1
|
Ghafar MZAA, Miptah HN, O'Caoimh R. Cognitive screening instruments to identify vascular cognitive impairment: A systematic review. Int J Geriatr Psychiatry 2019; 34:1114-1127. [PMID: 31050033 DOI: 10.1002/gps.5136] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/19/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). METHODS Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face-to-face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post-stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTS Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5 years. Most studies compared more than one instrument. Five papers examined clock-drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC > 0.90) and MMSE (AUC: 0.86-0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83-.88). The MoCA (AUC: 0.87-0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta-analysis. CONCLUSIONS Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.
Collapse
Affiliation(s)
- Mohd Zaquan Arif Abd Ghafar
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland
| | - Hayatul Nawwar Miptah
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland.,Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Cork City, Ireland
| |
Collapse
|
2
|
Pantsiou K, Sfakianaki O, Papaliagkas V, Savvoulidou D, Costa V, Papantoniou G, Moraitou D. Inhibitory Control, Task/Rule Switching, and Cognitive Planning in Vascular Dementia: Are There Any Differences From Vascular Aging? Front Aging Neurosci 2018; 10:330. [PMID: 30410439 PMCID: PMC6211074 DOI: 10.3389/fnagi.2018.00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 09/28/2018] [Indexed: 01/06/2023] Open
Abstract
Recent studies have shown that patients diagnosed with Vascular Dementia (VaD) exhibit deficits in executive functions. According to “vascular hypothesis of cognitive aging,” community-dwelling older adults having risk factors for vascular disease development (RVD) may suffer from cognitive decline of the same type. The aim of the study was to assess the level of specific executive functions (EF) that have been revealed as most affected by vascular abnormalities, in older adults with incipient VaD and RVD. Subsequently specific ways of EF measuring could be suggested for more accurate diagnosis of early stage VaD. The study compared three adult groups (N = 60): (a) patients diagnosed with incipient VaD, according to DSM-5 criteria (n = 20); (b) community-dwelling older adults presenting cardiovascular risk factors (RVD; n = 20); (c) healthy young adult controls (n = 20). Three types of executive functions were examined: inhibitory control, cognitive flexibility as rule/task switching, and planning. The following D-KEFS subtests were administered for their evaluation: The ‘Color-Word Interference Test,’ the ‘Verbal Fluency Test,’ and the ‘Tower Test.’ Mixed-measures ANOVA, MANOVA, and one-way ANOVA as well as Scheffe post hoc test were applied to the data of the scores in each condition of each test. The results showed that VaD patients had significantly lower performance in test conditions requiring switching and planning, compared to RVD group and young controls. The specific deficits of VaD patients, compared to older adults presenting RVD according to multiple-group path analyses were: more uncorrected errors in inhibition, the use of semantic knowledge primarily instead of switching ability to switch between semantic categories, as well as a lower level of movement precision in planning.
Collapse
Affiliation(s)
- Krystallia Pantsiou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ourania Sfakianaki
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Savvoulidou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Costa
- 1st Neurology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Papantoniou
- Department of Early Childhood Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Despina Moraitou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
3
|
Lin Y, Wang K, Ma C, Wang X, Gong Z, Zhang R, Zang D, Cheng Y. Evaluation of Metformin on Cognitive Improvement in Patients With Non-dementia Vascular Cognitive Impairment and Abnormal Glucose Metabolism. Front Aging Neurosci 2018; 10:227. [PMID: 30100873 PMCID: PMC6074058 DOI: 10.3389/fnagi.2018.00227] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
Objective: Recent studies have suggested that metformin can penetrate the blood–brain barrier, protecting neurons via anti-inflammatory action and improvement of brain energy metabolism. In this study, we aim to investigate the effect of metformin on cognitive function in patients with abnormal glucose metabolism and non-dementia vascular cognitive impairment (NDVCI). Methods: One hundred patients with NDVCI and abnormal glucose metabolism were randomly allocated into two groups: metformin and donepezil (n = 50) or acarbose and donepezil (n = 50). The neuropsychological status, glucose metabolism, and common carotid arteries intima–media thickness (CCA-IMT) before and after a year of treatment, were measured and compared between the groups. Results: Ninety four patients completed all the assessment and follow-up. After a year of treatment, there was a decrease in Alzheimer’s disease Assessment Scale-Cognitive Subscale scores and the duration of the Trail Making Test in the metformin-donepezil group. Furthermore, these patients showed a significant increase in World Health Organization–University of California–Los Angeles Auditory Verbal Learning Test scores after treatment (all P < 0.05). However, there was no obvious improvement in cognitive function in the acarbose-donepezil group. We also observed a significant decrease in the level of fasting insulin and insulin resistance (IR) index in the metformin-donepezil group, with a lower CCA-IMT value than that in the acarbose-donepezil group after a year of treatment (P < 0.05). Conclusion: We conclude that metformin can improve cognitive function in patients with NDVCI and abnormal glucose metabolism, especially in terms of performance function. Improved cognitive function may be related to improvement of IR and the attenuated progression of IMT. Trial Registration:ChiCTR-IPR-17011855.
Collapse
Affiliation(s)
- Yufeng Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Kaiyuan Wang
- Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chunchao Ma
- Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Xuesong Wang
- Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Zhongying Gong
- Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Rui Zhang
- Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Dawei Zang
- Department of Neurology, Tianjin First Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Yan Cheng
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
4
|
Automatic Artifact Removal in EEG of Normal and Demented Individuals Using ICA-WT during Working Memory Tasks. SENSORS 2017; 17:s17061326. [PMID: 28594352 PMCID: PMC5492863 DOI: 10.3390/s17061326] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/25/2017] [Accepted: 05/04/2017] [Indexed: 01/31/2023]
Abstract
Characterizing dementia is a global challenge in supporting personalized health care. The electroencephalogram (EEG) is a promising tool to support the diagnosis and evaluation of abnormalities in the human brain. The EEG sensors record the brain activity directly with excellent time resolution. In this study, EEG sensor with 19 electrodes were used to test the background activities of the brains of five vascular dementia (VaD), 15 stroke-related patients with mild cognitive impairment (MCI), and 15 healthy subjects during a working memory (WM) task. The objective of this study is twofold. First, it aims to enhance the recorded EEG signals using a novel technique that combines automatic independent component analysis (AICA) and wavelet transform (WT), that is, the AICA–WT technique; second, it aims to extract and investigate the spectral features that characterize the post-stroke dementia patients compared to the control subjects. The proposed AICA–WT technique is a four-stage approach. In the first stage, the independent components (ICs) were estimated. In the second stage, three-step artifact identification metrics were applied to detect the artifactual components. The components identified as artifacts were marked as critical and denoised through DWT in the third stage. In the fourth stage, the corrected ICs were reconstructed to obtain artifact-free EEG signals. The performance of the proposed AICA–WT technique was compared with those of two other techniques based on AICA and WT denoising methods using cross-correlation XCorr and peak signal to noise ratio (PSNR) (ANOVA, p ˂ 0.05). The AICA–WT technique exhibited the best artifact removal performance. The assumption that there would be a deceleration of EEG dominant frequencies in VaD and MCI patients compared with control subjects was assessed with AICA–WT (ANOVA, p ˂ 0.05). Therefore, this study may provide information on post-stroke dementia particularly VaD and stroke-related MCI patients through spectral analysis of EEG background activities that can help to provide useful diagnostic indexes by using EEG signal processing.
Collapse
|
5
|
van Straaten E, den Haan J, de Waal H, van der Flier W, Barkhof F, Prins N, Stam C. Disturbed phase relations in white matter hyperintensity based vascular dementia: An EEG directed connectivity study. Clin Neurophysiol 2015; 126:497-504. [DOI: 10.1016/j.clinph.2014.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
|
6
|
Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S, Mohamad K. Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment. Neuropsychiatr Dis Treat 2014; 10:1677-91. [PMID: 25228808 PMCID: PMC4164290 DOI: 10.2147/ndt.s67184] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors' quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA) scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An optimal therapeutic program that would help stroke patients enjoy additional years with higher quality of life is presented.
Collapse
Affiliation(s)
- Noor Kamal Al-Qazzaz
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia ; Department of Biomedical Engineering, Al-Khwarizmi College of Engineering, Baghdad University, Baghdad, Iraq
| | - Sawal Hamid Ali
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Shabiul Islam
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Khairiyah Mohamad
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S. Cognitive assessments for the early diagnosis of dementia after stroke. Neuropsychiatr Dis Treat 2014; 10:1743-51. [PMID: 25246795 PMCID: PMC4168871 DOI: 10.2147/ndt.s68443] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The early detection of poststroke dementia (PSD) is important for medical practitioners to customize patient treatment programs based on cognitive consequences and disease severity progression. The aim is to diagnose and detect brain degenerative disorders as early as possible to help stroke survivors obtain early treatment benefits before significant mental impairment occurs. Neuropsychological assessments are widely used to assess cognitive decline following a stroke diagnosis. This study reviews the function of the available neuropsychological assessments in the early detection of PSD, particularly vascular dementia (VaD). The review starts from cognitive impairment and dementia prevalence, followed by PSD types and the cognitive spectrum. Finally, the most usable neuropsychological assessments to detect VaD were identified. This study was performed through a PubMed and ScienceDirect database search spanning the last 10 years with the following keywords: "post-stroke"; "dementia"; "neuro-psychological"; and "assessments". This study focuses on assessing VaD patients on the basis of their stroke risk factors and cognitive function within the first 3 months after stroke onset. The search strategy yielded 535 articles. After application of inclusion and exclusion criteria, only five articles were considered. A manual search was performed and yielded 14 articles. Twelve articles were included in the study design and seven articles were associated with early dementia detection. This review may provide a means to identify the role of neuropsychological assessments as early PSD detection tests.
Collapse
Affiliation(s)
- Noor Kamal Al-Qazzaz
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, Malaysia ; Department of Biomedical Engineering, Al-Khwarizmi College of Engineering, Baghdad University, Baghdad, Iraq
| | - Sawal Hamid Ali
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Shabiul Islam
- Institute of Microengineering and Nanoelectronics (IMEN), UKM, Bangi, Selangor, Malaysia
| |
Collapse
|