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Wadu Mesthrige J, Oladinrin OT, Ojo LD. Critical Barriers of Using Smart Home Technologies (SHTs) to the Elderly in Hong Kong. JOURNAL OF AGING AND ENVIRONMENT 2022. [DOI: 10.1080/26892618.2022.2062805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jayantha Wadu Mesthrige
- School of Property Construction and Project Management, RMIT University, Melbourne, Australia
| | - Olugbenga Timo Oladinrin
- School of Architecture and Built Environment, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Lekan Damilola Ojo
- Department of Architecture and Civil Engineering, City University of Hong Kong, Kowloon Tong, Kowloon, Hong Kong
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2
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Majumder S, Deen MJ. Smartphone Sensors for Health Monitoring and Diagnosis. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2164. [PMID: 31075985 PMCID: PMC6539461 DOI: 10.3390/s19092164] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Abstract
Over the past few decades, we have witnessed a dramatic rise in life expectancy owing to significant advances in medical science and technology, medicine as well as increased awareness about nutrition, education, and environmental and personal hygiene. Consequently, the elderly population in many countries are expected to rise rapidly in the coming years. A rapidly rising elderly demographics is expected to adversely affect the socioeconomic systems of many nations in terms of costs associated with their healthcare and wellbeing. In addition, diseases related to the cardiovascular system, eye, respiratory system, skin and mental health are widespread globally. However, most of these diseases can be avoided and/or properly managed through continuous monitoring. In order to enable continuous health monitoring as well as to serve growing healthcare needs; affordable, non-invasive and easy-to-use healthcare solutions are critical. The ever-increasing penetration of smartphones, coupled with embedded sensors and modern communication technologies, make it an attractive technology for enabling continuous and remote monitoring of an individual's health and wellbeing with negligible additional costs. In this paper, we present a comprehensive review of the state-of-the-art research and developments in smartphone-sensor based healthcare technologies. A discussion on regulatory policies for medical devices and their implications in smartphone-based healthcare systems is presented. Finally, some future research perspectives and concerns regarding smartphone-based healthcare systems are described.
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Affiliation(s)
- Sumit Majumder
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - M Jamal Deen
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
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3
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Borelli E, Paolini G, Antoniazzi F, Barbiroli M, Benassi F, Chesani F, Chiari L, Fantini M, Fuschini F, Galassi A, Giacobone GA, Imbesi S, Licciardello M, Loreti D, Marchi M, Masotti D, Mello P, Mellone S, Mincolelli G, Raffaelli C, Roffia L, Salmon Cinotti T, Tacconi C, Tamburini P, Zoli M, Costanzo A. HABITAT: An IoT Solution for Independent Elderly. SENSORS 2019; 19:s19051258. [PMID: 30871107 PMCID: PMC6427271 DOI: 10.3390/s19051258] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
Abstract
In this work, a flexible and extensive digital platform for Smart Homes is presented, exploiting the most advanced technologies of the Internet of Things, such as Radio Frequency Identification, wearable electronics, Wireless Sensor Networks, and Artificial Intelligence. Thus, the main novelty of the paper is the system-level description of the platform flexibility allowing the interoperability of different smart devices. This research was developed within the framework of the operative project HABITAT (Home Assistance Based on the Internet of Things for the Autonomy of Everybody), aiming at developing smart devices to support elderly people both in their own houses and in retirement homes, and embedding them in everyday life objects, thus reducing the expenses for healthcare due to the lower need for personal assistance, and providing a better life quality to the elderly users.
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Affiliation(s)
- Elena Borelli
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | - Giacomo Paolini
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Francesco Antoniazzi
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
- INFN CNAF-Italian Institute for Nuclear Physics for the Research and Development in Information and Communication Technologies, 40127 Bologna, Italy.
| | - Marina Barbiroli
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Francesca Benassi
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Federico Chesani
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
| | - Lorenzo Chiari
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | | | - Franco Fuschini
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Andrea Galassi
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
| | | | - Silvia Imbesi
- TekneHub, University of Ferrara, 44122 Ferrara, Italy.
| | - Melissa Licciardello
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Daniela Loreti
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | | | - Diego Masotti
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Paola Mello
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
| | - Sabato Mellone
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | | | - Carla Raffaelli
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Luca Roffia
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
| | - Tullio Salmon Cinotti
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DISI-Department of Computer Science and Engineering, University of Bologna, 40126 Bologna, Italy.
- ARCES-Advanced Research Center on Electronic Systems "Ercole De Castro", University of Bologna, 40125 Bologna, Italy.
| | - Carlo Tacconi
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | - Paola Tamburini
- CIRI-Health Sciences & Technologies, University of Bologna, 40126 Bologna, Italy.
| | - Marco Zoli
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Alessandra Costanzo
- CIRI-Information and Communication Technologies, University of Bologna, 40126 Bologna, Italy.
- DEI-Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
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Montero-Odasso M, Pieruccini-Faria F, Bartha R, Black SE, Finger E, Freedman M, Greenberg B, Grimes DA, Hegele RA, Hudson C, Kleinstiver PW, Lang AE, Masellis M, McLaughlin PM, Munoz DP, Strother S, Swartz RH, Symons S, Tartaglia MC, Zinman L, Strong MJ, McIlroy W. Motor Phenotype in Neurodegenerative Disorders: Gait and Balance Platform Study Design Protocol for the Ontario Neurodegenerative Research Initiative (ONDRI). J Alzheimers Dis 2018; 59:707-721. [PMID: 28671116 PMCID: PMC5523841 DOI: 10.3233/jad-170149] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The association of cognitive and motor impairments in Alzheimer’s disease and other neurodegenerative diseases is thought to be related to damage in the common brain networks shared by cognitive and cortical motor control processes. These common brain networks play a pivotal role in selecting movements and postural synergies that meet an individual’s needs. Pathology in this “highest level” of motor control produces abnormalities of gait and posture referred to as highest-level gait disorders. Impairments in cognition and mobility, including falls, are present in almost all neurodegenerative diseases, suggesting common mechanisms that still need to be unraveled. Objective: To identify motor-cognitive profiles across neurodegenerative diseases in a large cohort of patients. Methods: Cohort study that includes up to 500 participants, followed every year for three years, across five neurodegenerative disease groups: Alzheimer’s disease/mild cognitive impairment, frontotemporal degeneration, vascular cognitive impairment, amyotrophic lateral sclerosis, and Parkinson’s disease. Gait and balance will be assessed using accelerometers and electronic walkways, evaluated at different levels of cognitive and sensory complexity, using the dual-task paradigm. Results: Comparison of cognitive and motor performances across neurodegenerative groups will allow the identification of motor-cognitive phenotypes through the standardized evaluation of gait and balance characteristics. Conclusions: As part of the Ontario Neurodegenerative Research Initiative (ONDRI), the gait and balance platform aims to identify motor-cognitive profiles across neurodegenerative diseases. Gait assessment, particularly while dual-tasking, will help dissect the cognitive and motor contribution in mobility and cognitive decline, progression to dementia syndromes, and future adverse outcomes including falls and mortality.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Frederico Pieruccini-Faria
- Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Sandra E Black
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery Sunnybrook Site, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Morris Freedman
- Department of Medicine (Neurology), Baycrest Health Sciences and University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, ON, Canada
| | - Barry Greenberg
- Toronto Dementia Research Alliance, University Health Network, Toronto, ON, Canada
| | - David A Grimes
- Department of Medicine, The Ottawa Hospital, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert A Hegele
- Department of Biochemistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Christopher Hudson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Peter W Kleinstiver
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and the Department of Medicine, University of Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Paula M McLaughlin
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Stephen Strother
- Department of Medical Biophysics, Rotman Research Institute, Baycrest, University of Toronto, ON, Canada
| | - Richard H Swartz
- Sunnybrook Health Sciences Centre, University of Toronto, Stroke Research Program, Toronto, ON, Canada
| | - Sean Symons
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Department of Medicine and Division of Neurology, University of Toronto, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, ON, Canada
| | - Lorne Zinman
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Michael J Strong
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Department of Medicine (Neurology), Baycrest Health Sciences and University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, ON, Canada
| | | | - William McIlroy
- Canadian Partnership for Stroke Recovery Sunnybrook Site, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and the Department of Medicine, University of Toronto, ON, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Majumder S, Aghayi E, Noferesti M, Memarzadeh-Tehran H, Mondal T, Pang Z, Deen MJ. Smart Homes for Elderly Healthcare-Recent Advances and Research Challenges. SENSORS 2017; 17:s17112496. [PMID: 29088123 PMCID: PMC5712846 DOI: 10.3390/s17112496] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/08/2017] [Accepted: 10/23/2017] [Indexed: 01/21/2023]
Abstract
Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies.
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Affiliation(s)
- Sumit Majumder
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Emad Aghayi
- Department of Network Science and Technology, Faculty of New Sciences and Technologies, University of Tehran, Tehran 141746-6191, Iran.
| | - Moein Noferesti
- Department of Network Science and Technology, Faculty of New Sciences and Technologies, University of Tehran, Tehran 141746-6191, Iran.
| | - Hamidreza Memarzadeh-Tehran
- Department of Network Science and Technology, Faculty of New Sciences and Technologies, University of Tehran, Tehran 141746-6191, Iran.
| | - Tapas Mondal
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Zhibo Pang
- ABB Corporate Research, 721 78 Vasteras, Sweden.
| | - M Jamal Deen
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada.
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6
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Montero-Odasso M, Bherer L, Studenski S, Gopaul K, Oteng-Amoako A, Woolmore-Goodwin S, Stoole P, Wells J, Doherty T, Zecevic AA, Galinsky D, Rylett RJ, Jutai J, Muir-Hunter S, Speechley M, Camicioli R. Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop. Can Geriatr J 2015; 18:159-67. [PMID: 26495050 PMCID: PMC4597816 DOI: 10.5770/cgj.18.188] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, ON; ; Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; ; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON
| | - Louis Bherer
- Department of Psychology and PERFORM Center, Concordia University, Montreal, QC
| | - Stephanie Studenski
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Bethesda, MA, USA
| | - Karen Gopaul
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, ON
| | - Afua Oteng-Amoako
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, ON
| | - Sarah Woolmore-Goodwin
- Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
| | - Paul Stoole
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON
| | - Jennie Wells
- Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
| | - Timothy Doherty
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON
| | | | | | - R Jane Rylett
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON
| | - Jeffrey Jutai
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON
| | - Susan Muir-Hunter
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, ON; ; School of Health Studies, University of Western Ontario, London, ON
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON
| | - Richard Camicioli
- Faculty of Medicine and Dentistry, Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB
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The neuroprotective role of metformin in advanced glycation end product treated human neural stem cells is AMPK-dependent. Biochim Biophys Acta Mol Basis Dis 2015; 1852:720-31. [PMID: 25595658 DOI: 10.1016/j.bbadis.2015.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 12/17/2022]
Abstract
Diabetic neuronal damage results from hyperglycemia followed by increased formation of advanced glycosylation end products (AGEs), which leads to neurodegeneration, although the molecular mechanisms are still not well understood. Metformin, one of the most widely used anti-diabetic drugs, exerts its effects in part by activation of AMP-activated protein kinase (AMPK). AMPK is a critical evolutionarily conserved enzyme expressed in the liver, skeletal muscle and brain, and promotes cellular energy homeostasis and biogenesis by regulating several metabolic processes. While the mechanisms of AMPK as a metabolic regulator are well established, the neuronal role for AMPK is still unknown. In the present study, human neural stem cells (hNSCs) exposed to AGEs had significantly reduced cell viability, which correlated with decreased AMPK and mitochondria associated gene/protein (PGC1α, NRF-1 and Tfam) expressions, as well as increased activation of caspase 3 and 9 activities. Metformin prevented AGEs induced cytochrome c release from mitochondria into cytosol in the hNSCs. Co-treatment with metformin significantly abrogated the AGE-mediated effects in hNSCs. Metformin also significantly rescued hNSCs from AGE-mediated mitochondrial deficiency (lower ATP, D-loop level, mitochondrial mass, maximal respiratory function, COX activity, and mitochondrial membrane potential). Furthermore, co-treatment of hNSCs with metformin significantly blocked AGE-mediated reductions in the expression levels of several neuroprotective genes (PPARγ, Bcl-2 and CREB). These findings extend our understanding of the molecular mechanisms of both AGE-induced neuronal toxicity, and AMPK-dependent neuroprotection by metformin. This study further suggests that AMPK may be a potential therapeutic target for treating diabetic neurodegeneration.
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Ravona-Springer R, Heymann A, Schmeidler J, Guerrero-Berroa E, Sano M, Preiss R, Koifman K, Hoffman H, Levy A, Silverman JM, Schnaider-Beeri M. Haptoglobin 1-1 genotype is associated with poorer cognitive functioning in the elderly with type 2 diabetes. Diabetes Care 2013; 36:3139-45. [PMID: 23990521 PMCID: PMC3781506 DOI: 10.2337/dc12-2250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Haptoglobin (Hp) genotype (Hp 1-1, 1-2, or 2-2) is associated with risk for type 2 diabetes complications, but its relationship with cognitive compromise, a growing concern in type 2 diabetes, has rarely been studied. This study investigated whether Hp genotype is associated with cognitive function in cognitively normal elderly diabetic subjects. RESEARCH DESIGN AND METHODS Relationships of Hp genotype with episodic memory, semantic categorization, attention/working memory and executive function, and an overall cognitive score were examined in subjects from the Israel Diabetes and Cognitive Decline (IDCD) study. RESULTS In the present analysis, 812 subjects participated (84 with Hp 1-1, 335 with Hp 1-2, and 393 with Hp 2-2 genotypes). Average was 72.9 years of age (SD 4.7), and Mini-Mental State Exam (MMSE) was 28.0 (SD 1.8). Compared with subjects with Hp 1-2 genotype, Hp 1-1 subjects performed significantly worse in semantic categorization (F=7.03; P=0.008) and the overall cognitive score (F=5.57; P=0.02). A separate stepwise multiple regression analysis demonstrated that compared with subjects with Hp 2-2 genotype, Hp 1-1 subjects performed significantly worse in semantic categorization (F=4.18; P=0.04) and the overall cognitive score (F=4.70; P=0.03). The contribution of cardiovascular risk factors to cognition was significantly higher in subjects with Hp 1-1 genotype compared with Hp 2 carriers (Hp 1-2 and Hp 2-2) in the semantic categorization (P=0.009) and attention/working memory (P=0.002) cognitive domains. CONCLUSIONS Compared with Hp 2 carriers, those with Hp 1-1 genotype present lower cognitive performance. Stronger relationships between cardiovascular risk factors and cognition in the latter group may suggest an underlying vascular mechanism.
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Chang XL, Zhou HQ, Lei CY, Wu B, Chen YC, Hao ZL, Dong W, Liu M. Association between asymptomatic carotid stenosis and cognitive function: A systematic review. Neurosci Biobehav Rev 2013; 37:1493-9. [DOI: 10.1016/j.neubiorev.2013.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022]
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10
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Moorhouse P, Mallery LH. Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults. J Am Geriatr Soc 2012; 60:2326-32. [PMID: 23110462 DOI: 10.1111/j.1532-5415.2012.04210.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Frail older adults face increasingly complex decisions regarding medical care. The Palliative and Therapeutic Harmonization (PATH) model provides a structured approach that places frailty at the forefront of medical and surgical decision-making in older adults. Preliminary data from the first 150 individuals completing the PATH program shows that the population served is frail (mean Clinical Frailty Score = 6.3), has multiple comorbidities (mean 8), and takes many medications (mean = 9). Ninety-two percent of participants were able to complete decision-making for an average of three current or projected health issues, most often (76.7%) with the help of a substitute decision-maker (SDM). Decisions to proceed with scheduled medical or surgical interventions correlated with baseline frailty level and dementia stage, with participants with a greater degree of frailty (odds ratio (OR) = 3.41, 95% confidence interval (CI) = 1.39-8.38) or more-advanced stage of dementia (OR = 1.66, 95% CI = 1.06-2.65) being more likely to choose less-aggressive treatment options. Although the PATH model is in the development stage, further evaluation is ongoing, including a qualitative analysis of the SDM experience of PATH and an assessment of the effectiveness of PATH in long-term care. The results of these studies will inform the design of a larger randomized controlled trial.
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Affiliation(s)
- Paige Moorhouse
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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11
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Ravona-Springer R, Schnaider-Beeri M. The association of diabetes and dementia and possible implications for nondiabetic populations. Expert Rev Neurother 2012; 11:1609-17. [PMID: 22014139 DOI: 10.1586/ern.11.152] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetes and prediabetic states have consistently been shown to be risk factors for cognitive decline, mild cognitive impairment and dementia. The importance of these findings is that diabetes and diabetes-related factors are modifiable, potentially permitting interventions aimed at postponing or preventing dementia. However, diabetes control cannot yet be implemented universally in diabetic subjects as a strategy for dementia prevention since the mechanisms by which diabetes impairs brain function and cognition are not fully understood. It is not clear which of the diabetes-related factors is crucial to this relationship. In addition, strict diabetic control has been demonstrated to carry risk for certain diabetic populations. The aim of the current article is to discuss current understanding of the relationships of diabetes and some of its characteristics with dementia, and suggest future questions to be answered.
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Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, García-García R, Escribano-Hernández A, García-Ortiz L, Perea-Bartolomé MV, Gómez-Marcos MA. Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study. BMC Neurol 2011; 11:147. [PMID: 22093337 PMCID: PMC3226440 DOI: 10.1186/1471-2377-11-147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/17/2011] [Indexed: 11/27/2022] Open
Abstract
Background Few data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors. Methods Design: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia. Results The prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk. Conclusions The observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.
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Affiliation(s)
- Emiliano Rodríguez-Sánchez
- Primary care research unit of La Alamedilla Health Center, Castilla y León Health Service- SACYL, Salamanca, Spain.
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Cong WN, Golden E, Pantaleo N, White CM, Maudsley S, Martin B. Ghrelin receptor signaling: a promising therapeutic target for metabolic syndrome and cognitive dysfunction. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2011; 9:557-63. [PMID: 20632971 DOI: 10.2174/187152710793361513] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 02/25/2010] [Indexed: 02/05/2023]
Abstract
The neuroendocrine hormone ghrelin is an octanoylated 28-residue peptide that exerts numerous physiological functions. Ghrelin exerts its effects on the body mainly through a highly conserved G protein-coupled receptor known as the growth hormone secretagagogue receptor subtype 1a (GHS-R1a). Ghrelin and GSH-R1a are widely expressed in both peripheral and central tissues/organs, and ghrelin signaling plays a critical role in maintaining energy balance and neuronal health. The multiple orexigenic effects of ghrelin and its receptor have been studied in great detail, and GHS-R1a-mediated ghrelin signaling has long been a promising target for the treatment of metabolic disorders, such as obesity. In addition to its well-characterized metabolic effects, there is also mounting evidence that ghrelin-mediated GHS-R1a signaling exerts neuroprotective effects on the brain. In this review, we will summarize some of the effects of ghrelin-mediated GSH-R1a signaling on peripheral energy balance and cognitive function. We will also discuss the potential pharmacotherapeutic role of GSH-R1a-mediated ghrelin signaling for the treatment of complex neuroendocrine disorders.
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Affiliation(s)
- Wei-na Cong
- Metabolism Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD 21224, USA
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Brown CA. Pain in communication impaired residents with dementia: Analysis of Resident Assessment Instrument (RAI) data. DEMENTIA 2010. [DOI: 10.1177/1471301210375337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pain has been identified as a significant and under-reported problem in the older adult and those persons with dementia who may face an impaired ability to communicate that they are in pain. Their pain, under-diagnosed and under-treated, has functional implications, such as decreased ambulation, mood and sleep disturbances, impaired appetite and exacerbation of cognitive functioning. Methods: Resident Assessment Instrument (RAI) data were analyzed in order to 1) identify a pain profile of all of the residents living in the facility across two sampling periods (December 2005 and December 2006) and 2) compare the pain profile of residents categorized into two subgroups (intact communication/impaired communication). Findings: Consistent with the literature, clear differences were demonstrated between pain reporting and management for communication impaired residents with dementia and residents with intact communication. Several incongruent findings were also demonstrated. Conclusions: The RAI is useful to identify patterns but insufficient in itself for pain management purposes in this vulnerable group. Pain assessment tools developed for this population must be employed.
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Ravona-Springer R, Luo X, Schmeidler J, Wysocki M, Lesser G, Rapp M, Dahlman K, Grossman H, Haroutunian V, Schnaider Beeri M. Diabetes is associated with increased rate of cognitive decline in questionably demented elderly. Dement Geriatr Cogn Disord 2010; 29:68-74. [PMID: 20130405 PMCID: PMC2840245 DOI: 10.1159/000265552] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2009] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study examines whether the association of diabetes with the rate of cognitive decline varies according to dementia severity. METHODS Longitudinal study on subjects residing in nursing homes and assisted living (n = 342). The Mini Mental State Examination (MMSE) was used to measure the rate of cognitive decline in diabetic and nondiabetic subjects who were nondemented (Clinical Dementia Rating, CDR = 0; n = 125), questionably demented (CDR = 0.5; n = 58) or frankly demented (CDR > or =1; n = 89) at baseline. Diagnosis of diabetes was ascertained by review of medical records and history. RESULTS Diabetes was associated with an increased rate of decline in the MMSE score of questionably demented subjects (p < 0.0001). In frankly demented subjects, diabetes tended to be associated with less cognitive decline (p = 0.04). Diabetes was not associated with the rate of MMSE decline in nondemented subjects (p = 0.89). CONCLUSION In individuals with questionable dementia (CDR = 0.5), diabetes is associated with a faster rate of cognitive decline as measured by the MMSE, but not in nondemented (CDR = 0) or frankly demented (CDR > or =1) individuals.
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Affiliation(s)
| | - Xiaodong Luo
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - James Schmeidler
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Michael Wysocki
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | | | - Michael Rapp
- Department of Psychiatry, Campus Charité Mitte, Humboldt University, Berlin, Germany
| | - Karen Dahlman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Hillel Grossman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Vahram Haroutunian
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
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Montero-Odasso M, Wells JL, Borrie MJ, Speechley M. Can cognitive enhancers reduce the risk of falls in older people with mild cognitive impairment? A protocol for a randomised controlled double blind trial. BMC Neurol 2009; 9:42. [PMID: 19674471 PMCID: PMC3224736 DOI: 10.1186/1471-2377-9-42] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 08/12/2009] [Indexed: 11/17/2022] Open
Abstract
Background Older adults with cognitive problems have a higher risk of falls, at least twice that of cognitively normal older adults. The consequences of falls in this population are very serious: fallers with cognitive problems suffer more injuries due to falls and are approximately five times more likely to be admitted to institutional care. Although the mechanisms of increased fall risk in cognitively impaired people are not completely understood, it is known that impaired cognitive abilities can reduce attentional resource allocation while walking. Since cognitive enhancers, such as cholinesterase inhibitors, improve attention and executive function, we hypothesise that cognitive enhancers may reduce fall risk in elderly people in the early stages of cognitive decline by improving their gait and balance performance due to an enhancement in attention and executive function. Method/Design Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls. Discussion By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia. Trial Registration The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 http://www.clinicaltrials.gov
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, University of Western Ontario, London, ON, Canada.
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S Roriz-Filho J, Sá-Roriz TM, Rosset I, Camozzato AL, Santos AC, Chaves MLF, Moriguti JC, Roriz-Cruz M. (Pre)diabetes, brain aging, and cognition. Biochim Biophys Acta Mol Basis Dis 2008; 1792:432-43. [PMID: 19135149 DOI: 10.1016/j.bbadis.2008.12.003] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 12/08/2008] [Accepted: 12/08/2008] [Indexed: 12/14/2022]
Abstract
Cognitive dysfunction and dementia have recently been proven to be common (and underrecognized) complications of diabetes mellitus (DM). In fact, several studies have evidenced that phenotypes associated with obesity and/or alterations on insulin homeostasis are at increased risk for developing cognitive decline and dementia, including not only vascular dementia, but also Alzheimer's disease (AD). These phenotypes include prediabetes, diabetes, and the metabolic syndrome. Both types 1 and 2 diabetes are also important risk factors for decreased performance in several neuropsychological functions. Chronic hyperglycemia and hyperinsulinemia primarily stimulates the formation of Advanced Glucose Endproducts (AGEs), which leads to an overproduction of Reactive Oxygen Species (ROS). Protein glycation and increased oxidative stress are the two main mechanisms involved in biological aging, both being also probably related to the etiopathogeny of AD. AD patients were found to have lower than normal cerebrospinal fluid levels of insulin. Besides its traditional glucoregulatory importance, insulin has significant neurothrophic properties in the brain. How can clinical hyperinsulinism be a risk factor for AD whereas lab experiments evidence insulin to be an important neurothrophic factor? These two apparent paradoxal findings may be reconciliated by evoking the concept of insulin resistance. Whereas insulin is clearly neurothrophic at moderate concentrations, too much insulin in the brain may be associated with reduced amyloid-beta (Abeta) clearance due to competition for their common and main depurative mechanism - the Insulin-Degrading Enzyme (IDE). Since IDE is much more selective for insulin than for Abeta, brain hyperinsulinism may deprive Abeta of its main clearance mechanism. Hyperglycemia and hyperinsulinemia seems to accelerate brain aging also by inducing tau hyperphosphorylation and amyloid oligomerization, as well as by leading to widespread brain microangiopathy. In fact, diabetes subjects are more prone to develop extense and earlier-than-usual leukoaraiosis (White Matter High-Intensity Lesions - WMHL). WMHL are usually present at different degrees in brain scans of elderly people. People with more advanced WMHL are at increased risk for executive dysfunction, cognitive impairment and dementia. Clinical phenotypes associated with insulin resistance possibly represent true clinical models for brain and systemic aging.
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Affiliation(s)
- Jarbas S Roriz-Filho
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo-RP, Brazil
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Asakawa K, Rolfson D, Senthilselvan A, Feeny D, Johnson JA. Health Utilities Index Mark 3 showed valid in Alzheimer disease, arthritis, and cataracts. J Clin Epidemiol 2008; 61:733-9. [PMID: 18359192 DOI: 10.1016/j.jclinepi.2007.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 09/20/2007] [Accepted: 09/23/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the cross-sectional construct validity of the Health Utilities Index Mark 3 (HUI3) in Alzheimer disease (AD), arthritis (AR), and cataracts (CA). STUDY DESIGN AND SETTING The 1996-97 Canadian National Population Health Survey for community and institution-dwelling respondents aged 40 years and above was used in the study. Adjusted means for overall and single-attribute HUI3 scores of five subgroups were compared: (1) AD only, (2) AR only, (3) CA only, (4) at least two of the three conditions, and (5) none of the three (reference group). Regression analyses were conducted for community and institutional data to obtain adjusted mean utility scores. RESULTS Of the 76 a priori hypotheses, 55 were confirmed. HUI3 was able to describe overall burdens of AD, AR, and CA as well as vision problems associated with CA, speech and cognition problems associated with AD, and ambulation and pain problems associated with AR. Adjusted mean differences in overall HUI3 scores between AD, AR, or CA only groups and reference group ranged from -0.04 to -0.42 (P<0.05); all differences were quantitatively important. CONCLUSION HUI3 is useful in assessing the health-related quality of life of AD, AR, and CA of those living in the community and institutions.
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Affiliation(s)
- Keiko Asakawa
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes--systematic overview of prospective observational studies. Diabetologia 2005; 48:2460-9. [PMID: 16283246 DOI: 10.1007/s00125-005-0023-4] [Citation(s) in RCA: 663] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 07/21/2005] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS We systematically reviewed and summarised prospective data relating diabetes status to changes in cognitive function over time. METHODS Published reports of longitudinal studies that described assessment of cognitive function in people with diabetes were sought. Studies were included if they assessed cognitive function in participants with diabetes at the beginning and at follow-up. Studies were excluded if they had (1) a follow-up period of less than 1 year, (2) a rate of loss to follow-up in excess of 30%, or (3) described selected subgroups. Change in cognitive function was recorded as either the mean change in score and/or the proportion of individuals developing various degrees of change in cognitive function. A pooled estimate was calculated for the latter. RESULTS Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria. Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes. When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05-1.4) and 1.7-fold (95% CI 1.3-2.3), respectively . The odds of future dementia increased 1.6-fold (95% CI 1.4-1.8). CONCLUSIONS/INTERPRETATION Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline. Cognitive dysfunction should therefore be added to the list of chronic complications of diabetes.
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Affiliation(s)
- T Cukierman
- Division of Endocrinology & Metabolism and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
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Xu G, Meyer JS, Huang Y, Du F, Chowdhury M, Quach M. Adapting mini-mental state examination for dementia screening among illiterate or minimally educated elderly Chinese. Int J Geriatr Psychiatry 2003; 18:609-16. [PMID: 12833305 DOI: 10.1002/gps.890] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Illiteracy is prevalent among current elderly Chinese. There are few brief cognitive tests in Chinese designed to screen those possibly demented for more detailed evaluation in a clinical setting. OBJECTIVES The present study adapted the Mini-Mental State Examination (MMSE) for screening dementia among illiterate or less educated elderly Chinese. METHODS Literacy-dependent items of the MMSE were modified or substituted by equivalent items that are not literacy-dependment. Some items were modified to provide socio-cultural compatibility. After developing it, the Chinese adapted MMSE (CAMSE) was administered to 370 elderly outpatients from Xijing hospitals located in Xi'an, China, 93 of whom were found to be demented and 277 non-demented. Sensitivities and specificities for detecting dementia were evaluated by adjusting for different CAMSE cut-off points. The optimal cut-off points of 22 for literates and 20 for illiterates yielded a sensitivity of 83.87% and a specificity of 84.48%. Corresponding positive predictive value (PPV) was 0.65, and negative predictive value (NPV) was 0.94. The impact of literacy on CAMSE and individual test items was also evaluated. Illiterate subjects got a higher CAMSE total score than literate subjects (p < 0.05). Only one out of 12 test items, serial sevens, was negatively influenced by illiteracy (p < 0.01). After an interval of 4-6 weeks, 32 randomly selected subjects were retested with CAMSE. The test-retest reliability for total scores was 0.75 (p < 0.01). CONCLUSIONS Results suggest that in the socio-cultural context for Chinese, irrespective of their literacy skills, CAMSE proved feasible for use in clinical settings for dementia screening.
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Affiliation(s)
- Gelin Xu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR, China
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2002; 17:593-600. [PMID: 12112187 DOI: 10.1002/gps.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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