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Edmonds EC, Thomas KR, Rapcsak SZ, Lindemer SL, Delano‐Wood L, Salmon DP, Bondi MW. Data-driven classification of cognitively normal and mild cognitive impairment subtypes predicts progression in the NACC dataset. Alzheimers Dement 2024; 20:3442-3454. [PMID: 38574399 PMCID: PMC11095435 DOI: 10.1002/alz.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Data-driven neuropsychological methods can identify mild cognitive impairment (MCI) subtypes with stronger associations to dementia risk factors than conventional diagnostic methods. METHODS Cluster analysis used neuropsychological data from participants without dementia (mean age = 71.6 years) in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (n = 26,255) and the "normal cognition" subsample (n = 16,005). Survival analyses examined MCI or dementia progression. RESULTS Five clusters were identified: "Optimal" cognitively normal (oCN; 13.2%), "Typical" CN (tCN; 28.0%), Amnestic MCI (aMCI; 25.3%), Mixed MCI-Mild (mMCI-Mild; 20.4%), and Mixed MCI-Severe (mMCI-Severe; 13.0%). Progression to dementia differed across clusters (oCN < tCN < aMCI < mMCI-Mild < mMCI-Severe). Cluster analysis identified more MCI cases than consensus diagnosis. In the "normal cognition" subsample, five clusters emerged: High-All Domains (High-All; 16.7%), Low-Attention/Working Memory (Low-WM; 22.1%), Low-Memory (36.3%), Amnestic MCI (16.7%), and Non-amnestic MCI (naMCI; 8.3%), with differing progression rates (High-All < Low-WM = Low-Memory < aMCI < naMCI). DISCUSSION Our data-driven methods outperformed consensus diagnosis by providing more precise information about progression risk and revealing heterogeneity in cognition and progression risk within the NACC "normal cognition" group.
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Affiliation(s)
- Emily C. Edmonds
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Kelsey R. Thomas
- Research Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Steven Z. Rapcsak
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
- Department of Speech, Language, & Hearing SciencesUniversity of ArizonaTucsonArizonaUSA
| | | | - Lisa Delano‐Wood
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - David P. Salmon
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
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Fei T, Hanfelt JJ, Peng L. Latent Class Proportional Hazards Regression with Heterogeneous Survival Data. STATISTICS AND ITS INTERFACE 2023; 17:79-90. [PMID: 38222248 PMCID: PMC10786342 DOI: 10.4310/23-sii785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Heterogeneous survival data are commonly present in chronic disease studies. Delineating meaningful disease subtypes directly linked to a survival outcome can generate useful scientific implications. In this work, we develop a latent class proportional hazards (PH) regression framework to address such an interest. We propose mixture proportional hazards modeling, which flexibly accommodates class-specific covariate effects while allowing for the baseline hazard function to vary across latent classes. Adapting the strategy of nonparametric maximum likelihood estimation, we derive an Expectation-Maximization (E-M) algorithm to estimate the proposed model. We establish the theoretical properties of the resulting estimators. Extensive simulation studies are conducted, demonstrating satisfactory finite-sample performance of the proposed method as well as the predictive benefit from accounting for the heterogeneity across latent classes. We further illustrate the practical utility of the proposed method through an application to a mild cognitive impairment (MCI) cohort in the Uniform Data Set.
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Affiliation(s)
- Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, Fl 3, New York, New York 10017, U.S.A
| | - John J Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
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Wang X, Ye T, Zhou W, Zhang J. Uncovering heterogeneous cognitive trajectories in mild cognitive impairment: a data-driven approach. Alzheimers Res Ther 2023; 15:57. [PMID: 36941651 PMCID: PMC10026406 DOI: 10.1186/s13195-023-01205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Given the complex and progressive nature of mild cognitive impairment (MCI), the ability to delineate and understand the heterogeneous cognitive trajectories is crucial for developing personalized medicine and informing trial design. The primary goals of this study were to examine whether different cognitive trajectories can be identified within subjects with MCI and, if present, to characterize each trajectory in relation to changes in all major Alzheimer's disease (AD) biomarkers over time. METHODS Individuals with a diagnosis of MCI at the first visit and ≥ 1 follow-up cognitive assessment were selected from the Alzheimer's Disease Neuroimaging Initiative database (n = 936; age 73 ± 8; 40% female; 16 ± 3 years of education; 50% APOE4 carriers). Based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale-13 (ADAS-Cog-13) total scores from baseline up to 5 years follow-up, a non-parametric k-means longitudinal clustering method was performed to obtain clusters of individuals with similar patterns of cognitive decline. We further conducted a series of linear mixed-effects models to study the associations of cluster membership with longitudinal changes in other cognitive measures, neurodegeneration, and in vivo AD pathologies. RESULTS Four distinct cognitive trajectories emerged. Cluster 1 consisted of 255 individuals (27%) with a nearly non-existent rate of change in the ADAS-Cog-13 over 5 years of follow-up and a healthy-looking biomarker profile. Individuals in the cluster 2 (n = 336, 35%) and 3 (n = 240, 26%) groups showed relatively mild and moderate cognitive decline trajectories, respectively. Cluster 4, comprising about 11% of our study sample (n = 105), exhibited an aggressive cognitive decline trajectory and was characterized by a pronouncedly abnormal biomarker profile. CONCLUSIONS Individuals with MCI show substantial heterogeneity in cognitive decline. Our findings may potentially contribute to improved trial design and patient stratification.
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Affiliation(s)
- Xiwu Wang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Teng Ye
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjun Zhou
- Research and Development, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
| | - Jie Zhang
- Department of Data Science, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
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Fei T, Hanfelt J, Peng L. Evaluating the association between latent classes and competing risks outcomes with multiphenotype data. Biometrics 2023; 79:488-501. [PMID: 34532859 PMCID: PMC8926941 DOI: 10.1111/biom.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
Latent class analysis is an intuitive tool to characterize disease phenotype heterogeneity. With data more frequently collected on multiple phenotypes in chronic disease studies, it is of rising interest to investigate how the latent classes embedded in one phenotype are related to another phenotype. Motivated by a cohort with mild cognitive impairment (MCI) from the Uniform Data Set (UDS), we propose and study a time-dependent structural model to evaluate the association between latent classes and competing risk outcomes that are subject to missing failure types. We develop a two-step estimation procedure which circumvents latent class membership assignment and is rigorously justified in terms of accounting for the uncertainty in classifying latent classes. The new method also properly addresses the realistic complications for competing risks outcomes, including random censoring and missing failure types. The asymptotic properties of the resulting estimator are established. Given that the standard bootstrapping inference is not feasible in the current problem setting, we develop analytical inference procedures, which are easy to implement. Our simulation studies demonstrate the advantages of the proposed method over benchmark approaches. We present an application to the MCI data from UDS, which uncovers a detailed picture of the neuropathological relevance of the baseline MCI subgroups.
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Affiliation(s)
- Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, New York, 10017, U.S.A
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
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Anda-Duran ID, Kolachalama VB, Carmichael OT, Hwang PH, Fernandez C, Au R, Bazzano LA, Libon DJ. Midlife Neuropsychological Profiles and Associated Vascular Risk: The Bogalusa Heart Study. J Alzheimers Dis 2023; 94:101-113. [PMID: 37212094 PMCID: PMC10443183 DOI: 10.3233/jad-220931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease (AD) often present with coexisting vascular pathology that is expressed to different degrees and can lead to clinical heterogeneity. OBJECTIVE To examine the utility of unsupervised statistical clustering approaches in identifying neuropsychological (NP) test performance subtypes that closely correlate with carotid intima-media thickness (cIMT) in midlife. METHODS A hierarchical agglomerative and k-means clustering analysis based on NP scores (standardized for age, sex, and race) was conducted among 1,203 participants (age 48±5.3 years) from the Bogalusa Heart Study. Regression models assessed the association between cIMT ≥50th percentile and NP profiles, and global cognitive score (GCS) tertiles for sensitivity analysis. RESULTS Three NP profiles were identified: Mixed-low performance [16%, n = 192], scores ≥1 SD below the mean on immediate, delayed free recall, recognition verbal memory, and information processing; Average [59%, n = 704]; and Optimal [26%, n = 307] NP performance. Participants with greater cIMT were more likely to have a Mixed-low profile [OR = 3.10, 95% CI (2.13, 4.53), p < 0.001] compared to Optimal. After adjusting for education and cardiovascular (CV) risks, results remained. The association with GCS tertiles was more attenuated [lowest (34%, n = 407) versus highest (33%, n = 403) tertile: adjusted OR = 1.66, 95% CI (1.07, 2.60), p = 0.024]. CONCLUSION As early as midlife, individuals with higher subclinical atherosclerosis were more likely to be in the Mixed-low profile, underscoring the potential malignancy of CV risk as related to NP test performance, suggesting that classification approaches may aid in identifying those at risk for AD/vascular dementia spectrum illness.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Owen T. Carmichael
- Louisiana State University’s Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Center, Boston, MA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David J. Libon
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
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Qiu J, Goldstein FC, Hanfelt JJ. An Exploration of Subgroups of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Their Risks of Conversion to Dementia or Death. Am J Geriatr Psychiatry 2022; 30:925-934. [PMID: 35067420 PMCID: PMC9250542 DOI: 10.1016/j.jagp.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore the heterogeneity of neuropsychiatric symptom (NPS) complexes in individuals with mild cognitive impairment (MCI) and assess the relative risks of converting to dementia or dying. DESIGN Latent class analysis using 7,971 participants with MCI. SETTING Participants in the Uniform Data Set (UDS) from 39 NIH Alzheimer's Disease Centers. PARTICIPANTS Persons with a diagnosis of MCI at initial visit from each center and with either a Mini-Mental State Examination (MMSE) score of 22 or greater or an equivalent education-adjusted Montreal Cognitive Assessment (MoCA) score of 16 or greater. MEASUREMENTS Neuropsychiatric Inventory Questionnaire (NPI-Q) administered at initial visit. RESULTS In addition to a subgroup with mild or no NPS (relative frequency, 50%), three empirically-based subgroups of NPS were identified: 1) an "affect" or "negative mood" subgroup (27%) with depression, anxiety, apathy, nighttime disturbance, and change in appetite; 2) a "hyperactive" subgroup (14%) with agitation, irritability, and disinhibition; and 3) a "psychotic with additional severe NPS" subgroup (9%) with the highest risk of delusions and hallucinations, as well as highest risk of all other NPS. Each of these three subgroups had significantly higher risk of converting to dementia than the "mild NPS" class, with the "psychotic with additional severe NPS" subgroup possessing a 64% greater risk. The subgroups did not differ in their risks of death without dementia. CONCLUSION Our findings of three NPS subgroups in MCI characterized by affect, hyperactive, or psychotic features are largely consistent with a previous 3-factor model of NPS found in a demented population. The consistency of these findings across studies and samples, coupled with our results on the associated risks of converting to dementia, suggests that the NPS structure is robust, and warrants further consideration in classification models of MCI.
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Affiliation(s)
- Jiayue Qiu
- School of Dental Medicine, University of Pennsylvania
| | - Felicia C. Goldstein
- Department of Neurology, Emory University School of Medicine,Goizueta Alzheimer’s Disease Research Center, Emory University School of Medicine
| | - John J. Hanfelt
- Goizueta Alzheimer’s Disease Research Center, Emory University School of Medicine,Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health
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Devlin KN, Brennan L, Saad L, Giovannetti T, Hamilton RH, Wolk DA, Xie SX, Mechanic-Hamilton D. Diagnosing Mild Cognitive Impairment Among Racially Diverse Older Adults: Comparison of Consensus, Actuarial, and Statistical Methods. J Alzheimers Dis 2021; 85:627-644. [PMID: 34864658 DOI: 10.3233/jad-210455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Actuarial and statistical methods have been proposed as alternatives to conventional methods of diagnosing mild cognitive impairment (MCI), with the aim of enhancing diagnostic and prognostic validity, but have not been compared in racially diverse samples. OBJECTIVE We compared the agreement of consensus, actuarial, and statistical MCI diagnostic methods, and their relationship to race and prognostic indicators among diverse older adults. METHODS Participants (N = 354; M age = 71; 68% White, 29% Black) were diagnosed with MCI or normal cognition (NC) according to clinical consensus, actuarial neuropsychological criteria (Jak/Bondi), and latent class analysis (LCA). We examined associations with race/ethnicity, longitudinal cognitive and functional change, and incident dementia. RESULTS MCI rates by consensus, actuarial criteria, and LCA were 44%, 53%, and 41%, respectively. LCA identified three MCI subtypes (memory; memory/language; memory/executive) and two NC classes (low normal; high normal). Diagnostic agreement was substantial, but agreement of the actuarial method with consensus and LCA was weaker than the agreement between consensus and LCA. Among cases classified as MCI by actuarial criteria only, Black participants were over-represented, and outcomes were generally similar to those of NC participants. Consensus diagnoses best predicted longitudinal outcomes overall, whereas actuarial diagnoses best predicted longitudinal functional change among Black participants. CONCLUSION Consensus diagnoses optimize specificity in predicting dementia, but among Black older adults, actuarial diagnoses may be more sensitive to early signs of decline. Results highlight the need for cross-cultural validity in MCI diagnosis and should be explored in community- and population-based samples.
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Affiliation(s)
- Kathryn N Devlin
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Laura Saad
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | | | - Roy H Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawn Mechanic-Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Khanthong P, Sriyakul K, Dechakhamphu A, Krajarng A, Kamalashiran C, Tungsukruthai P. Traditional Thai exercise (Ruesi Dadton) for improving motor and cognitive functions in mild cognitive impairment: a randomized controlled trial. J Exerc Rehabil 2021; 17:331-338. [PMID: 34805022 PMCID: PMC8566108 DOI: 10.12965/jer.2142542.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022] Open
Abstract
This study determined the effectiveness of a 12-week cycle of Ruesi Dadton (RSD) among older adults with mild cognitive impairment (MCI), for improving cognitive and physical performance. Seventy-six participants were included and were divided equally into two groups. A group performed RSD exercise for 60 min, 3 times/wk for 12 weeks, and the control group did not perform RSD exercise. The primary endpoint was cognitive function, as assessed by the Montreal cognitive assessment (MoCA), Mini-Mental State Examination, verbal fluency (VF) test, and trail making test parts A and B (TMT-A and TMT-B). The secondary endpoints were the Timed Up and Go (TUG) test, handgrip, and gait speed results, which were used to evaluate the physical function. There were significant differences in the TMT-B and handgrip scores (P<0.05) between the two groups. Both groups had improved MoCA scores (P<0.05) and normal walking speeds (P<0.01). Additionally, the RSD group showed improved VF test (P<0.01), TMT-B (P<0.01), and TUG test (P<0.05); a negative correlation was found between MoCA and TUG test (P<0.05). However, high walking speed and handgrip (P<0.05) worsened in the control group. RSD exercise resulted in relevant improvements in the cognitive and physical functions in MCI.
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Affiliation(s)
| | - Kusuma Sriyakul
- Chulabhorn International College of Medicine, Thammasat University, Klonglaung, Thailand
| | - Ananya Dechakhamphu
- Faculty of Thai Traditional Medicine and Alternative Medicine, Ubon Ratchathani Rajabhat University, Ubon Ratchathani, Thailand
| | - Aungkana Krajarng
- Chulabhorn International College of Medicine, Thammasat University, Klonglaung, Thailand
| | - Chuntida Kamalashiran
- Chulabhorn International College of Medicine, Thammasat University, Klonglaung, Thailand
| | - Parunkul Tungsukruthai
- Chulabhorn International College of Medicine, Thammasat University, Klonglaung, Thailand
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Edmonds EC, Smirnov DS, Thomas KR, Graves LV, Bangen KJ, Delano-Wood L, Galasko DR, Salmon DP, Bondi MW. Data-Driven vs Consensus Diagnosis of MCI: Enhanced Sensitivity for Detection of Clinical, Biomarker, and Neuropathologic Outcomes. Neurology 2021; 97:e1288-e1299. [PMID: 34376506 PMCID: PMC8480404 DOI: 10.1212/wnl.0000000000012600] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given prior work demonstrating that mild cognitive impairment (MCI) can be empirically differentiated into meaningful cognitive subtypes, we applied actuarial methods to comprehensive neuropsychological data from the University of California San Diego Alzheimer's Disease Research Center (ADRC) in order to identify cognitive subgroups within ADRC participants without dementia and to examine cognitive, biomarker, and neuropathologic trajectories. METHODS Cluster analysis was performed on baseline neuropsychological data (n = 738; mean age 71.8). Survival analysis examined progression to dementia (mean follow-up 5.9 years). CSF Alzheimer disease (AD) biomarker status and neuropathologic findings at follow-up were examined in a subset with available data. RESULTS Five clusters were identified: optimal cognitively normal (CN; n = 130) with above-average cognition, typical CN (n = 204) with average cognition, nonamnestic MCI (naMCI; n = 104), amnestic MCI (aMCI; n = 216), and mixed MCI (mMCI; n = 84). Progression to dementia differed across MCI subtypes (mMCI > aMCI > naMCI), with the mMCI group demonstrating the highest rate of CSF biomarker positivity and AD pathology at autopsy. Actuarial methods classified 29.5% more of the sample with MCI and outperformed consensus diagnoses in capturing those who had abnormal biomarkers, progressed to dementia, or had AD pathology at autopsy. DISCUSSION We identified subtypes of MCI and CN with differing cognitive profiles, clinical outcomes, CSF AD biomarkers, and neuropathologic findings over more than 10 years of follow-up. Results demonstrate that actuarial methods produce reliable cognitive phenotypes, with data from a subset suggesting unique biological and neuropathologic signatures. Findings indicate that data-driven algorithms enhance diagnostic sensitivity relative to consensus diagnosis for identifying older adults at risk for cognitive decline.
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Affiliation(s)
- Emily C Edmonds
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla.
| | - Denis S Smirnov
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Kelsey R Thomas
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa V Graves
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Katherine J Bangen
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa Delano-Wood
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Douglas R Galasko
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - David P Salmon
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Mark W Bondi
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
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10
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Valero S, Marquié M, De Rojas I, Espinosa A, Moreno-Grau S, Orellana A, Montrreal L, Hernández I, Mauleón A, Rosende-Roca M, Alegret M, Pérez-Cordón A, Ortega G, Roberto N, Sanabria A, Abdelnour C, Gil S, Tartari JP, Vargas L, Esteban-De Antonio E, Benaque A, Tárraga L, Boada M, Ruíz A. Interaction of neuropsychiatric symptoms with APOE ε4 and conversion to dementia in MCI patients in a Memory Clinic. Sci Rep 2020; 10:20058. [PMID: 33208795 PMCID: PMC7674479 DOI: 10.1038/s41598-020-77023-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/04/2020] [Indexed: 11/09/2022] Open
Abstract
To date, very few studies have been focused on the impact of the convergence of neuropsychiatric symptoms (NPS) and APOE ε4 on the conversion to dementia in patients with Mild Cognitive Impairment patients (MCI), and none has been based in a clinical setting. The objective of the study is to determine the predictive value of additive and multiplicative interactions of NPS and APOE ε4 status on the prediction of incident dementia among MCI patients monitored in a Memory Clinic. 1512 patients (aged 60 and older) with prevalent MCI were followed for a mean of 2 years. Neuropsychiatric symptoms were assessed at baseline using the Neuropsychiatric Inventory Questionnaire. Cox proportional hazards models were calculated. Additive interactions for depression, apathy, anxiety, agitation, appetite, or irritability and a positive ε4 carrier status were obtained, significantly increasing the hazard ratios of incident dementia (HR range 1.3-2.03). Synergistic interactions between NPS and APOE ε4 are identified among MCI patients when predicting incident dementia. The combination of the behavioral status and the genetic trait could be considered a useful strategy to identify the most vulnerable MCI patients to dementia conversion in a Memory Clinic.
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Affiliation(s)
- Sergi Valero
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain.
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Marquié
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar De Rojas
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Ana Espinosa
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Moreno-Grau
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Adelina Orellana
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Montrreal
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Mauleón
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Maitée Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Montse Alegret
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Pérez-Cordón
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Roberto
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Angela Sanabria
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Silvia Gil
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Juan Pablo Tartari
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Liliana Vargas
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Ester Esteban-De Antonio
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Alba Benaque
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruíz
- Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Gran Via Carles III, 85 bis., 08028, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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11
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Goldstein FC, Loring DW, Thomas T, Saleh S, Hajjar I. Recognition Memory Performance as a Cognitive Marker of Prodromal Alzheimer's Disease. J Alzheimers Dis 2020; 72:507-514. [PMID: 31594225 DOI: 10.3233/jad-190468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The utility of recognition memory for identifying persons with biomarker evidence of Alzheimer's disease (AD) is unclear since prior studies of mild cognitive impairment (MCI) relied only on clinical diagnosis and did not include simultaneous measures of central amyloidosis and tauopathy. OBJECTIVE We evaluated whether recognition memory and associated indices, including discriminability and response bias from signal detection theory, differentiate persons with amnestic MCI (aMCI) due to prodromal AD from non-prodromal AD. METHOD Sixty older adults with aMCI were classified as prodromal AD (n = 28) or non-prodromal AD (n = 32) based upon cerebrospinal fluid levels of amyloid-β and tau. Memory was assessed using the Hopkins Verbal Learning Test-Revised which includes free recall and recognition. RESULTS ANCOVAs adjusting for age indicated comparable (all p > 0.05) performances between prodromal and non-prodromal MCI groups respectively on traditional HVLT-R recognition measures of hits (mean±SD: 9.5±3.0 versus 10.9±1.7), false alarms (1.8±1.8 versus 1.5±1.5), and hits minus false alarms (7.7±3.0 versus 9.2±2.6). In contrast, discriminability (d'), which reflects how easily targets and distractors are distinguished, was significantly (p = 0.009) poorer in the prodromal versus non-prodromal groups (3.1±1.9 versus 4.8±2.0, effect size = 0.87). In addition, only d' significantly predicted group membership (OR = 0.66, CI = 0.48-0.92, p = 0.04). Response bias, the tendency to report that a target did or did not appear, was comparable between groups (0.08±1.1 versus -0.04±1.3). CONCLUSION Recognition discriminability is significantly poorer in aMCI with biomarker evidence of prodromal AD. In contrast to traditional recognition indices, discriminability from signal detection theory may be superior in identifying aMCI due to AD versus non-AD etiologies.
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Affiliation(s)
| | - David W Loring
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Tiffany Thomas
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sabria Saleh
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Ihab Hajjar
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
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12
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S AA, Ranjan U, Sharma M, Dutt S. Identification of Patterns of Cognitive Impairment for Early Detection of Dementia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5498-5501. [PMID: 33019224 DOI: 10.1109/embc44109.2020.9175495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Early detection of dementia is crucial to devise effective interventions. Comprehensive cognitive tests, while being the most accurate means of diagnosis, are long and tedious, thus limiting their applicability to a large population, especially when periodic assessments are needed. The problem is compounded by the fact that people have differing patterns of cognitive impairment as they progress to different forms of dementia. This paper presents a novel scheme by which individual-specific patterns of impairment can be identified and used to devise personalized tests for periodic follow-up. Patterns of cognitive impairment are initially learned from a population cluster of combined normals and cognitively impaired subjects, using a set of standardized cognitive tests. Impairment patterns in the population are identified using a 2-step procedure involving an ensemble wrapper feature selection followed by cluster identification and analysis. These patterns have been shown to correspond to clinically accepted variants of Mild Cognitive Impairment (MCI), a prodrome of dementia. The learned clusters of patterns can subsequently be used to identify the most likely route of cognitive impairment, even for pre-symptomatic and apparently normal people. Baseline data of 24,000 subjects from the NACC database was used for the study.
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13
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Hart KR, Fei T, Hanfelt JJ. Scalable and robust latent trajectory class analysis using artificial likelihood. Biometrics 2020; 77:1118-1128. [PMID: 32896901 DOI: 10.1111/biom.13366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Latent trajectory class analysis is a powerful technique to elucidate the structure underlying population heterogeneity. The standard approach relies on fully parametric modeling and is computationally impractical when the data include a large collection of non-Gaussian longitudinal features. We introduce a new approach, the first based on artificial likelihood concepts, that avoids undue modeling assumptions and is computationally tractable. We show that this new method provides reliable estimates of the underlying population structure and is from 20 to 200 times faster than conventional methods when the longitudinal features are non-Gaussian. We apply the approach to explore subgroups among research participants in the early stages of neurodegeneration.
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Affiliation(s)
| | - Teng Fei
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - John J Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
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14
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Matsunaga S, Fujishiro H, Takechi H. Efficacy and Safety of Cholinesterase Inhibitors for Mild Cognitive Impairment:A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 71:513-523. [PMID: 31424411 DOI: 10.3233/jad-190546] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical benefit of cholinesterase inhibitors (ChEIs) for mild cognitive impairment (MCI) remains inconclusive. OBJECTIVE We performed a systematic review and meta-analysis of the efficacy/safety of ChEIs on subjects with MCI. METHODS We included randomized controlled trials (RCTs) of ChEIs in subjects with MCI, using cognitive function scores as a primary outcome measure. RESULTS Fourteen RCTs (six using donepezil, four using galantamine, and four using rivastigmine) with 5,278 subjects were included. We found no significant difference in cognitive function scores between the ChEIs and placebo groups [standardized mean difference (SMD) = -0.06, p = 0.38, I2 = 76% ]. However, in the secondary outcomes, ChEIs were associated with a lower incidence of progression to dementia compared with placebo (risk ratio = 0.76, the number needed to treat = 20). For safety outcomes, ChEIs were associated with a lower prevalence of fall than placebo. On the other hand, compared with placebo, ChEIs were associated with a higher incidence of discontinuation due to all causes, discontinuation due to adverse events, at least one adverse event, abnormal dreams, diarrhea, dizziness, headache, insomnia, loose stools, muscle cramps, nausea, vomiting, and weight loss. CONCLUSIONS Although ChEIs have a slight efficacy in the treatment of MCI, there are many safety issues. Therefore, ChEIs are difficult to recommend for MCI. However, the efficacy and safety of ChEIs on MCI with a biomarker-based diagnosis is unclear. Further RCTs are needed to confirm the efficacy and safety of ChEIs when used for individual neuropathological classifications of MCI.
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Affiliation(s)
- Shinji Matsunaga
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Kawasaki Memorial Hospital, Miyamae, Kawasaki, Kanagawa, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
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15
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Alves L, Cardoso S, Silva D, Mendes T, Marôco J, Nogueira J, Lima M, Tábuas-Pereira M, Baldeiras I, Santana I, de Mendonça A, Guerreiro M. Neuropsychological profile of amyloid-positive versus amyloid-negative amnestic Mild Cognitive Impairment. J Neuropsychol 2020; 15 Suppl 1:41-52. [PMID: 32588984 DOI: 10.1111/jnp.12218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/19/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of progressing to dementia. It became possible, through the use of biomarkers, to diagnose those patients with aMCI who have Alzheimer's disease. However, it is presently unfeasible that all patients undergo biomarker testing. Since neuropsychological testing is required to make a formal diagnosis of aMCI, it would be interesting if it could be used to predict the amyloid status of patients with aMCI. METHODS Participants with aMCI, known amyloid status (Aβ+ or Aβ-) and a comprehensive neuropsychological evaluation, were selected from the Cognitive Complaints Cohort database for this study. Neuropsychological tests were compared in Aβ+ and Aβ- aMCI patients. A binary logistic regression analysis was conducted to model the probability of being amyloid positive. RESULTS Of the 216 aMCI patients studied, 117 were Aβ+ and 99 were Aβ-. Aβ+ aMCI patients performed worse on several memory tests, namely Word Total Recall, Logical Memory Immediate and Delayed Free Recall, and Verbal Paired Associate Learning, as well as on Trail Making Test B, an executive function test. In a binary logistic regression model, only Logical Memory Delayed Free Recall retained significance, so that for each additional score point in this test, the probability of being amyloid positive decreased by 30.6%. The resulting model correctly classified 64.6% of the aMCI cases regarding their amyloid status. CONCLUSIONS The neuropsychological assessment remains an essential step to diagnose and characterize patients with aMCI; however, neuropsychological tests have limited value to distinguish the aMCI patients who have amyloid pathology from those who might suffer from other clinical conditions.
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Affiliation(s)
- Luísa Alves
- Chronic Diseases Research Centre, NOVA Medical School, NOVA University of Lisbon, Portugal
| | | | - Dina Silva
- Faculty of Medicine, University of Lisbon, Portugal.,Cognitive Neuroscience Research Group, Department of Psychology and Educational Sciences and Center for Biomedical Research (CBMR), Universidade do Algarve, Faro, Portugal
| | - Tiago Mendes
- Faculty of Medicine, University of Lisbon, Portugal.,Psychiatry and Mental Health Department, Santa Maria Hospital, Lisbon, Portugal
| | - João Marôco
- Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Joana Nogueira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Marisa Lima
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Inês Baldeiras
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
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16
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Picón E, Juncos-Rabadán O, Lojo-Seoane C, Campos-Magdaleno M, Mallo SC, Nieto-Vietes A, Pereiro AX, Facal D. Does Empirically Derived Classification of Individuals with Subjective Cognitive Complaints Predict Dementia? Brain Sci 2019; 9:brainsci9110314. [PMID: 31703450 PMCID: PMC6895967 DOI: 10.3390/brainsci9110314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Early identification of mild cognitive impairment (MCI) in people reporting subjective cognitive complaints (SCC) and the study of progression of cognitive decline are important issues in dementia research. This paper examines whether empirically derived procedures predict progression from MCI to dementia. (2) Methods: At baseline, 192 participants with SCC were diagnosed according to clinical criteria as cognitively unimpaired (70), single-domain amnestic MCI (65), multiple-domain amnestic MCI (33) and multiple-domain non-amnestic MCI (24). A two-stage hierarchical cluster analysis was performed for empirical classification. Categorical regression analysis was then used to assess the predictive value of the clusters obtained. Participants were re-assessed after 36 months. (3) Results: Participants were grouped into four empirically derived clusters: Cluster 1, similar to multiple-domain amnestic MCI; Cluster 2, characterized by subjective cognitive decline (SCD) but with low scores in language and working memory; Cluster 3, with specific deterioration in episodic memory, similar to single-domain amnestic MCI; and Cluster 4, with SCD but with scores above the mean in all domains. The majority of participants who progressed to dementia were included in Cluster 1. (4) Conclusions: Cluster analysis differentiated between MCI and SCD in a sample of people with SCC and empirical criteria were more closely associated with progression to dementia than standard criteria.
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Affiliation(s)
- Eduardo Picón
- Department of Methodology of Behavioral Sciences, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain;
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Cristina Lojo-Seoane
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Sabela C. Mallo
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Ana Nieto-Vietes
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - Arturo X. Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia, Spain; (O.J.-R.); (C.L.-S.); (M.C.-M.); (S.C.M.); (A.X.P.)
- Correspondence:
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17
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Mendes T, Cardoso S, Guerreiro M, Maroco J, Silva D, Alves L, Schmand B, Gerardo B, Lima M, Santana I, de Mendonça A. Can Subjective Memory Complaints Identify Aβ Positive and Aβ Negative Amnestic Mild Cognitive Impairment Patients? J Alzheimers Dis 2019; 70:1103-1111. [DOI: 10.3233/jad-190414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tiago Mendes
- Faculty of Medicine, University of Lisboa, Lisbon, Portugal
- Department of Psychiatry and Mental Health, Santa Maria Hospital, Lisbon, Portugal
| | - Sandra Cardoso
- Faculty of Medicine, University of Lisboa, Lisbon, Portugal
| | | | - João Maroco
- Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Dina Silva
- Faculty of Medicine, University of Lisboa, Lisbon, Portugal
- Department of Psychology and Educational Sciences and Centre for Biomedical Research (CBMR), Cognitive Neuroscience Research Group, Universidade do Algarve, Faro, Portugal
| | - Luísa Alves
- Chronic Diseases Research Centre, NOVA Medical School, NOVA University of Lisbon, Portugal
| | - Ben Schmand
- Faculty of Social and Behavioral Sciences, University of Amsterdam, the Netherlands
| | - Bianca Gerardo
- Neuropsychology Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Marisa Lima
- Neuropsychology Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Isabel Santana
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
- Neuropsychology Unit, Centro Hospitalar e Universitário de Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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18
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Tan EY, Köhler S, Hamel RE, Muñoz-Sánchez JL, Verhey FR, Ramakers IH. Depressive Symptoms in Mild Cognitive Impairment and the Risk of Dementia: A Systematic Review and Comparative Meta-Analysis of Clinical and Community-Based Studies. J Alzheimers Dis 2019; 67:1319-1329. [DOI: 10.3233/jad-180513] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Y.L. Tan
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
- Geestelijk Gezondheidszorg Eindhoven en de Kempen (GGzE), The Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | | | | | - Frans R.J. Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
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