1
|
Nyholm J, Ghazi AN, Ghazi SN, Sanmartin Berglund J. Prediction of dementia based on older adults' sleep disturbances using machine learning. Comput Biol Med 2024; 171:108126. [PMID: 38342045 DOI: 10.1016/j.compbiomed.2024.108126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The most common degenerative condition in older adults is dementia, which can be predicted using a number of indicators and whose progression can be slowed down. One of the indicators of an increased risk of dementia is sleep disturbances. This study aims to examine if machine learning can predict dementia and which sleep disturbance factors impact dementia. METHODS This study uses five machine learning algorithms (gradient boosting, logistic regression, gaussian naive Bayes, random forest and support vector machine) and data on the older population (60+) in Sweden from the Swedish National Study on Ageing and Care - Blekinge (n=4175). Each algorithm uses 10-fold stratified cross-validation to obtain the results, which consist of the Brier score for checking accuracy and the feature importance for examining the factors which impact dementia. The algorithms use 16 features which are on personal and sleep disturbance factors. RESULTS Logistic regression found an association between dementia and sleep disturbances. However, it is slight for the features in the study. Gradient boosting was the most accurate algorithm with 92.9% accuracy, 0.926 f1-score, 0.974 ROC AUC and 0.056 Brier score. The significant factors were different in each machine learning algorithm. If the person sleeps more than two hours during the day, their sex, education level, age, waking up during the night and if the person snores are the variables that most consistently have the highest feature importance in all algorithms. CONCLUSION There is an association between sleep disturbances and dementia, which machine learning algorithms can predict. Furthermore, the risk factors for dementia are different across the algorithms, but sleep disturbances can predict dementia.
Collapse
Affiliation(s)
- Joel Nyholm
- Department of Computer Science, Blekinge Institute of Technology, Karlskrona, 37179, Blekinge, Sweden
| | - Ahmad Nauman Ghazi
- Department of Software Engineering, Blekinge Institute of Technology, Karlskrona, 37179, Blekinge, Sweden.
| | - Sarah Nauman Ghazi
- Department of Health, Blekinge Institute of Technology, Karlskrona, 37179, Blekinge, Sweden
| | | |
Collapse
|
2
|
Tsiaras Y, Kiosseoglou G, Dardiotis E, Yannakoulia M, Hadjigeorgiou GM, Sakka P, Ntanasi E, Scarmeas N, Kosmidis MH. Predictive ability of the clock drawing test to detect mild cognitive impairment and dementia over time: Results from the HELIAD study. Clin Neuropsychol 2023; 37:1651-1668. [PMID: 36645823 DOI: 10.1080/13854046.2023.2167736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Objective: We investigated the diagnostic accuracy of the Clock Drawing Test (CDT) in discriminating Mild Cognitive Impairment (MCI) and dementia from normal cognition. Additionally, its clinical utility in predicting the transition from normal cognition to MCI and dementia over the course of several years was explored. Method: In total, 1037 older adults (633 women) who completed the CDT in a baseline assessment were drawn from the population-based HELIAD cohort. Among these, 848 participants were identified as cognitively normal, 142 as having MCI and 47 with dementia during the baseline assessment. Of these individuals, 565 attended the follow-up assessment (mean interval: 3.21 years). ROC curve and binary logistic regression analyses were performed. Results: The CDT exhibited good diagnostic accuracy for the discrimination between dementia and normal cognition (AUC = .879, SN = .813, SP = .778, LR+ = 3.66, LR- = .240, < .001, d = 1.655) and acceptable diagnostic accuracy for the discrimination between dementia and MCI (AUC=.761, SN= .750, SP= .689, LR+ = 2.41, LR- = .362, p < .001, d = 1.003). We found limited diagnostic accuracy, however, for the discrimination between MCI and normal cognition (AUC = .686, SN = .764, SP = .502, LR+ = 1.53, LR- = .470, p < .001, d = .685). Moreover, the CDT significantly predicted the transition from normal cognition to dementia [Exp(B)= 1.257, p = .022], as well as the transition from MCI to normal cognition [Exp(B) = 1.334, p = .023] during the longitudinal investigation. Conclusions: The CDT is a neuropsychological test with acceptable diagnostic accuracy for the discrimination of dementia from MCI and normal cognition. Furthermore, it has an important predictive value for the transition from normal cognition to dementia and from MCI to normal cognition.
Collapse
Affiliation(s)
- Yiannis Tsiaras
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Volos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and-Dietetics, Harokopio University, Kallithea, Greece
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Eva Ntanasi
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Τhe Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, ΝΥ, USA
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
3
|
Mandal PK, Dwivedi D, Joon S, Goel A, Ahasan Z, Maroon JC, Singh P, Saxena R, Roy RG. Quantitation of Brain and Blood Glutathione and Iron in Healthy Age Groups Using Biophysical and In Vivo MR Spectroscopy: Potential Clinical Application. ACS Chem Neurosci 2023. [PMID: 37257017 DOI: 10.1021/acschemneuro.3c00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The antioxidant glutathione (GSH) and pro-oxidant iron levels play a balancing role in the modulation of oxidative stress (OS). There is a significant depletion of GSH in the left hippocampus (LH) in patients with Alzheimer's disease (AD) with concomitant elevation of iron level. However, the correlation of GSH and iron distribution patterns between the brain and the peripheral system (blood) is not yet known. We measured GSH and magnetic susceptibility (e.g., iron) in the LH region along with GSH in plasma and iron in serum across four age groups consisting of healthy volunteers (age range 18-72 y, n = 70). We report non-variability of the mean GSH in the plasma and LH region across mentioned age groups. The mean iron level in the LH region does not change, but the iron level in the serum in the 51-72 y age group increases non-significantly. Regression analysis of our data indicated that GSH and iron levels (both in blood and in brain) are not related to age. This research pave the way for the identification of a risk/susceptibility biomarker for AD and Parkinson's disease from the evaluation of GSH (in plasma) and iron (in serum) levels concomitantly.
Collapse
Affiliation(s)
- Pravat K Mandal
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
- Florey Institute of Neuroscience and Mental Health, Melbourne School of Medicine Campus, Melbourne 3052, VIC, Australia
| | - Divya Dwivedi
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
| | - Shallu Joon
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
| | - Anshika Goel
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
| | - Zoheb Ahasan
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
| | - Joseph C Maroon
- Department of Neurosurgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania 15260, United States
| | - Padam Singh
- Department of Biostatistics, Medanta Medicity, Gurgaon 122001, Haryana, India
| | - Renu Saxena
- Department of Laboratory Medicine, Medanta Medicity, Gurgaon 122001, Haryana, India
| | - Rimil Guha Roy
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon, 122052 Haryana, India
| |
Collapse
|
4
|
Nikolac Perkovic M, Borovecki F, Filipcic I, Vuic B, Milos T, Nedic Erjavec G, Konjevod M, Tudor L, Mimica N, Uzun S, Kozumplik O, Svob Strac D, Pivac N. Relationship between Brain-Derived Neurotrophic Factor and Cognitive Decline in Patients with Mild Cognitive Impairment and Dementia. Biomolecules 2023; 13:biom13030570. [PMID: 36979505 PMCID: PMC10046678 DOI: 10.3390/biom13030570] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
In the last decade, increasing evidence has emerged linking alterations in the brain-derived neurotrophic factor (BDNF) expression with the development of Alzheimer's disease (AD). Because of the important role of BDNF in cognition and its association with AD pathogenesis, the aim of this study was to evaluate the potential difference in plasma BDNF concentrations between subjects with mild cognitive impairment (MCI; N = 209) and AD patients (N = 295) and to determine the possible association between BDNF plasma levels and the degree of cognitive decline in these individuals. The results showed a significantly higher (p < 0.001) concentration of plasma BDNF in subjects with AD (1.16; 0.13-21.34) compared with individuals with MCI (0.68; 0.02-19.14). The results of the present study additionally indicated a negative correlation between cognitive functions and BDNF plasma concentrations, suggesting higher BDNF levels in subjects with more pronounced cognitive decline. The correlation analysis revealed a significant negative correlation between BDNF plasma levels and both Mini-Mental State Examination (p < 0.001) and Clock Drawing test (p < 0.001) scores. In conclusion, the results of our study point towards elevated plasma BDNF levels in AD patients compared with MCI subjects, which may be due to the body's attempt to counteract the early and middle stages of neurodegeneration.
Collapse
Affiliation(s)
- Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Fran Borovecki
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Igor Filipcic
- Psychiatric Hospital "Sveti Ivan", 10090 Zagreb, Croatia
| | - Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, 10090 Zagreb, Croatia
| | - Suzana Uzun
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, 10090 Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, 10090 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
- University of Applied Sciences Hrvatsko Zagorje Krapina, 49000 Krapina, Croatia
| |
Collapse
|
5
|
Heyrani R, Sarabi-Jamab A, Grafman J, Asadi N, Soltani S, Mirfazeli FS, Almasi-Dooghaei M, Shariat SV, Jahanbakhshi A, Khoeini T, Joghataei MT. Limits on using the clock drawing test as a measure to evaluate patients with neurological disorders. BMC Neurol 2022; 22:509. [PMID: 36585622 PMCID: PMC9805016 DOI: 10.1186/s12883-022-03035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Clock Drawing Test (CDT) is used as a quick-to-conduct test for the diagnosis of dementia and a screening tool for cognitive impairments in neurological disorders. However, the association between the pattern of CDT impairments and the location of brain lesions has been controversial. We examined whether there is an association between the CDT scores and the location of brain lesions using the two available scoring systems. METHOD One hundred five patients with brain lesions identified by CT scanning were recruited for this study. The Montreal Cognitive Assessment (MoCA) battery including the CDT were administered to all partcipants. To score the CDT, we used a qualitative scoring system devised by Rouleau et al. (1992). For the quantitative scoring system, we adapted the algorithm method used by Mendes-Santos et al. (2015) based on an earlier study by Sunderland et al. (1989). For analyses, a machine learning algorithm was used. RESULTS Remarkably, 30% of the patients were not detected by the CDT. Quantitative and qualitative errors were categorized into different clusters. The classification algorithm did not differentiate the patients with traumatic brain injury 'TBI' from non-TBI, or the laterality of the lesion. In addition, the classification accuracy for identifying patients with specific lobe lesions was low, except for the parietal lobe with an accuracy of 63%. CONCLUSION The CDT is not an accurate tool for detecting focal brain lesions. While the CDT still is beneficial for use with patients suspected of having a neurodegenerative disorder, it should be cautiously used with patients with focal neurological disorders.
Collapse
Affiliation(s)
- Raheleh Heyrani
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Atiye Sarabi-Jamab
- grid.418744.a0000 0000 8841 7951School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Jordan Grafman
- grid.477681.bShirly Ryan AbilityLab, Departments of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology, and Alzheimer’s Center, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL USA
| | - Nesa Asadi
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Soltani
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran ,grid.490421.a0000 0004 0612 3773Faculty of Medicine, Rasool Akram Hospital, Iran Unversity of Medical Sciences, Tehran, Iran
| | - Mostafa Almasi-Dooghaei
- grid.411746.10000 0004 4911 7066Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Shariat
- grid.411746.10000 0004 4911 7066Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- grid.411746.10000 0004 4911 7066Department of Neurosurgery, Skull Base Research Center, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran ,grid.411746.10000 0004 4911 7066Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tara Khoeini
- grid.411746.10000 0004 4911 7066Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- grid.411746.10000 0004 4911 7066Cellular and Molecular Research Center (CMRC), Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Abstract
OBJECTIVE Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment. METHODS To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity. RESULTS We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies. CONCLUSIONS Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.
Collapse
|
7
|
Casanova-Muñoz V, Hernández-Ruiz Á, Durantez-Fernández C, López-Mongil R, Niño-Martín V. Descripción y aplicación clínica de las escalas de valoración geriátrica integral: una revisión sistemática rápida de revisiones. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Casanova-Muñoz V, Hernández-Ruiz Á, Durantez-Fernández C, López-Mongil R, Niño-Martín V. Description and clinical application of comprehensive geriatric assessment scales: A rapid systematic review of reviews. Rev Clin Esp 2022; 222:417-431. [PMID: 35504782 DOI: 10.1016/j.rceng.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. METHODS We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. RESULTS Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. CONCLUSION Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results.
Collapse
Affiliation(s)
- V Casanova-Muñoz
- Departamento de Enfermería, Universidad de Valladolid, Valladolid, Spain; Unidad de Onco-Hematología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Á Hernández-Ruiz
- Área de Desarrollo de proyectos científicos, Fundación Iberoamericana de Nutrición (FINUT), Granada, Spain.
| | - C Durantez-Fernández
- Facultad de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
| | | | - V Niño-Martín
- Departamento de Enfermería, Universidad de Valladolid, Valladolid, Spain; Grupo de investigación en Cuidados de Enfermería (GICE), Facultad de Enfermería, Universidad de Valladolid, Valladolid, Spain; Gerencia de Atención Primaria Valladolid Este (SACYL), Valladolid, Spain
| |
Collapse
|
9
|
Graeff DB, Lui JM, Zucco NDP, Alves ALS, Forcelini CM, Dalmolin BM. Clock drawing test: comparison between the Pfizer and the Shulman systems. Dement Neuropsychol 2021; 15:480-484. [PMID: 35509798 PMCID: PMC9018089 DOI: 10.1590/1980-57642021dn15-040009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects’ CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman’s rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
Collapse
|
10
|
Cecato JF, Balduino E, Martinelli JE, Aprahamian I. Brief version of the CAMCOG for illiterate older adults with Alzheimer's dementia. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:864-870. [PMID: 34706015 DOI: 10.1590/0004-282x-anp-2020-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults. OBJECTIVE To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer's dementia (AD) and healthy controls (CG). METHODS Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis. RESULTS Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively). CONCLUSION The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.
Collapse
Affiliation(s)
- Juliana Francisca Cecato
- Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.,Universidade São Francisco, Departamento de Psicologia, Bragança Paulista SP, Brazil
| | - Everton Balduino
- Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil
| | - José Eduardo Martinelli
- Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil
| |
Collapse
|
11
|
Ortega LV, Aprahamian I, Martinelli JE, Cecchini MA, Cação JDC, Yassuda MS. Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease. J Geriatr Psychiatry Neurol 2021; 34:222-231. [PMID: 32969281 DOI: 10.1177/0891988720958542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The accuracy of commonly used screening tests for Alzheimer's disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. OBJECTIVE To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. METHODS The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. RESULTS The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. CONCLUSION Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.
Collapse
Affiliation(s)
- Luciane Viola Ortega
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - José Eduardo Martinelli
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Mário Amore Cecchini
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Mônica Sanches Yassuda
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.,School of Arts, Sciences and Humanities, 28133University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
12
|
Ophey A, Roheger M, Folkerts AK, Skoetz N, Kalbe E. A Systematic Review on Predictors of Working Memory Training Responsiveness in Healthy Older Adults: Methodological Challenges and Future Directions. Front Aging Neurosci 2020; 12:575804. [PMID: 33173503 PMCID: PMC7591761 DOI: 10.3389/fnagi.2020.575804] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Research on predictors of working memory training responsiveness, which could help tailor cognitive interventions individually, is a timely topic in healthy aging. However, the findings are highly heterogeneous, reporting partly conflicting results following a broad spectrum of methodological approaches to answer the question “who benefits most” from working memory training. Objective: The present systematic review aimed to systematically investigate prognostic factors and models for working memory training responsiveness in healthy older adults. Method: Four online databases were searched up to October 2019 (MEDLINE Ovid, Web of Science, CENTRAL, and PsycINFO). The inclusion criteria for full texts were publication in a peer-reviewed journal in English/German, inclusion of healthy older individuals aged ≥55 years without any neurological and/or psychiatric diseases including cognitive impairment, and the investigation of prognostic factors and/or models for training responsiveness after targeted working memory training in terms of direct training effects, near-transfer effects to verbal and visuospatial working memory as well as far-transfer effects to other cognitive domains and behavioral variables. The study design was not limited to randomized controlled trials. Results: A total of 16 studies including n = 675 healthy older individuals with a mean age of 63.0–86.8 years were included in this review. Within these studies, five prognostic model approaches and 18 factor finding approaches were reported. Risk of bias was assessed using the Quality in Prognosis Studies checklist, indicating that important information, especially regarding the domains study attrition, study confounding, and statistical analysis and reporting, was lacking throughout many of the investigated studies. Age, education, intelligence, and baseline performance in working memory or other cognitive domains were frequently investigated predictors across studies. Conclusions: Given the methodological shortcomings of the included studies, no clear conclusions can be drawn, and emerging patterns of prognostic effects will have to survive sound methodological replication in future attempts to promote precision medicine approaches in the context of working memory training. Methodological considerations are discussed, and our findings are embedded to the cognitive aging literature, considering, for example, the cognitive reserve framework and the compensation vs. magnification account. The need for personalized cognitive prevention and intervention methods to counteract cognitive decline in the aging population is high and the potential enormous. Registration: PROSPERO, ID CRD42019142750.
Collapse
Affiliation(s)
- Anja Ophey
- Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
13
|
A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations. J Int Neuropsychol Soc 2020; 26:331-351. [PMID: 31511111 DOI: 10.1017/s1355617719000894] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations. METHOD A systematic review was performed using six databases, without restrictions on the year or language of publication. RESULTS Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29). CONCLUSIONS Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.
Collapse
|
14
|
Ortega LDFV, Aprahamian I, Borges MK, Cação JDC, Yassuda MS. Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:279-288. [PMID: 31090809 DOI: 10.1590/0004-282x20190024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.
Collapse
Affiliation(s)
- Luciane de Fátima Viola Ortega
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Grupo de Investigação em Multimorbidades e Saúde Mental em Idosos, Disciplina de Geriatria e Gerontologia, Jundiaí SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcus Kiiti Borges
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - João de Castilho Cação
- Faculdade de Medicina de São José do Rio Preto, Unidade de Geriatria, São José do Rio Preto SP, Brasil
| | - Mônica Sanches Yassuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil.,Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brasil
| |
Collapse
|
15
|
The Relationship between Plasma Al Levels and Multi-domain Cognitive Performance among In-service Aluminum-exposed Workers at the SH Aluminum Factory in China: A Cross-sectional Study. Neurotoxicology 2020; 76:144-152. [DOI: 10.1016/j.neuro.2019.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022]
|
16
|
Brum PS, Borella E, Carretti B, Sanches Yassuda M. Verbal working memory training in older adults: an investigation of dose response. Aging Ment Health 2020; 24:81-91. [PMID: 30596450 DOI: 10.1080/13607863.2018.1531372] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The WM training protocol proposed by Borella et al. found specific and transfer effects among seniors, however, the studies were carried out in the same socio-cultural context and variations in the procedure were never tested. The present study aimed at analyzing the efficacy of Borella et al.'s training, in terms of short and long-term benefits, in a different socio-cultural context (Study 1), and the effect of change in the training's length (duplicating the number of sessions (Study 2). Participants were randomly assigned to a trained group (N = 18 for Study 1, and N = 23 for Study 2) and active control group (N = 28 for Study 1, and N = 27 for Study 2), and evaluated at pre, post-test and six-month follow-up for verbal WM task (criterion task), and for visuospatial and verbal WM, inhibition, processing speed, executive function, and fluid intelligence measures (transfer tasks). The trained groups had higher performance in all tasks when compared with active control groups after training and at 6 month follow-up. The longer training (Study 2) generated similar gains as the original protocol, with some advantage in far transfer tasks at post-test and follow-up. Study limitations include the small sample sizes. In conclusion, this training was effective in a different socio-cultural context and adding three sessions to the protocol did not significantly change training impact.
Collapse
Affiliation(s)
| | - Erika Borella
- Department of General Psychology, University of Padua, Padua, Italy
| | - Barbara Carretti
- Department of General Psychology, University of Padua, Padua, Italy
| | - Mônica Sanches Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
17
|
Shanhu X, Linhui C, Xiaoqing J, Jing Y, Saizhu X, Ying X, Caixia L, Yu J. Effects of age and education on clock-drawing performance by elderly adults in China. Clin Neuropsychol 2019; 33:96-105. [PMID: 31322036 DOI: 10.1080/13854046.2019.1640285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xu Shanhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chen Linhui
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Xiaoqing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yan Jing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Saizhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Ying
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Liu Caixia
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Yu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| |
Collapse
|
18
|
Adherence to the Mediterranean and MIND diets is associated with better cognition in healthy seniors but not in MCI or AD. Clin Nutr ESPEN 2018; 28:201-207. [DOI: 10.1016/j.clnesp.2018.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/07/2018] [Indexed: 11/19/2022]
|
19
|
Yokomizo JE, Seeher K, Oliveira GMD, Silva LDSVE, Saran L, Brodaty H, Aprahamian I, Yassuda MS, Bottino CMDC. Cognitive screening test in primary care: cut points for low education. Rev Saude Publica 2018; 52:88. [PMID: 30484482 PMCID: PMC6280619 DOI: 10.11606/s1518-8787.2018052000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.
Collapse
Affiliation(s)
- Juliana Emy Yokomizo
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
| | - Katrin Seeher
- University of New South Wales. Dementia Collaborative Research Center. Sydney, New South Wales, Australia
| | | | | | - Laura Saran
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
| | - Henry Brodaty
- University of New South Wales. Dementia Collaborative Research Center. Sydney, New South Wales, Australia
| | - Ivan Aprahamian
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil.,Departmento de Clínica Médica. Faculdade de Medicina de Jundiaí. Jundiaí, SP, Brasil
| | - Monica Sanches Yassuda
- Universidade de São Paulo. Escola de Artes, Ciências e Humanidades. São Paulo, SP, Brasil
| | - Cássio Machado de Campos Bottino
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
| |
Collapse
|
20
|
Zhang Y, Liu YX, Xiao QX, Liu Q, Deng R, Bian J, Deng IB, Al-Hawwas M, Yu FX. Microarray Expression Profiles of lncRNAs and mRNAs in Postoperative Cognitive Dysfunction. Front Neurosci 2018; 12:694. [PMID: 30349449 PMCID: PMC6187303 DOI: 10.3389/fnins.2018.00694] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/18/2018] [Indexed: 12/17/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is serious disorder in the central nervous system common in aged patients after anesthesia. Although its clinical symptoms are well recognized, however, the molecular etiology of the POCD remains unrevealed. Similarly, neither gold standard molecular diagnosis nor effective treatment is available for POCD until the present. Therefore, we aimed to explore the molecular mechanism of this disorder through investigating lncRNAs and mRNAs associated with POCD human patients and investigate their underlying regulatory pathways. In this study, we recruited 200 patients requiring hip or knee replacement surgery. Their neurological functions were assessed at two time points, 1 day before the surgery and 30 days post-surgery. In parallel, serum samples were collected from the participants to analyze lncRNAs and mRNAs differential expression profile between POCD and non-POCD patients using microarray analysis. To further investigate the role differentially expressed mRNA and lncRNAs, Gene Ontology (GO), pathway analyses on mRNAs and lncRNA-mRNA interaction network were performed. As a result, 68 lncRNAs and 115 mRNAs were dysregulated in the POCD group compared to non-POCD group. Among them, the top 10 upregulated lncRNAs and 10 downregulated lncRNAs were listed for enrichment analysis. Interestingly, we found that these lncRNA and mRNA are involved in biological process, molecular function, and cellular component in addition to various signaling pathways, suggesting that the pathogenesis of POCD involves lncRNAs and mRNAs differential expression. Consequently, the genetic dysregulation between the non-POCD and POCD patients participates in the occurrence and development of POCD, and could be served as diagnostic biomarkers and drug targets for POCD treatment.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Yue-Xin Liu
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Qiu-Xia Xiao
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Qing Liu
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Rui Deng
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Jiang Bian
- Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Isaac Bul Deng
- School of Pharmacy and Medical Sciences, Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Mohammed Al-Hawwas
- School of Pharmacy and Medical Sciences, Sansom Institute, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Feng-Xu Yu
- Department of Cardiothoracic Surgery, Affiliated Hospital, Southwest Medical University, Luzhou, China
| |
Collapse
|
21
|
Park J, Jeong E, Seomun G. The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy. J Adv Nurs 2018; 74:2742-2754. [DOI: 10.1111/jan.13810] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
|
22
|
Merims D, Ben Natan M, Milawi D, Boguslavsky T. The clock-drawing test: normative data in adult and elderly Israeli Arabs. Psychogeriatrics 2018; 18:175-181. [PMID: 29415342 DOI: 10.1111/psyg.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/20/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
AIM Despite the widespread use of the clock-drawing test (CDT), normative data and information regarding the influence of sociodemographic factors on test performance by adult and elderly Israeli Arabs are lacking. The current study aimed to establish normative data for this population group by exploring the impact of sociodemographic factors such as age, education, and gender on CDT performance. In addition, this study examined the association between CDT performance and Mini-Mental State Examination (MMSE) scores. METHODS The sample consisted of 295 community-dwelling healthy adult and elderly Israeli Arabs, aged 20-86 years, with a MMSE score ≥24. The MMSE and the CDT were administered to participants. RESULTS Statistical analyses revealed that age had a negative effect on CDT performance, which was most pronounced in the 60-86 age group, but education and occupation (academic vs non-academic) had a positive effect. Gender and place of residence (urban vs rural) had no effect. CDT performance predicted the MMSE score. CONCLUSIONS The present study provides preliminary normative data on adult and elderly Israeli Arabs. The CDT appears to be applicable to Israeli Arabs, while the normative data might help interpret cognitive function results in this population.
Collapse
Affiliation(s)
- Doron Merims
- Department of Geriatrics, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hana, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Deep Milawi
- Department of Geriatrics, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hana, Israel
| | - Tania Boguslavsky
- Director, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hanna, Israel
| |
Collapse
|
23
|
Duro D, Tábuas-Pereira M, Freitas S, Santiago B, Botelho MA, Santana I. Validity and Clinical Utility of Different Clock Drawing Test Scoring Systems in Multiple Forms of Dementia. J Geriatr Psychiatry Neurol 2018; 31:114-122. [PMID: 29742972 DOI: 10.1177/0891988718774432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) has a known potential for the detection of cognitive impairment in populations with dementia, especially Alzheimer disease (AD). Our aim was to compare the clinical utility of 3 CDT scoring systems (Rouleau, Cahn, and Babins) in several pathologies with cognitive compromise from a tertiary center memory clinic. We selected patients with a clinical diagnosis of mild stage AD, behavioral variant frontotemporal dementia (FTD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and Parkinson disease with dementia (PDD). The results showed significant differences between the several diagnoses with the following pattern of results: AD, DLB < FTD, VaD, PDD. Qualitative analysis of clock drawing errors confirmed the stimulus-bound response as a hallmark of AD, while conceptual deficit was significantly more prevalent in patients with AD and DLB. Our results supported the CDT potential as a cognitive screening measure for mild dementia, particularly sensitive to AD and DLB, especially when we used the Cahn scoring system and its analysis of qualitative errors.
Collapse
Affiliation(s)
- Diana Duro
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Tábuas-Pereira
- 2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sandra Freitas
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Beatriz Santiago
- 2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Isabel Santana
- 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,2 Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
24
|
Martinelli JE, Cecato JF, Martinelli MO, de Melo BAR, Aprahamian I. Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia. Dement Neuropsychol 2018; 12:54-60. [PMID: 29682234 PMCID: PMC5901250 DOI: 10.1590/1980-57642018dn12-010008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Pentagon Drawing Test (PDT) is a common cognitive screening test.
Collapse
Affiliation(s)
- José Eduardo Martinelli
- MS, PhD, Division of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil
| | - Juliana Francisca Cecato
- MS, PhD, Division of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil
| | - Marcos Oliveira Martinelli
- MD, Division of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil
| | - Brian Alvarez Ribeiro de Melo
- PhD, Division of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil
| | - Ivan Aprahamian
- MD, MS, PhD, Division of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil
| |
Collapse
|
25
|
Batistaki C, Riga M, Zafeiropoulou F, Lyrakos G, Kostopanagiotou G, Matsota P. Effect of sugammadex versus neostigmine/atropine combination on postoperative cognitive dysfunction after elective surgery. Anaesth Intensive Care 2017; 45:581-588. [PMID: 28911287 DOI: 10.1177/0310057x1704500508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years. The Mini-Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block reversal, which was administered by random allocation using either sugammadex or neostigmine/atropine after the reappearance of T2 in the train-of-four sequence. POCD was defined as a decline ≥1 standard deviation in ≥2 cognitive tests. The incidence of POCD was similar in both groups at one hour postoperatively and at discharge (28% and 10%, in the neostigmine group, 23% and 5.4% in the sugammadex group, P=0.55 and 0.27 respectively). In relation to individual tests, a significant decline of clock-drawing test in the neostigmine group was observed at one hour postoperatively and at discharge. For the Isaacs Set test, a greater decline was found in the sugammadex group. These findings suggest that there are no clinically important differences in the incidence of POCD after neostigmine or sugammadex administration.
Collapse
|
26
|
Muela HCS, Costa-Hong VA, Yassuda MS, Moraes NC, Memória CM, Machado MF, Bor-Seng-Shu E, Nogueira RC, Mansur AJ, Massaro AR, Nitrini R, Macedo TA, Bortolotto LA. Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension. J Clin Hypertens (Greenwich) 2017; 20:22-30. [PMID: 29106057 DOI: 10.1111/jch.13129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/15/2017] [Accepted: 07/23/2017] [Indexed: 11/30/2022]
Abstract
Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.
Collapse
Affiliation(s)
- Henrique C S Muela
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Valeria A Costa-Hong
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mônica S Yassuda
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Natália C Moraes
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia M Memória
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Michel F Machado
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo C Nogueira
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfredo J Mansur
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ayrton R Massaro
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Thiago A Macedo
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
27
|
Morelli NL, Cachioni M, Lopes A, Batistoni SST, Falcão DVDS, Neri AL, Yassuda MS. Verbal fluency in elderly with and without hypertension and diabetes from the FIBRA study in Ermelino Matarazzo. Dement Neuropsychol 2017; 11:413-418. [PMID: 29354222 PMCID: PMC5770000 DOI: 10.1590/1980-57642016dn11-040011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are few studies on the qualitative variables derived from the animal category verbal fluency test (VF), especially with data originating from low-income samples of community-based studies. OBJECTIVE To compare elderly with and without hypertension (HTN) and diabetes mellitus (DM) regarding the total number of animals spoken, number of categories, groups and category switches on the VF test. METHODS We used the database of the FIBRA (Frailty in Brazilian Elderly) community-based study. The variables number of Categories, Groups and Category Switches were created for each participant. The total sample (n = 384) was divided into groups of elderly who reported having HTN, DM, both HTN and DM, or neither of these conditions. RESULTS There were no significant differences between the groups with and without these chronic diseases for VF total score or for the qualitative variables. CONCLUSION Among independent community-dwelling elderly, the qualitative variables derived from the VF animal category may not add information regarding the cognitive profile of elderly with chronic diseases. Total VF score and the qualitative variables Category, Group and Switching did not differentiate elderly with and without HTN and DM.
Collapse
Affiliation(s)
- Nathalia Lais Morelli
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Meire Cachioni
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Gerontologia, Faculdade de Ciências Médicas, UNICAMP, Campinas, São Paulo, Brazil
| | - Andrea Lopes
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Samila Sathler Tavares Batistoni
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Gerontologia, Faculdade de Ciências Médicas, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Anita Liberalesso Neri
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Gerontologia, Faculdade de Ciências Médicas, UNICAMP, Campinas, São Paulo, Brazil
| | - Monica Sanches Yassuda
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Gerontologia, Faculdade de Ciências Médicas, UNICAMP, Campinas, São Paulo, Brazil
| |
Collapse
|
28
|
Muela HCS, Costa-Hong VA, Yassuda MS, Machado MF, Nogueira RDC, Moraes NC, Memória CM, Macedo TA, Bor-Seng-Shu E, Massaro AR, Nitrini R, Bortolotto LA. Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance. Dement Neuropsychol 2017; 11:389-397. [PMID: 29354219 PMCID: PMC5769997 DOI: 10.1590/1980-57642016dn11-040008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022] Open
Abstract
Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. OBJECTIVE To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. METHODS 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. RESULTS Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. CONCLUSION Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.
Collapse
Affiliation(s)
- Henrique Cotchi Simbo Muela
- Heart Institute (Incor), University of São Paulo Medical School – Hypertension Unit São Paulo, São Paulo, SP, Brazil
- Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Valeria A. Costa-Hong
- Heart Institute (Incor), University of São Paulo Medical School – Hypertension Unit São Paulo, São Paulo, SP, Brazil
| | - Monica Sanches Yassuda
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Natalia C. Moraes
- University of São Paulo Medical School, Department of Neurology, São Paulo, SP, Brazil
| | - Claudia Maia Memória
- University of São Paulo Medical School, Department of Neurology, São Paulo, SP, Brazil
| | - Thiago A. Macedo
- Heart Institute (Incor), University of São Paulo Medical School – Hypertension Unit São Paulo, São Paulo, SP, Brazil
| | - Edson Bor-Seng-Shu
- University of São Paulo Medical School, Department of Neurology, São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- University of São Paulo Medical School, Department of Neurology, São Paulo, SP, Brazil
| | - Luiz A. Bortolotto
- Heart Institute (Incor), University of São Paulo Medical School – Hypertension Unit São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
29
|
Vyhnálek M, Rubínová E, Marková H, Nikolai T, Laczó J, Andel R, Hort J. Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice. Int J Geriatr Psychiatry 2017; 32:933-939. [PMID: 27466038 DOI: 10.1002/gps.4549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The clock drawing test (CDT) is a commonly used brief cognitive measure. We evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. We further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. METHODS Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a "yes" (abnormal) versus "suspected" versus "no" (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. We also used a 17-point CDT rating system. RESULTS When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. CONCLUSIONS A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Martin Vyhnálek
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Rubínová
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Hana Marková
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Tomáš Nikolai
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jakub Hort
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| |
Collapse
|
30
|
Yassuda MS, da Silva HS, Lima-Silva TB, Cachioni M, Falcão DVDS, Lopes A, Batistoni SST, Neri AL. Normative data for the Brief Cognitive Screening Battery stratified by age and education. Dement Neuropsychol 2017; 11:48-53. [PMID: 29213493 PMCID: PMC5619214 DOI: 10.1590/1980-57642016dn11-010008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Diagnosing neurocognitive disorders is challenging in low-educated
individuals. Objective To report normative data for the Brief Cognitive Screening Battery (BCSB) and
to assess the association of age and education with performance on the BCSB
in 240 community-dwelling elderly from Ermelino Matarazzo, São Paulo
city. Methods The inclusion criteria were scoring above the education-adjusted cut-off
points on the Mini-Mental State Examination (MMSE) and below six points on
the Geriatric Depression Scale (GDS). Results Age was associated with performance on the Naming, Incidental Memory, Verbal
Fluency, Clock Drawing Test, Delayed Recall and Recognition subtests.
Education was associated with performance on Naming, Recognition, Verbal
Fluency and the Clock Drawing Test. Conclusion The normative values reported are relevant for diagnosing neurocognitive
disorders in low-educated elderly.
Collapse
Affiliation(s)
- Mônica Sanches Yassuda
- Núcleo de Estudos e Pesquisas em Gerontologia (NEPEG), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo SP - Brasil.,Grupo de Neurologia Cognitiva e do Comportamento (GNCC), Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP - Brazil.,Programa de Pós-graduação em Gerontologia, Faculdades de Ciências Médicas, da Universidade Estadual de Campinas (UNICAMP), Campinas SP - Brazil
| | - Henrique Salmazo da Silva
- Grupo de Pesquisa em Neurociência, Linguagem e Cognição. Universidade Federal do ABC, Santo André SP - Brazil
| | - Thais Bento Lima-Silva
- Grupo de Neurologia Cognitiva e do Comportamento (GNCC), Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP - Brazil
| | - Meire Cachioni
- Núcleo de Estudos e Pesquisas em Gerontologia (NEPEG), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo SP - Brasil.,Programa de Pós-graduação em Gerontologia, Faculdades de Ciências Médicas, da Universidade Estadual de Campinas (UNICAMP), Campinas SP - Brazil
| | - Deusivania Vieira da Silva Falcão
- Núcleo de Estudos e Pesquisas em Gerontologia (NEPEG), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo SP - Brasil
| | - Andrea Lopes
- Núcleo de Estudos e Pesquisas em Gerontologia (NEPEG), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo SP - Brasil
| | - Samila Sathler Tavares Batistoni
- Núcleo de Estudos e Pesquisas em Gerontologia (NEPEG), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo SP - Brasil.,Programa de Pós-graduação em Gerontologia, Faculdades de Ciências Médicas, da Universidade Estadual de Campinas (UNICAMP), Campinas SP - Brazil
| | - Anita Liberalesso Neri
- Programa de Pós-graduação em Gerontologia, Faculdades de Ciências Médicas, da Universidade Estadual de Campinas (UNICAMP), Campinas SP - Brazil
| |
Collapse
|
31
|
Spenciere B, Alves H, Charchat-Fichman H. Scoring systems for the Clock Drawing Test: A historical review. Dement Neuropsychol 2017; 11:6-14. [PMID: 29213488 PMCID: PMC5619209 DOI: 10.1590/1980-57642016dn11-010003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument
that is well accepted by patients and has solid psychometric properties. Several
different CDT scoring methods have been developed, but no consensus has been
reached regarding which scoring method is the most accurate. This article
reviews the literature on these scoring systems and the changes they have
undergone over the years. Historically, different types of scoring systems
emerged. Initially, the focus was on screening for dementia, and the methods
were both quantitative and semi-quantitative. Later, the need for an early
diagnosis called for a scoring system that can detect subtle errors, especially
those related to executive function. Therefore, qualitative analyses began to be
used for both differential and early diagnoses of dementia. A widely used
qualitative method was proposed by Rouleau et al. (1992). Tracing the historical
path of these scoring methods is important for developing additional scoring
systems and furthering dementia prevention research.
Collapse
Affiliation(s)
- Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | - Heloisa Alves
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | | |
Collapse
|
32
|
Muela HCS, Costa-Hong VA, Yassuda MS, Moraes NC, Memória CM, Machado MF, Macedo TA, Shu EBS, Massaro AR, Nitrini R, Mansur AJ, Bortolotto LA. Hypertension Severity Is Associated With Impaired Cognitive Performance. J Am Heart Assoc 2017; 6:e004579. [PMID: 28077386 PMCID: PMC5523638 DOI: 10.1161/jaha.116.004579] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. METHODS AND RESULTS In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on Mini-Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. CONCLUSIONS Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.
Collapse
Affiliation(s)
- Henrique C S Muela
- Hypertension Unit, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
- Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Valeria A Costa-Hong
- Hypertension Unit, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mônica S Yassuda
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Natália C Moraes
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia M Memória
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Michel F Machado
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Thiago A Macedo
- Hypertension Unit, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Edson B S Shu
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ayrton R Massaro
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfredo J Mansur
- Hypertension Unit, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
33
|
Cassimiro L, Fuentes D, Nitrini R, Yassuda MS. Decision-making in Cognitively Unimpaired Illiterate and Low-educated Older Women: Results on the Iowa Gambling Task. Arch Clin Neuropsychol 2016; 32:71-80. [PMID: 27680089 DOI: 10.1093/arclin/acw080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study investigated the pattern of decision-making (DM) on the Iowa Gambling Task (IGT) in a sample of Portuguese speaking healthy older women in Brazil with limited education: illiterate, 1-2 years, and 3-4 years of schooling. METHODS Around 164 non-demented community-dwelling women participated in the study. Among them 60 were illiterate, 52 had 1-2 years of schooling and 52 had 3-4 years of schooling. Participants completed the instruments: Brief Cognitive Screening Battery (BCSB), Mini-Mental State Examination, Verbal Fluency Test (animal category), Clock Drawing Test, Geriatric Depression Scale, Geriatric Anxiety Inventory, Digit Span Forward and Backward, Raven's Coloured Progressive Matrices, Wisconsin Card Sorting Test, and IGT. RESULTS The three education groups were equivalent as to age, number of diseases, medications taken daily, depression, and anxiety symptoms. In the IGT the literate older adults made more advantageous choices than the illiterate and IGT performance improved linearly with higher levels of education. IGT performance correlated significantly with all cognitive test scores with the exception of the memorization of the pictures on the BCSB. CONCLUSION The results suggested that education influences IGT performance, with worse scores among the illiterate. Results may be used by clinicians to interpret IGT performance among seniors with low literacy levels.
Collapse
Affiliation(s)
- Luciana Cassimiro
- Cognitive Behavior Neurology Group (GNCC), Neurology Department, University of São Paulo, São Paulo, Brazil.,Paulista Institute of Geriatrics and Gerontology , São Paulo, Brazil
| | - Daniel Fuentes
- Cognitive Behavior Neurology Group (GNCC), Neurology Department, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Cognitive Behavior Neurology Group (GNCC), Neurology Department, University of São Paulo, São Paulo, Brazil
| | - Mônica Sanches Yassuda
- Cognitive Behavior Neurology Group (GNCC), Neurology Department, University of São Paulo, São Paulo, Brazil .,School of Arts, Sciences and Humanities, Gerontology, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
34
|
El entrenamiento cognitivo en los ancianos y efectos en las funciones ejecutivas. ACTA COLOMBIANA DE PSICOLOGIA 2016. [DOI: 10.14718/acp.2016.19.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
El envejecimiento se asocia comúnmente con el deterioro cognitivo y la pérdida de otras capacidades, lo cual conlleva la necesidad de investigar elementos que puedan contribuir a las intervenciones preventivas de rehabilitación cognitiva y que tienen como objetivo garantizar la calidad de vida de los ancianos. El objetivo de este estudio fue caracterizar ancianos que se inscribieron en esta intervención, para medir los efectos del entrenamiento cognitivo, con énfasis en las funciones ejecutivas, comparando un grupo experimental con un grupo control. Se trata de una investigación cuantitativa, con un diseño cuasi-experimental; es correlacional y comparativa, con pre y post-test e intervención. La muestra estuvo conformada por 83 ancianos, dividida en un grupo experimental (GE) (45 personas) y un grupo control (GC) (38 personas). Se utilizaron los siguientes instrumentos: entrevista neuropsicológica semiestructurada sobre características sociodemográficas; Examen Mínimo del Estado Mental (Mini Mental State o MMSE, por sus siglas en inglés); Inventario de Ansiedad Beck (BAI, por sus siglas en inglés); Escala de Depresión Geriátrica (GDS, por sus siglas en inglés); subpruebas WAIS-III: prueba de amplitud de dígitos (Digit Span), vocabulario, diseño con bloques, codificación, Secuenciación de Letras y Números (LNS por sus siglas en inglés), y la búsqueda de símbolos; Test de Trazos (TMT por sus siglas en inglés); Figuras Complejas de Rey; Paradigma de Sternberg; tareas de fluidez verbal sobre semántica (animales) y fonemas (F-A-S); Prueba de Aprendizaje Verbal-auditiva de Rey (RVLT por sus siglas en inglés); Prueba de Stroop: colores y palabras; tareas ir/no ir; y Test Wisconsin de Clasificación de Cartas (WCST por sus siglas en inglés). Los resultados de la comparación entre los grupos mostraron que hubo una diferencia significativa en cuanto al número de errores en el Paradigma de Sternberg y las categorías completas del WCST. Las comparaciones intragrupales mostraron que el GE tuvo mejores resultados después de la intervención en las siguientes pruebas: GDS, RAVLT, Figuras Complejas de Rey (memoria), prueba de amplitud de dígitos y vocabulario.
Collapse
|
35
|
The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil. Int Psychogeriatr 2016; 28:93-9. [PMID: 25921381 DOI: 10.1017/s1041610215000642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Cognitive Abilities Screening Instrument - Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care. OBJECTIVES To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy. METHODS In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients' health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status. RESULTS The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = -0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%. CONCLUSIONS The CASI-S can be useful for dementia screening in primary care in Brazil.
Collapse
|
36
|
Lotfi MS, Tagharrobi Z, Sharifi K, Abolhasani J. Diagnostic Accuracy of the Cognitive State Test in the Detection of Dementia Among Iranian Older Adults. Res Gerontol Nurs 2015. [DOI: 10.3928/19404921-20150521-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
37
|
Mak JCS, Klein L, Mason RS, Cameron ID. Contemporary Pain Management in Elderly Patients After Hip Fracture Surgery: Cross-sectional Analyses at Baseline of a Randomized Controlled Trial. Clin J Pain 2015; 31:788-793. [PMID: 29498627 DOI: 10.1097/ajp.0000000000000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adequate pain management following hip fracture surgery reduces length of stay, reduces incidence of delirium, promotes recovery, and improves mobility. Previous research suggests that hip fracture pain is undertreated in some patient subgroups, and that hypovitaminosis D can further aggravate pain which could hinder active rehabilitation. We provide a cross-sectional analysis of the baseline characteristics of participants in the REVITAHIP study with the aim of documenting pain intensity and its associations after hip fracture and to explore the characteristics of people who report higher levels of pain. METHOD We analyzed the baseline characteristics with a focus on pain scores in patients admitted with a hip fracture (undergoing surgery) to 3 teaching hospitals over New South Wales, Australia, between January 2011 and April 2013. Patients were evaluated using the Verbal Rating Scale (VRS). Secondary measures including 25-hydroxyvitamin D levels at baseline, hip fracture subtype, type of surgical intervention, quality of life score, and cognitive and mobility status were correlated with the VRS using the Pearson correlation, ANOVA, and regression analysis. RESULTS The 218 participants had a mean age of 83.9±7.2 years and 77.1% were women of whom 16.0% had a Mini Mental State Examination score of ≤23 of 30. The mean and SD VRS pain score was 3.5±2.3. More than half (61.9%, n=113) had VRS≥3 and 18.1% (n=52) had VRS≥5. Using the EuroQOL pain subscore, 78.1% had moderate pain or discomfort and 7.9% had extreme pain or discomfort. Using a multivariate regression model, postoperative VRS was significantly higher in persons with a higher comorbidity count, those previously living independently alone, and surgical fixative modality with hemiarthroplasty. CONCLUSIONS Overall, the levels of pain reported by this cohort are acceptable although approximately 10% to 15% had higher than reasonable levels of pain. This study provides an insight into pain assessment and management by identifying certain patient subtypes who are vulnerable to undertreatment of pain.
Collapse
Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales.,John Walsh Centre for Rehabilitation Research
| | - Linda Klein
- Office of Medical Education, Sydney Medical School
| | - Rebecca S Mason
- Department of Physiology, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
38
|
Sposito G, Neri AL, Yassuda MS. Cognitive performance and engagement in physical, social and intellectual activities in older adults: The FIBRA study. Dement Neuropsychol 2015; 9:270-278. [PMID: 29213972 PMCID: PMC5619369 DOI: 10.1590/1980-57642015dn93000010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cognitive decline in aging can negatively impact quality of life in the elderly.
However, studies have shown that elderly engaged in advanced activities of daily
living (AADLs) can maintain or enhance global cognitive function or specific
domains.
Collapse
Affiliation(s)
- Giovana Sposito
- Physiotherapist, doctoral student on the Post-graduate Program in Gerontology. School of Medical Sciences, State University of Campinas
| | - Anita Liberalesso Neri
- Psychologist. Full Professor of the Post-graduate Program in Gerontology. School of Medical Sciences, State University of Campinas
| | - Mônica Sanches Yassuda
- Psychologist. Associate Professor of the School of Arts, Sciences and Humanities (EACH). University of São Paulo (USP) and Lecturer on the Post-graduate Program in Gerontology. School of Medical Sciences, State University of Campinas
| |
Collapse
|
39
|
Mendes-Santos LC, Mograbi D, Spenciere B, Charchat-Fichman H. Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly. Dement Neuropsychol 2015; 9:128-135. [PMID: 29213954 PMCID: PMC5619351 DOI: 10.1590/1980-57642015dn92000007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary. Objective The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989). Methods We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability. Results and Conclusion A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.
Collapse
Affiliation(s)
| | - Daniel Mograbi
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil.,Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil
| | | |
Collapse
|
40
|
Likova LT. Temporal evolution of brain reorganization under cross-modal training: Insights into the functional architecture of encoding and retrieval networks. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9394:939417. [PMID: 31423042 PMCID: PMC6697260 DOI: 10.1117/12.2178069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study is based on the recent discovery of massive and well-structured cross-modal memory activation generated in the primary visual cortex (V1) of totally blind people as a result of novel training in drawing without any vision (Likova, 2012). This unexpected functional reorganization of primary visual cortex was obtained after undergoing only a week of training by the novel Cognitive-Kinesthetic Method, and was consistent across pilot groups of different categories of visual deprivation: congenitally blind, late-onset blind and blindfolded (Likova, 2014). These findings led us to implicate V1 as the implementation of the theoretical visuo-spatial 'sketchpad' for working memory in the human brain. Since neither the source nor the subsequent 'recipient' of this non-visual memory information in V1 is known, these results raise a number of important questions about the underlying functional organization of the respective encoding and retrieval networks in the brain. To address these questions, an individual totally blind from birth was given a week of Cognitive-Kinesthetic training, accompanied by functional magnetic resonance imaging (fMRI) both before and just after training, and again after a two-month consolidation period. The results revealed a remarkable temporal sequence of training-based response reorganization in both the hippocampal complex and the temporal-lobe object processing hierarchy over the prolonged consolidation period. In particular, a pattern of profound learning-based transformations in the hippocampus was strongly reflected in V1, with the retrieval function showing massive growth as result of the Cognitive-Kinesthetic memory training and consolidation, while the initially strong hippocampal response during tactile exploration and encoding became non-existent. Furthermore, after training, an alternating patch structure in the form of a cascade of discrete ventral regions underwent radical transformations to reach complete functional specialization in terms of either encoding or retrieval as a function of the stage of learning. Moreover, several distinct patterns of learning-evolution within the patches as a function of their anatomical location, implying a complex reorganization of the object processing sub-networks through the learning period. These first findings of complex patterns of training-based encoding/retrieval reorganization thus have broad implications for a newly emerging view of the perception/memory interactions and their reorganization through the learning process. Note that the temporal evolution of these forms of extended functional reorganization could not be uncovered with conventional assessment paradigms used in the traditional approaches to functional mapping, which may therefore have to be revisited. Moreover, as the present results are obtained in learning under life-long blindness, they imply amodal operations, transcending the usual tight association with visual processing. The present approach of memory drawing training in blindness, has the dual-advantage of being both non-visual and causal intervention, which makes it a promising 'scalpel' to disentangle interactions among diverse cognitive functions.
Collapse
|
41
|
Rubínová E, Nikolai T, Marková H, Siffelová K, Laczó J, Hort J, Vyhnálek M. Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: can more detailed scoring systems do the work? J Clin Exp Neuropsychol 2014; 36:1076-83. [PMID: 25486502 DOI: 10.1080/13803395.2014.977233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. METHOD Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. RESULTS Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p < .001) and increased specificity (43.8%), but did not increase sensitivity, which remained high (85.4%). CONCLUSIONS A simple 6-point scoring system for the Clock Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods.
Collapse
Affiliation(s)
- Eva Rubínová
- a International Clinical Research Center, St. Anne's University Hospital Brno , Brno , Czech Republic
| | | | | | | | | | | | | |
Collapse
|
42
|
Peles E, Schreiber S, Domany Y, Sason A, Tene O, Adelson M. Achievement of take-home dose privileges is associated with better-perceived sleep and with cognitive status among methadone maintenance treatment patients. World J Biol Psychiatry 2014; 15:620-8. [PMID: 24666249 DOI: 10.3109/15622975.2014.897003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Methadone maintenance treatment (MMT) patients may achieve up to a 2-week privilege of methadone take-home doses (THD), which is associated with considerable responsibility. MMT patients are characterized as having poor sleep quality and low cognitive states. We studied sleep indices and cognitive status with respect to THD privileges. METHODS A sample of 123 MMT patients stratified by THD groups was studied. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the cognitive Clock Drawing Test (CDT) were performed. RESULTS Thirty-one of 123 patients never had any THD and 92 did (25 had the maximum of 2 weeks). The never THD had history of longer duration of opiate usage and a shorter period in MMT. They had the highest rates of poor sleep (80.6%, PSQI > 5), daily sleepiness ("fall asleep while talking") (41.9%), and impaired cognitive status (58.1%, CDT < 3), while those who had 2-week privileges had the lowest (56, 8, and 28%, respectively). Logistic regression characterized THD patients as no-benzodiazepine and no-cocaine, short opiate usage duration, low ADHD scores, and no cognitive impairment (CDT = 3) and its interaction with treatment duration. CONCLUSION Privileges that reflect patients' abstinence and rehabilitation were also expanded to be associated with better cognitive states. These finding confirm the THD dispensing performance. Including CDT as part of the decision for dispensing THD may be considered.
Collapse
Affiliation(s)
- Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | | | | | | | | | | |
Collapse
|
43
|
Mak JCD, Klein LA, Finnegan T, Mason RS, Cameron ID. An initial loading-dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP). BMC Geriatr 2014; 14:101. [PMID: 25200552 PMCID: PMC4164764 DOI: 10.1186/1471-2318-14-101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/27/2014] [Indexed: 12/31/2022] Open
Abstract
Background Hypovitaminosis D is particularly common among older people with a proximal femoral (hip) fracture. There are currently no agreed strategies for vitamin D replenishment after hip fracture surgery. The REVITAHIP Study is a multisite, double-blinded randomized-controlled trial investigating the effects of an oral vitamin D loading dose on gait velocity after hip fracture surgery. We describe the baseline characteristics of participants, aiming to document hypovitaminosis D and its associations after hip fracture. Methods Participants, over 65, recruited within 7 days following hip fracture surgery from 3 Australia hospitals, were randomly allocated to receive a loading dose of vitamin D3 (250,000IU) or placebo, followed by oral maintenance vitamin D3/calcium (800 IU/500 mg) and the usual hip fracture rehabilitation pathway. Demographic and clinical data were collected, including surgical procedure, pre-fracture functional status, Mini Mental State Examination (MMSE) score, serum 25-hydroxyvitamin D (25-OHD), Verbal Rating Scale (VRS) for pain, grip strength and gait velocity. The associations of baseline 25-OHD levels with demographic and clinical data were assessed using Pearson’s correlation, ANOVA and regression analyses. Results Two-hundred-and-eighteen people with hip fracture participated in the study. Mean age was 83.9+/-7.2 years, 77% were women and 82% lived in private homes. Fifty-six percent had a subcapital fracture. Mean comorbidity count was 3.13+/-2.0. Mean MMSE was 26.1+/-3.9. Forty-seven percent of participants had hypovitaminosis D (<50 nmol/L). Multivariate regression models demonstrated higher baseline vitamin D levels were significantly associated with higher premorbid Barthel index scores, lower post-operative VRS pain levels and use of vitamin D. Conclusion This study cohort shared similar demographic characteristics and comorbidities with other cohorts of people with hip fracture, with the probable exception of less cognitive impairment. Hypovitaminosis D was not as prevalent as previously documented. Patients taking vitamin D supplements and with higher premorbid Barthel index, reflecting greater independence and activity, tended to have higher 25-OHD levels at baseline. Further, lower VRS pain ratings following surgery were associated with higher vitamin D levels. Such associations will need further investigation to determine causation. (ANZCTR number, ACTRN12610000392066). Trial registration The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066.
Collapse
Affiliation(s)
- Jenson C D Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, NSW, Australia.
| | | | | | | | | |
Collapse
|
44
|
Paula JJD, Miranda DMD, Moraes END, Malloy-Diniz LF. Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging? ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:763-8. [PMID: 24212511 DOI: 10.1590/0004-282x20130118] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 05/13/2013] [Indexed: 11/22/2022]
Abstract
The Clock Drawing Test (CDT) is a cognitive screening tool used in clinical and research settings. Despite its role on the assessment of global cognitive functioning, the specific cognitive components required for test performance are still unclear. We aim to assess the role of executive functioning, global cognitive status, visuospatial abilities, and semantic knowledge on Shulman's CDT performance. Fifty-three mild cognitive impairment, 60 Alzheimer's dementia, and 57 normal elderly controls performed the CDT, the Frontal Assessment Battery, the Mini-Mental State Examination, the Stick Design Test, and a naming test (TN-LIN). An ordinal regression assessed specific neuropsychological influences on CDT performance. All the cognitive variables were related to the CDT, accounting for 53% of variance. The strongest association was between the CDT and executive functions, followed by global cognitive status, visuospatial processing, and semantic knowledge. Our result confirms the multidimensional nature of the test and the major role of executive functions on performance.
Collapse
Affiliation(s)
- Jonas Jardim de Paula
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo HorizonteMG, Brazil
| | | | | | | |
Collapse
|
45
|
Yoo DH, Hong DG, Lee JS. The Standardization of the Clock Drawing Test (CDT) for People with Stroke Using Rasch Analysis. J Phys Ther Sci 2014; 25:1587-90. [PMID: 24409026 PMCID: PMC3885845 DOI: 10.1589/jpts.25.1587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to standardize the clock drawing test (CDT) for
people with stroke using Rasch analysis. [Subjects and Methods] Seventeen items of the CDT
identified through a literature review were performed by 159 stroke patients. The data was
analyzed with Winstep version 3.57 using the Rasch model to examine the unidimensionality
of the items’ fit, the distribution of the items’ difficulty, and the reliability and
appropriateness of the rating scale. [Result] Ten out of the 159 participations (6.2%)
were considered misfit subjects, and one item of the CDT was determined to be a misfit
item based on Rasch analysis. The rating scales were judged as suitable because the
observed average showed an array of vertical orders and MNSQ values < 2. The separate
index and reliability of the subject (1.98, 0.80) and item (6.45, 0.97) showed relatively
high values. [Conclusion] This study is the first to examine the CDT scale in stroke
patients by Rasch analysis. The CDT is expected to be useful for screening stroke patients
with cognitive problems.
Collapse
Affiliation(s)
- Doo Han Yoo
- Department of Occupational Therapy, Chonbuk National University Hospital, Republic of Korea
| | - Deok Gi Hong
- Department of Occupational Therapy, Wonkwang University Oriental Medical Hospital, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Graduate School of Konyang University: 158 Kwanjeo, Seo, Daejeon 302-718, Republic of Korea
| |
Collapse
|
46
|
Ismail Z, Mulsant BH, Herrmann N, Rapoport M, Nilsson M, Shulman K. Canadian academy of geriatric psychiatry survey of brief cognitive screening instruments. Can Geriatr J 2013; 16:54-60. [PMID: 23737930 PMCID: PMC3671013 DOI: 10.5770/cgj.16.81] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The use of brief cognitive screening instruments is essential in the assessment of dementia. The purpose of this study is to determine the frequency of use and perceived characteristics of cognitive screening instruments among Canadian psychogeriatric clinicians. Methods Members of the Canadian Academy of Geriatric Psychiatry (CAGP) and attendees to the 2010 Annual Scientific Meeting were asked to complete a computerized survey. This survey assessed the perceived characteristics and frequency of use of 14 instruments. Results The survey had a 55% response rate, with a total of 155 respondents. The most commonly used instruments are the Clock Drawing Test (CDT), Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), and Delayed Word Recall. Effectiveness, ease of administration, and speed of administration were the perceived characteristics of instruments most correlated with frequency of use. Conclusions Consistent with previous surveys, a small number of cognitive screening instruments are used by the majority of clinicians. Use of the CDT and the MMSE were comparable. To our knowledge, this is the first survey demonstrating that the MMSE is not the most commonly used tool, and other, newer instruments like the MoCA, are gaining prominence.
Collapse
Affiliation(s)
- Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB; ; Department of Psychiatry, University of Toronto, Toronto, ON
| | | | | | | | | | | |
Collapse
|
47
|
Kiral K, Ozge A, Sungur MA, Tasdelen B. Detection of memory impairment in a community-based system: a collaborative study. HEALTH & SOCIAL WORK 2013; 38:89-96. [PMID: 23865286 DOI: 10.1093/hsw/hlt004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The ability to distinguish between older people with cognitive impairment and those who age in a healthy manner is crucial because cognitive impairment may be a precursor to full-blown dementia. Therefore, an early diagnosis of cognitive impairment is important. However, patients are often admitted to a hospital only when they already have a serious cognitive impairment. Consequently, cooperative studies between clinics and community-based organizations may assist hospitals in detecting early cognitive impairment. This article examines how community-based organizations can contribute to the early diagnosis of dementia. A cooperation model between the Neurology Department of Mersin University Hospital and the Mersin branch of the Alzheimer's Association was developed. Trained professionals used a neuropsychological battery to evaluate 50 individuals at the Mersin branch of the Alzheimer's Association in Turkey. Individuals whose performance fell below the average (1 standard deviation or less) were subsequently referred to the hospital. On the basis of the neurological and neuropsychological assessments, 11 participants were placed in the mild cognitive impairment group and 39 were placed in the healthy group. The results suggest that the Standardized Mini-Mental State Examination and the Three Words-Three Shapes Test are useful tools for detecting early memory impairments in a community-based setting.
Collapse
Affiliation(s)
- Kahraman Kiral
- Department of Psychology, Ca University, Mersin, Turkey.
| | | | | | | |
Collapse
|
48
|
Cecato JF, Fiorese B, Montiel JM, Bartholomeu D, Martinelli JE. Clock drawing test in elderly individuals with different education levels: correlation with clinical dementia rating. Am J Alzheimers Dis Other Demen 2012; 27:620-4. [PMID: 23118201 PMCID: PMC10845329 DOI: 10.1177/1533317512463954] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE The aim of this study was to describe the performance in Clock Drawing Test (CDT) of the elderly individuals assessed in a geriatric clinic, with at least 1 year of schooling, comparing with other groups with higher education and with Clinical Dementia Rating (CDR) levels. The study also aims to correlate the results of CDT and other used diagnostic tests for dementia by CDR levels, providing additional validity evidence to the CDT. METHODS Cross-sectional study with 426 elderly individuals, >60 years old and at least 1 year of education. All participants searched for medical assistance at Geriatric and Gerontology Ambulatory of Jundiaí city, in Brazil. The community-dwelling outpatients previously undergone a detailed clinical examination and neuropsychological evaluation: Cambrigde Cognitive Examination (CAMCOG), Mini-Mental State Examination (MMSE), andCDT. To differentiate data from diagnostic groups based on CDR, it Kruskal-Wallis test was used. Pearson statistics were calculated to compare data from CDT and CDR. The statistical analyses were 2-tailed and were considered significant when P < .05. RESULTS Regarding CDT, groups with more years of schooling showed similar means in CDR = 0 and CDR = 0.5 and in CDR = 1 and CDR = 2. Shulman and Sunderland scale were high score in groups with more years of education and above of cutoff points in all CDT score. On the contrary, in Mendez scale we did not observed similar means. Otherwise, in the group with less years of schooling greater means differences in the CDT were observed. CONCLUSION The CDT did not show a strong correlation with MMSE and CAMCOG, both important instruments in Brazilian population to investigate dementia. For elderly individuals with high education levels, the CDT did not seem to be a good test to detect cognitive impairment.
Collapse
Affiliation(s)
| | | | | | - Daniel Bartholomeu
- Laboratory of Psychodiagnostic and Cognitive Neurosciencies - UNISAL - Brasil, Psychology Department
| | | |
Collapse
|
49
|
Oliveira AAVD, Satler C, Tomaz C. Neuropsychological performance differences between two groups of probable-AD patients from different areas of Brazil. Dement Neuropsychol 2012; 6:97-103. [PMID: 29213781 PMCID: PMC5619248 DOI: 10.1590/s1980-57642012dn06020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During normal aging there are some cognitive and behavioral changes similar to
those observed in a transitional state or mild cognitive impairment (MCI) and
early onset dementia, making it challenging for health care professionals to
reach an accurate and reliable diagnosis.
Collapse
|
50
|
Teixeira-Fabrício A, Lima-Silva TB, Kissaki PT, Vieira MG, Ordonez TN, Oliveira TBD, Aramaki FO, Souza PF, Yassuda MS. Treino cognitivo em adultos maduros e idosos: impacto de estratégias segundo faixas de escolaridade. PSICO-USF 2012. [DOI: 10.1590/s1413-82712012000100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivou-se com este estudo testar a eficácia de treino cognitivo de seis sessões, baseado na apresentação e prática de estratégias de memória (categorização) e na realização de atividades que recrutam as funções executivas, oferecido a idosos. Objetivou-se, também, identificar e comparar as estratégias mnemônicas utilizadas pelos participantes antes e após treino, segundo faixas de escolaridade. Participaram do estudo 31 idosos, divididos em Grupo 1 (com até 8 anos de escolaridade) e Grupo 2 (com 9 anos ou mais). Foram aplicadas questões sociodemográficas, escalas cognitivas e uma lista de estratégias possíveis para identificação das estratégias usadas. Os resultados indicaram a influência da escolaridade no uso de estratégias de memória no pré-teste. No pós-teste, apontaram para aumento na velocidade de processamento e na utilização de estratégias. Concluiu-se que o uso de estratégias, a autoeficácia para a memória e o ganho após o treino cognitivo podem ser influenciados pela escolaridade.
Collapse
|