstances.

The study on effects of acute exposure to high altitude hypoxia on cognitive function in lowlander

The investigation of cognitive functions in response to high-altitude exposure has garnered increasing scientific interest. However, it remains unclear whether cognitive abilities are selectively impaired or what are the trends of the function. In this study, we examined the effects of acute exposure to 3800 m on cognition among 20 lowlanders (27.9 ± 3.08 years; 18 males) for 1 week. Cognitive functions, physiological parameters, various questionnaires, and electroencephalogram (EEG) data were assessed at 400 m (D0) and during the acute phase at 3800 m (D1, D2, D3, D5, D7). A control group consisting of 23 subjects (26.5 ± 3.17 years; 21 males) underwent identical assessments at 400 m. Our findings indicate that within two days following ascent to 3800 m, nearly all cognitive indicators exhibited impairment, but gradually improved from the 3rd day and largely recovered to the plain level on the 5th to 7th day. EEG frequency analysis also revealed significant alterations, relative power in the delta band decreased markedly by D7 compared with D0, while theta and alpha bands showed the opposite trends. Correlational analyses between EEG features and cognitive functions revealed that relative power in the delta band exhibited a negative correlation with most cognitive measures, while relative power in the theta and beta bands predominantly demonstrated positive correlations. We conclude that most cognitive functions exhibit a pattern characterized by initial decline followed by recovery at 3800 m-an observation closely linked to observed EEG changes. These findings provide valuable insights into cognitive function and EEG performance at high altitudes.

The Social Vulnerability Index and Incidence of Alzheimer Disease in a Population-Based Sample of Older Adults

BACKGROUND AND OBJECTIVES

The primary study objective was to examine the association between Social Vulnerability index (SVI) and risk of incident Alzheimer disease (AD) and rate of cognitive decline.

METHODS

This is a secondary analysis of data from the Chicago Health and Aging Project, a population-based cohort study. Participants were recruited through door visits, were at least 65 years of age at enrollment, and lived in one of 4 Chicago communities representing 24 US census tracts. The association of SVI with clinically diagnosed incident AD was examined using a logistic regression model and global cognitive decline using a linear mixed-effects model.

RESULTS

A total of 6,781 participants were in this study, with a mean age of 72 years, representing over 60% Black participants and over 60% female participants, and with a mean of 12 years of education. Over 90% of Black participants were in tracts above 50% or higher SVI, and approximately 87% of White participants were in tracts with SVI 50% or less. Participants in tracts with SVI above 50th to 75th percentiles had OR = 2.23 (95% CI 1.23-4.05) for clinical AD, and participants in tracts greater than the 75th percentile had OR = 2.04 (95% CI 1.03-4.04). Participants in more vulnerable tracts had greater incident AD risk than participants in less vulnerable tracts. The annual rate of global cognitive decline was 0.055 SD units (SDU) for participants below the 25th SVI percentile. The annual rate of global cognitive decline was faster by 0.010 SDU (approximately 18% faster, p = 0.025) in those above the 50th-75th percentile and by 0.014 SDU (approximately 25% faster, p = 0.005) in participants above the 75th percentile than in participants below the 25th SVI percentile.

DISCUSSION

Most Black participants who lived in areas with higher SVI that had over twice the risk of incident AD than most White participants who lived in areas with lower SVI, showing a higher social burden in Black older adults. There was no statistically significant race difference in incident AD after adjusting for SVI. SVI should be accounted for when examining race differences in AD.

Correlation between self-management, psychological cognitive impairment, and quality of life in elderly chronic obstructive pulmonary disease patients

BACKGROUND

The correlation conclusions between self-management, frailty, and quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients are inconsistent.

AIM

To comprehensively assess the current status of self-management, psychological cognitive impairment, and QoL in elderly patients with COPD.

METHODS

Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024. The study utilized demographic information and clinical characteristics, self-management behavior, occurrence of psychological cognitive impairment, and QoL as evaluated through general information questionnaires, the COPD patient self-management scale, simple frailty scale, simple mental status scale, clinical dementia assessment scale, and the clinical COPD assessment test questionnaire. This research aims to describe the current status and correlations among self-management behavior, cognitive impairment occurrence, and QoL.

RESULTS

The average score for self-management behavior in elderly COPD patients was 136.00 (119.00, 164.50), indicating a moderate level overall. There were 98 cases of cognitive impairment, accounting for 31.4%, with a mental status score of 3 (2, 3.75). The average QoL score was 24 (19, 28), indicating a low level. Additionally, there was a negative correlation between total self-management behavior score and cognitive impairment occurrence (r = -0.589, P < 0.001), and QoL total score (r = -0.409, P < 0.001). Cognitive impairment occurrence was positively correlated with QoL total score (r = 0.345, P < 0.001). Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients (P < 0.05).

CONCLUSION

The self-management behavior of elderly patients with COPD is at a moderate level. However, the occurrence of cognitive impairment is high and significantly influenced by disease course, level of self-management, and mental status. The QoL is low, emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients, actively reduce the occurrence of cognitive impairment, and mitigate the impact of the disease on QoL.

Alterations of white matter integrity in patients with intracranial tuberculosis: A tract-based spatial statistics study

OBJECTIVE

Intracranial tuberculosis has high mortality and morbidity. Its physiopathologic mechanism, especially neurocognitive mechanism, remains unclear, and there are few studies on white matter in such patients. This study aimed to investigate the white matter abnormalities in patients with intracranial tuberculosis using tract-based spatial statistics (TBSS) method of diffusion tensor imaging (DTI).

METHODS

Fifty patients with intracranial tuberculosis and 49 healthy controls (HCs) were included in this study. Differences in the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) between patients and HCs were investigated using TBSS analysis. Partial correlation analysis was performed to explore correlations between DTI values and cognitive functions in patients with intracranial tuberculosis, with age and gender as covariates. Subgroup analysis was also conducted using the same method.

RESULTS

Compared to HCs, patients with intracranial tuberculosis showed a widespread reduction of FA and increase of MD, RD and AD (P < 0.05, TFCE and FWE corrected). Notably, abnormalities in all four metrics were observed in 25 white matter tracts according to the Johns Hopkins University ICBM-DTI-81 White Matter Atlas. Patients with mixed intracranial tuberculosis (mixed-ITB) showed increased AD in a limited range compared with patients with tuberculous meningitis (TBM). With age and gender considered, the MD, RD and AD values in some regions significantly correlated with the cognitive assessment scores.

CONCLUSIONS

The results of this study indicated that patients with intracranial tuberculosis might have widespread abnormalities in the white matter of the brain, which might associate with their cognitive impairment.

Development and preliminary validation of a standardized measure of neuropsychological assessment readiness

Neuropsychological evaluations are typically conducted under specific preconditions as it has been long established that many factors unrelated to an individual's true neurocognitive functioning can influence their cognitive test performance. Assessment readiness refers to the extent to which a client is in a state appropriate for undergoing a neuropsychological evaluation (e.g., well rested, sober) as well as any atypical characteristics that require specific accommodations from the administering clinician (e.g., mobility limitations, colorblindness). The purpose of this study was to propose and investigate the preliminary validation of a screening measure of assessment readiness in order to introduce a systematic method for assessing this novel construct. Younger and older adults (N = 93) were administered the Barnett-Coldiron Assessment Readiness Inventory (BCARI) prior to completing a short battery of neuropsychological tests. Additionally, subject matter experts (SMEs) were asked to rate the content validity of this inventory. The BCARI showed preliminary evidence of discriminant validity when compared to other neuropsychological tests and produced the expected minimal variance in assessment readiness scores among healthy, assessment-ready participant samples and across multiple demographic variables. SMEs were largely in support of the BCARI as a valid scale for measuring assessment readiness and positively rated its application in both clinical and research settings. The BCARI shows potential as a useful tool in evaluating the profile validity of clients prior to neuropsychological testing and for reporting a standardized measure of assessment readiness within the profile validity of evaluation reports and research articles.

Slow-wave sleep is associated with nucleus accumbens volume in elderly adults

Slow-wave sleep (SWS) is essential for restorative neural processes and its decline is associated with both healthy and pathological ageing. Building on previous rodent research, this longitudinal study identified a significant association between nucleus accumbens (NAcc) volume and SWS duration in cognitively unimpaired older adults, whilst no significant link was observed between NAcc volume and N2 or rapid eye movement (REM) sleep percentage. Our findings support the involvement of the NAcc in ageing-related modulation of SWS and thus suggest the NAcc as a potential neural marker or therapeutic target for improving SWS.

Retinal vessel density and cognitive function in healthy older adults

The eye is considered a gateway to the brain, as the retina is the only tissue of the central nervous system not protected by bones. This enables non-invasive imaging to provide exceptional insights into the brain. Based on the similarity of brain and retinal structure, it is being investigated whether changes in retinal blood flow could serve as a potential biomarker for cognitive decline. Optical coherence tomography angiography (OCTA) enables an examination of the microcirculation of the retina on the basis of retinal flow registration. Retinal blood flow has been associated with cognitive function and changes have been shown for Alzheimer's patients, whereas data for healthy older subjects are contradictory. The aim of this study was to correlate OCTA parameters with the individual performance in tests assessing the executive functions (EFs) inhibition, updating and shifting in a group of healthy older adults (range: 65-79) using structural equation modeling, with hematocrit serving as a mediator. A model was obtained for vessel density (VD) of the retinal superficial vascular complex and the EF parameters inhibition and updating. The model revealed that only the mediator hematocrit correlated with EF, whereas neither the direct path VD to EF nor the indirect path VD via hematocrit to EF were significantly correlated. Regression analysis with hematocrit yielded significant results for the variable updating. We conclude that higher levels of hematocrit shorten reaction time and the coefficient of variation increases correspondingly, indicating a positive effect of hematocrit on EF.

Speech differences between aged women with and without early Alzheimer's Disease: linguistic indicators of cognitive decline

Despite extensive research on language impairments of individuals with Alzheimer's disease (AD), little is known about whether women with mild cognitive impairment (MCI), an early stage of AD, differ in their language use from healthy controls. To address this gap, the present study investigates speech differences between 22 older women with early AD and 22 age- and education-matched controls with lexical-semantic and disfluency linguistic features, comparing their performance on the Cookie Theft picture description and Cinderella story retelling tasks from the Delaware corpus. Results reveal that, compared with the control group, women with early AD i) produced a smaller average number of tokens and types, with the differences in the Cinderella retelling task reaching statistical significance; ii) exhibited more pronouns and higher anomia values, with both features showing significant differences in recalling the Cinderella story; and iii) produced more disfluencies such as lexical fillers, repeats, and false starts, with a significant difference in lexical fillers in the Cinderella retelling task. These patterns suggest that complex language tasks prove to be more capable of revealing pre-existing cognitive changes in women with early AD, as manifested in their reduced lexical retrieval abilities, higher anomia levels, and increased speech disfluency compared to healthy controls. These findings provide empirical evidence of speech differences between aged women with and without early AD, underscoring the importance of linguistic analysis as a valuable tool in the early detection of AD-related language, memory, and cognitive impairments and timely intervention in the AD continuum.

Pupil and Eye Blink Response Abnormalities During Emotional Conflict Processing in Late-Life Depression

IntroductionThis study aims to investigate the locus coeruleus-norepinephrine system (LC-NE) function in late-life depression (LLD) patients by examining task-evoked pupil dilation in the emotional face-word Stroop task, given the recently established coupling between task-evoked pupil dilation and LC-NE activation.Materials and MethodsUsing video-based eye-tracking and principal component analysis, we explored task-evoked pupil responses and eye blinks in LLD patients (N = 25) and older healthy controls (CTRL) (N = 29) to determine whether there were alterations in pupil responses and eye blinks in LLD compared to CTRL.ResultsLLD patients exhibited significantly different pupil and eye-blink behavior compared to CTRL, with dampened task-evoked pupil dilation associated with emotional congruency and valence processing mediated by the sympathetic system compared to CTRL. Eye-blink rates associated with emotional valence were also altered in LLD compared to CTRL Moreover, Geriatric Depression Scale-15 scores in LLD correlated with emotional congruency effects revealed by task-evoked pupil dilation.ConclusionThe findings demonstrate that LLD patients display altered pupil behavior compared to CTRL. These altered responses correlated with the severity of depressive symptoms, indicating their potential as objective biomarkers for use in large at-risk populations for LLD.

Compromised Agency in the Subjective Experiences of Temporal Distortions Among Institutionalized Alzheimer's Patients in China: A Qualitative Study

Temporal distortions in Alzheimer's disease (AD) patients have been extensively studied from neuroanatomical and empirical perspectives. However, the subjective experiences of these temporal disturbances are relatively under-researched. This study, using inductive content analysis, explored the lived experiences of temporal distortions among AD patients in two integrated clinical and elderly care centers in China. Seventeen participants were involved in the study. Three key themes emerged regarding Chinese institutionalized AD patients' experiences of temporal distortions: limited agency in temporal orientation of the present, futile agency in mental time travel to the past, and relinquished agency in the imagination and planning of the future. The study identifies institutional and cultural factors as potential contributing influences. The scheduled institutional routines can constrain AD patients' sense of agency over temporal perceptions. Expectations derived from the Chinese cultural principle of filial piety might also contribute to the participants' relinquishment of agency.

Hands-free Atalante exoskeleton in post-stroke gait and balance rehabilitation: a safety study

BACKGROUND

Stroke often results in gait dysfunction, impairing daily activities and quality of life. Overground robotic exoskeletons hold promise for post-stroke rehabilitation. This study primarily aimed to assess the safety of hands-free Atalante exoskeleton training in post-stroke subjects, with a secondary aim to assess gait and balance.

METHODS

Forty subjects (10.2 ± 12.1 months post-stroke) with gait dysfunction (Functional Ambulation Category [FAC] score ≤ 3) underwent five training sessions over three weeks with a hands-free exoskeleton (Atalante, Wandercraft, France). Safety, the primary outcome, was evaluated by the number and severity of adverse events (AEs), judged by an independent clinical evaluation committee (CEC). A usability test was performed during the fifth training session followed by the exoskeleton use questionnaire. Gait and balance were assessed pre/post-training via walking capacity score (FAC), gait speed by 10-meter walk test (10MWT), walked distance by 6-minute walk test (6MWT), and balance by Berg Balance Scale (BBS). Spasticity was assessed with the Modified Ashworth scale. Anxiety and depression were quantified using the Hospital Anxiety and Depression Scale. Safety outcomes were analyzed using the Wilson, Lee and Dubin methods for proportions, and occurrence rates were computed. Within-group differences were compared using Wilcoxon, McNemar, and Friedman tests, with significance set at P < 0.05.

RESULTS

Thirty-one subjects completed the training sessions, while nine discontinued. The study reported two serious adverse events (SAE) (vertigo, dysarthria) and six AEs, with the CEC concluding that no SAE was linked to the device/study procedure. The average AE rate per session was 2.5 ± 1.4%, including four events possibly linked to the device/study procedure (knee pain [n = 1], skin lacerations [n = 3]), classified as negligible or minor by the CEC. A high proportion (82.6%) successfully completed the usability test and reported satisfaction (90%) on the exoskeleton use questionnaire. For gait and balance, favorable changes were observed in FAC, 10MWT, 6MWT, and BBS scores Post-training (p < 0.05, respectively). Spasticity, anxiety, and depression remained unchanged.

CONCLUSIONS

This study indicates that the hands-free Atalante exoskeleton is safe, feasible, and well-tolerated for gait and balance rehabilitation in post-stroke subjects, warranting larger randomized controlled trials to assess its efficacy.

TRIAL REGISTRATION

Evaluation of the Use of the Atalante Exoskeleton in Patients Presenting an Hemiplegia Due to Cerebrovascular Accident (INSPIRE) trial was registered at ClinicalTrials.gov (NCT04694001, registered on 20201231).

Test-retest reliability of pre-cue and anticipatory alpha activity in visual spatial attention

Alpha-band activity over the parietal-occipital cortex is a canonical neural marker of visual spatial attention. However, the ongoing debate surrounds whether this activity represents as an active mechanism in gating visual information processing or if it merely reflects an epiphenomenal consequence of anticipatory attentional shifts. Despite this debate, the temporal stability of alpha activity in visual spatial attention, an essential aspect for this discussion, remains ambiguous. Notably, our recent findings highlighted the significant impact of pre-cue alpha power on anticipatory alpha activity in spatial attention tasks, yet the reliability of these pre-cue alpha effects remained unexplored. Here we evaluated the short-term test-retest reliability of both pre-cue and anticipatory alpha activity in healthy young adults who engaged in the same spatial cueing paradigm over two consecutive days. Reliability was gauged using the intraclass coefficient (ICC). Our results demonstrated excellent reliability of pre-cue alpha power, alpha event-related desynchronization (ERD) and individual alpha frequency (IAF), and moderate reliability of alpha lateralization index (LI). Additionally, by categorizing participants into higher and lower pre-cue alpha power sub-groups based on median-splitting, we observed no significant differences in ICCs between the two sub-groups for anticipatory alpha ERD, LI and IAF, except for a significantly higher ICC of pre-cue alpha power in the higher sub-group than the lower sub-group. Taken together, by examining the short-term reliability of alpha-band activity in visual spatial attention for the first time, our study lays a foundational step for the ongoing discourse regarding its functional implications in visual spatial attention.

The relationships between self-neglect and depression, social networks, and health literacy in Turkish older adults: a cross-sectional study

BACKGROUND

Self-neglect is common among older adults and may have devastating health consequences.

OBJECTIVE

This study aims to examine the relationships between self-neglect and depression, social networks, and health literacy (HL) in older adults.

METHODS

The cross-sectional study was conducted between March and May 2024 at four family health centres located in a district of Istanbul, Turkey. A total of 370 older adults, aged 65 years and above, were selected by simple random sampling from among those who visited the family health centres during the study period. A Sociodemographic Information Form, the Revised Turkish version of Mini Mental State Examination, the Istanbul Medical School Elder Self-Neglect Questionnaire, the Lubben Social Network Scale, the Geriatric Depression Scale-Short Form, and the Turkish Health Literacy Scale-32 were used for data collection. Data were analysed using descriptive statistics, Pearson's correlation analysis, hierarchical linear regression analysis, and serial multiple mediation analysis.

RESULTS

The mean age of the participants was 71.42 ± 5.54 (65-90) years, and 55.7% were women. The prevalence of self-neglect among the participants was 34.9%, and the prevalence of depressive symptoms was 46.2%. The HL levels of 62.7% of the participants were inadequate, and those of 31.6% were problematic-limited. HL, depression, social networks, gender, education status, and income status were statistically significant predictors of self-neglect (R2 = 0.508, p < 0.001). Depression had a significant direct effect on self-neglect (effect = -0.148, p < 0.001), as did social networks (effect = 0.107, p < 0.001) and HL (effect = 0.107, p < 0.001). The mediating effect of social networks in the relationship between depression and self-neglect was significant (LLCI = -0.043, ULCI = -0.015), with an effect size of -0.028. The mediating effect of HL in the relationship between depression and self-neglect was also significant (LLCI = -0.121, ULCI = -0.063), with an effect size of -0.089.

CONCLUSION

Our findings showed that HL, depression, and social networks play a critical role in predicting self-neglect in older adults, and social networks and HL partially mediate the relationship between depression and self-neglect. Based on these results, efforts to improve HL and strengthen social support systems would be beneficial in mitigating the effects of depression and reducing self-neglect in older adults.

The effects of task-specific home-based touchscreen training in people with Parkinson's disease: a pilot randomized controlled trial

BACKGROUND

Manual dexterity deficits impair the ability to effectively use touchscreen devices in people with Parkinson's disease (PD).

OBJECTIVE

To examine the effects and feasibility of a home-based, unsupervised tablet-task training on task-specific performance in a randomized controlled trial and to determine which individuals are likely to benefit.

METHODS

Thirty-four PD patients were randomized and included into an experimental training (EXP, N = 16) and passive control group (CTL, N = 18). The EXP practiced a Swipe-Slide Pattern (SSP) task on a tablet (5x/week for 2 weeks) as fast and accurately as possible in single and dual task conditions. Performance on the SSP and an untrained mobile phone task (MPT) were tested before and after two weeks of training and after four weeks follow-up. SSP-Time (primary outcome), SSP-Accuracy (% correct) and MPT-Time were recorded. Linear mixed models were used to assess training effects.

RESULTS

The home-based task-specific training program significantly improved the SSP-Time immediately after training (p < 0.001, d = 0.917) and at follow-up (p = 0.006, d = 0.663), and showed excellent compliance rates (average 98%). No transfer occurred to the untrained MPT. Worse baseline SSP-performance and older age were significantly associated with short- and long-term gains (p < 0.010).

CONCLUSION

Home-based, unsupervised touchscreen training is feasible and effective to improve movement time of the trained task, albeit without transfer to an untrained task. The heterogeneity and variability of the effects underscore the importance of personalizing rehabilitation programs in PD, according to baseline performance. Future studies should investigate a wider range of transfer tasks and clinical determinants that could impact the training response.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ : NTC05696197, retrospectively registered on January 13, 2023.

Anosmia and Upper Limb Rigidity-A Potential Phenotype of Idiopathic Normal Pressure Hydrocephalus with Cerebrospinal Fluid α-Synuclein Seeds

BACKGROUND

The pathophysiology of idiopathic normal pressure hydrocephalus (iNPH) and its association with neurodegenerative disorders is poorly understood.

OBJECTIVES

The aim was to determine the prevalence of α-synuclein pathology in iNPH and its associations with clinical characteristics.

METHODS

We used α-synuclein seed amplification assay (synSAA) to retrospectively analyze cerebrospinal fluid (CSF) from a large single-center iNPH cohort (n = 144). Clinical assessments comprised Unified Parkinson's Disease Rating Scale part III, Mini-Mental State Examination, levodopa-challenge test, and olfactory identification test. Degenerative biomarkers (total-tau, phospho-tau, β-amyloid 1-42, and β-amyloid 1-40) were measured in CSF.

RESULTS

A total of 30.1% of iNPH patients were synSAA+, and presented significantly more upper limb (UL) rigidity, hallucinations, and worse olfactory performance than synSAA- cases. Anosmia was higher in synSAA+ patients (64.0%) than synSAA- patients (15.3%). Clinical assessments and other biomarkers did not significantly vary with synSAA status.

CONCLUSIONS

Underlying α-synuclein pathology is common in iNPH and presents with UL rigidity and olfactory dysfunction, suggesting a distinct synSAA+ phenotype in iNPH. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Anticipatory reaching motor behavior characterizes patients within the Alzheimer's disease continuum in a virtual reality environment

BACKGROUND

Alzheimer's Disease (AD) is characterized by progressive declines in cognitive and motor functions, impairing daily activities. Traditionally, AD diagnosis relies on cognitive assessments, but emerging evidence highlights motor function deficits as early indicators of AD and Mild Cognitive Impairment (MCI). These motor declines, which often precede cognitive symptoms, include slower and less accurate reaching movements. This study explored reaching actions in a Virtual Reality (VR) environment in AD and MCI patients to identify motor deficits and their link to cognitive decline.

METHODS

The study involved 61 right-handed participants (19 AD, 21 MCI, and 21 healthy age-matched controls), screened for cognitive health using a Mini-Mental State Examination (MMSE). Participants performed upper-limb motor tasks (sequentially reaching targets) in a Virtual Reality (VR). Kinematic data was recorded and analyzed focusing on task success rate, frequency of anticipatory responses, and direction of anticipatory responses. Statistical analysis was performed using Generalized Linear Mixed Models to differentiate the three groups of participants based on performance metrics, anticipation behavior, and the correlation between anticipation rate and MMSE score.

RESULTS

Both AD and MCI patients showed more anticipatory responses than healthy controls (HC), inversely related to success rates and cognitive function. AD patients exhibited lower success rates and a higher frequency of anticipatory responses, often biased toward previous trial targets, suggesting impaired motor planning or difficulty adapting to new cues. MCI patients showed an intermediate pattern, with more anticipatory responses than HC but comparable success rates. These results highlight the crucial role of anticipatory behavior in motor task performance, with AD patients displaying the most pronounced deficits.

CONCLUSIONS

This study highlights significant impairments of reaching movements in AD patients, particularly in terms of anticipatory behavior and success rates. The observed deficits suggest that kinematic metrics could serve as early biomarkers for diagnosis and intervention. These findings emphasize the importance of combining cognitive and sensorimotor assessments for the early detection of AD-related motor dysfunctions. Additionally, they highlight the potential of VR-based motor rehabilitation as a promising approach to address sensorimotor deficits in the AD continuum, improving both motor and cognitive outcomes.

Impact of dementia-landscaped therapy garden on psychological well-being- A pilot study

Non-pharmacological interventions are increasingly recognized as first-line therapies for managing dementia symptoms alongside pharmacologic strategies. Among these, therapy gardens and horticultural interventions have emerged as promising adjunctive approaches. This pilot study aimed to evaluate the effects of a six-month dementia-friendly therapy garden intervention on psychological well-being, specifically depression levels, and to determine whether baseline dementia severity predicts treatment success. The study was conducted in a real-world setting, with a final sample of 28 dementia patients. Unlike previous studies, this intervention incorporated multimodal stimulation, including sensory, motor, and cognitive elements. Results indicated a significant reduction in depression, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) after six months of intervention (p <.05). However, depression scores assessed using the Hamilton Depression Rating Scale (HAM-D) showed only a trend toward improvement but did not reach statistical significance. No improvements were observed at the three-month mark, suggesting that sustained engagement is necessary for measurable benefits. Cognitive function, as assessed by dementia severity, did not show significant improvement, and dementia severity at baseline was not a significant predictor of treatment response. These findings underscore the potential of dementia-friendly therapy gardens to provide meaningful psychological benefits by significantly reducing depression over time. Notably, even individuals with more advanced dementia benefited, challenging the prevailing notion that non-pharmacological interventions are primarily effective in early disease stages. These results highlight the need for further research on the long-term effects and mechanisms underlying garden-based interventions in dementia care.

Identifying comorbidity patterns of mental health disorders in community-dwelling older adults: a cluster analysis

As global life expectancy increases, understanding mental health patterns and their associated risk factors in older adults becomes increasingly critical. Using data from the cross-sectional Trinity Ulster Department of Agriculture study (TUDA, 2008-2012; n = 5186 ; mean age 74.0 years) and a subset of participants followed-up longitudinally (TUDA 5+, 2014-2018; n = 953 ), we perform a multi-view co-clustering analysis to identify distinct mental health profiles and their relationships with potential risk factors. The TUDA multi-view dataset consists of five views: (1) mental health, measured with Center for Epidemiologic Studies Depression Scale [CES-D] and Hospital Anxiety and Depression Scale [HADS], (2) cognitive and neuropsychological function, (3) illness diagnoses and medical prescription history, (4) lifestyle and nutritional attainment, and (5) physical well-being. That is, each participant is described by five distinct sets of features. The mental health view serves as the target feature set, while the other four views are analyzed as potential contributors to mental health risks. Under the multi-view co-clustering framework, for each view data, the participants (rows) are partitioned into different row-clusters, and the features (columns) are partitioned into different column-clusters. Each row-cluster is most effectively explained by the features in one or two column-clusters. Notably, the row-clusterings across views are dependent. By analyzing the associations between row clusters in the mental health view and those in each of the other four views, we can identify which risk factors co-occur and contribute to an increased risk of poor mental health. We identify five distinct row-clusters in the mental-health view data, characterized by varying levels of depression and anxiety: Group 1, mild depressive symptoms and no symptoms of anxiety; Group 2, acute depression and anxiety; Group 3, less severe but persistent depression and anxiety symptoms; Group 4, symptoms of anxiety with no depressive symptoms; and Group 5, no symptoms of either depression or anxiety. Cross-view association analysis revealed the following key insights: Participants in Group 3 exhibit lower neuropsychological function, are older, more likely to live alone, come from more deprived regions, and have reduced physical independence. Contrasting Group 3, participants in Group 2 show better neuropsychological function, greater physical independence, and higher socioeconomic status. Participants in Group 5 report fewer medical diagnoses and prescriptions, more affluent backgrounds, less solitary living, and stronger physical independence. A significant portion of this group aligns with cognitive health row-clusters 1 and 3, suggesting a strong link between cognitive and mental health in older age. Participants with only depressive (Group 1) or anxiety symptoms (Group 4) exhibit notable differences. Those with anxiety symptoms are associated with healthier clusters across other views. The co-clustering methodology also categorizes the questions in the CES-D and HADS scales into meaningful clusters, providing valuable insights into the underlying dimensions of mental health assessment. In the CES-D scale, the questions are divided into four clusters: those related to loneliness and energy, those addressing feelings of insecurity, worthlessness, and fear, those concerning concentration and effort, and those focused on sleep disturbances. Similarly, the HADS questions are grouped into clusters that reflect themes such as a strong sense of impending doom, nervousness or unease, and feelings of tension or restlessness. By organizing the questions from both scales into these smaller groups, the methodology highlights distinct symptom patterns and their varying severity among participants. This approach could be leveraged to develop abridged versions of the assessment scales, enabling faster and more efficient triage in clinical practice.

Chronic Pruritus in Geriatric Patients: Prevalence, Associated Factors, and Itch-related Quality of Life

Chronic pruritus is a common condition that significantly impacts quality of life. However, data on chronic pruritus in geriatric populations remain limited. A prospective observational study was conducted at the Centre for Geriatrics in Southern Saxony-Anhalt (ZASSA), involving 201 geriatric patients (mean age 83.5±5.1 years). Chronic pruritus was found in 23.4% of patients, persisting for an average of 8 years with moderate to severe intensity (mean=6.36 on a 0 to 10 numeric scale). It commonly affected the legs (48.9%) and arms (44.7%) and was linked to depressive symptoms and daily medication use. Chronic pruritus significantly impaired physical functioning, particularly in moderate activities and stair climbing, and increased pain levels. ItchyQoL scores highlighted adverse effects on symptoms, functioning, feelings, and self-perception. Overall, chronic pruritus is prevalent among geriatric patients and substantially reduces quality of life. Addressing both dermatological and psychological factors is essential for effective management and improving quality of life in this population.

Parkinson's disease functional movement battery a comprehensive test set to evaluate of motor abilities in persons with Parkinson's disease

Clinicians require quantitative measures of functional movement to inform care decisions for persons with Parkinson's disease (PWPs). To address this need, we developed the Parkinson's Disease-Functional Movement Battery (PD-FUNC), which includes valid items from existing assessments and evaluates five key areas from the MDS-UPDRS-III: manual dexterity, functional strength, locomotion, static balance, and activities of daily living. This study assessed the PD-FUNC's ability to distinguish between PWPs and healthy controls based on effect sizes and analyzed differences according to disease progression using years since diagnosis and MDS-UPDRS-III scores, as well as Hoehn & Yahr (H&Y) stages. The test was administered to 81 PD patients (H&Y stages 1-3) and 81 age-matched controls. All items, except grip force, discriminated effectively, with dexterity tasks showing the highest sensitivity (effect size r = 0.52-0.63). The PD-FUNC distinguished PD stages well, revealing early symptoms through dexterity tests (p = 0.001) and late-stage symptoms via dynamic stability tests. The PD-FUNC could provide a comprehensive assessment within 30-40 min and could be used to evaluate disease progression and medication effectiveness at home and in clinical settings.

Impact of comprehensive geriatric assessment on treatment decisions in older prostate cancer patients

BACKGROUND

Prostate cancer is the most common cancer in men aged above 75 years old. Given their heterogeneity, the International Society of Geriatric Oncology recommends using a comprehensive geriatric assessment (CGA) to adapt anticancer treatment management according to their geriatric status. While the theoretical value of this approach is in no doubt, the impact of the CGA on the final therapeutic decision remains elusive. This study therefore investigated the impact of comprehensive geriatric assessment on treatment decisions in older patients diagnosed with prostate cancer and described the factors associated with a change in treatment plan.

METHODS

This single-centre retrospective study included prostate cancer patients who received a CGA prior to a therapeutic decision from January 2012 to December 2022. The CGA included medical, nutritional, cognitive, social, functional and psychological evaluation.

RESULTS

140 patients were included, of whom 57 (40.7%) benefited from a change in their therapeutic plan after CGA, all in favour of a less aggressive treatment. There was no difference in event-free (EFS) or overall survival (OS) between patients with or without a therapeutic modification (HR for OS = 1.12 [0.68;1.84] p = 0.048). Factors associated with a change in treatment plan were a WHO performance status > 1, a high age-adjusted Charlson score, polymedication, an impaired functional independence with the ADL (Activities of Daily Living) scale and a 'frail' or 'vulnerable' geriatric profile according to Balducci's classification.

CONCLUSION

A comprehensive geriatric assessment prior to prostate cancer treatment plan initiation lead to therapeutic de-escalation in 40% of cases of without affecting overall survival or event-free survival. This adaptation offering a more tailored cancer management while preventing functional impact of treatment due to toxicity and improving patient quality of life.

TRIAL REGISTRATION

The study was registered as (number's register: F20240123102237) and MR004 (CNIL number: 23RDUROL01).

Remembering delayed intentions in patients with mild cognitive impairment and Alzheimer's disease

Prospective memory (PM) is the ability to remember intended actions and to evoke delayed intentions. It is a crucial skill in daily life functioning in the elderly and can be prematurely compromised in neurodegenerative processes. In the Latin American region, there are no established impartial metrics for its assessment. The purpose of this study is to explore PM in patients diagnosed with Mild cognitive impairment (MCI) and Alzheimer's disease (AD). The specific objectives are to: to differentiate the performance of healthy subjects, patients with MCI, and patients with AD; to measure the relationship between PM and other cognitive test performance; and lastly, to analyze the internal consistency and inter-rater reliability of the Mini Cóndor Test, a brief PM assessment tool adapted for elderly patients with low-education levels The test only exist in Spanish. A comparative study of independent samples was conducted between 33 patients diagnosed with AD, 39 patients with MCI, and a control group of 33 healthy subjects. The results showed significant differences in the performance of PM, with the control group performing best, while the AD group had a significantly worse performance in the test than the MCI group. PM performance correlated significantly with retrospective memory and executive function. The Mini Cóndor Test yielded adequate indices for internal consistency and inter-rater reliability. This Test has the potential to detect cognitive impairment associated with neurodegenerative pathology at an early stage.

Acute effects of high-intensity interval exercise plus whole-body vibration on bone turnover markers, BDNF, irisin, and neurocognitive performance in postmenopausal women

The acute effects of exercise can elucidate the molecular and psychophysiological mechanisms underlying exercise's benefits in several systems (e.g., the brain, muscle, and bone). In this study, a single 30-minute session of high-intensity interval aerobic exercise (HIIAE) administered in conjunction with isometric resistance exercise on a whole-body vibration (WBV) platform (HIIAE+WBV) was compared with HIIAE alone in their effects on molecular and neurocognitive indices among 63 sedentary, healthy postmenopausal women who were randomly assigned to HIIAE (n = 20), HIIAE+WBV (n = 20), and Control (n = 23) groups. The assessed molecular indices were serum levels of osteocalcin (OC), uncarboxylated OC (ucOC), carboxylated OC (cOC), brain-derived neurotrophic factor (BDNF), and irisin, and the assessed neurocognitive indices were the accuracy rate (AR), reaction time (RT), and electroencephalography event-related potentials (ERPs) of P2 and P3 components in a visuospatial working memory task. Data on these indices before versus after an acute bout of HIIAE or HIIAE+WBV or after a resting session were compared. An HIIAE or HIIAE+WBV intervention yielded no significant change in ERP P2 latency/amplitude and P3 latency but yielded significantly higher ARs, shorter RTs, larger ERP P3 amplitudes, and higher OC, cOC, BDNF, and irisin levels in the postmenopausal women. HIIAE+WBV outperformed HIIAE alone in AR, ucOC, and BDNF. However, the changes in these molecular and neurocognitive indices induced by the two exercise modes did not show any significant correlations in the present study. The present findings suggest that HIIAE and HIIAE+WBV have the potential to acutely influence markers of bone and brain health, with HIIAE+WBV showing greater effectiveness than HIIAE alone. These interventions should be further investigated in future randomized controlled trials involving postmenopausal women.

Does the degree of limitation in activities of daily living in geriatric patients influence the amount of care and case management required? An analysis from the RubiN project

BACKGROUND

The number of people in Germany over the age of 70 will increase significantly over the next 10 years. This will be accompanied by an increase in geriatric diseases and disabilities. An important goal for many geriatric patients is to remain in their own homes for as long as possible, while making use of support services. To achieve this, patients with limitations in their daily activities and in need of geriatric care should be identified as early as possible. The RubiN project implemented assessment-based care and case management for geriatric patients in physician networks in Germany. To support future planning, the present analysis investigated whether the intensity of case management increases with increasing limitations in patients' activities of daily living.

METHODS

Using the Barthel Index, an assessment tool to record patients' ability to perform activities of daily living, patients' current limitations were assessed for ten activities (eating; sitting up and moving; washing; toileting; bathing/showering; getting up and walking; climbing stairs; dressing/undressing; bowel incontinence; urinary incontinence). For each item, the score (0 to max. 15 points) is determined and added to the Barthel Index score (max. 100 points). Counselling and coordination services provided by case managers were documented according to medical, nursing, therapeutic and social counselling content. Linear multivariate analysis was performed to determine whether the Barthel Index score was a determinant of the intensity of care and case management.

RESULTS

Two thousand three hundred six patients in the RubiN intervention group (65% female; mean age 81.5 years (SD 5.6)) were included in the analysis. 74% of these patients achieved a Barthel Index score between 100 and 85 points at baseline, and correspondingly, 26% of the patients had a Barthel Index score of 80 points or less. Problems with 'bathing/showering', 'getting up and walking', 'climbing stairs', 'dressing/undressing' and 'controlling urination' were the most common reasons for not achieving the maximum Barthel Index score of 100 points. A total of 26,833 patient contacts were documented by the care and case manager. On average, patients received 11.6 contacts (SD = 9.1). Social (31.8%) and medical (26.3%) counselling and coordination services were provided in the majority of contacts. "Therapeutic counselling content" and "nursing counselling content" were provided in 21.7% and 20.1% of contacts, respectively. Multivariate analysis showed a significant correlation between an decreasing Barthel Index and a higher number of contacts with the care and case manager.

CONCLUSIONS

The Barthel Index score can be used to predict the intensity of care and assistance needed by geriatric patients. The scores provide a good basis for planning and implementing care and case management.

TRIAL REGISTRATION

German Clinical Trials Register, ID: DRKS00016642. Registered on 29.10.2019-retrospectively registered.