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Cabreira V, Frostholm L, McWhirter L, Stone J, Carson A. Clinical signs in functional cognitive disorders: A systematic review and diagnostic meta-analysis. J Psychosom Res 2023; 173:111447. [PMID: 37567095 DOI: 10.1016/j.jpsychores.2023.111447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Functional cognitive disorder (FCD) accounts for around a third of patients attending specialized memory clinics. It is also overrepresented in patients with other functional and somatic diagnoses. So far, no long-term diagnostic validity studies were conducted, and a positive diagnostic profile is yet to be identified. We aimed to review the literature on diagnostic signs and symptoms that allow for a discrimination between FCD and neurodegeneration. METHODS Systematic review of Ovid-Medline®, Embase and PsycINFO databases. Relevant clinical features were extracted including demographics, symptom history, comorbidities, language and interaction profiles and cognitive assessments. Studies with quantifiable diagnostic accuracy data were included in a diagnostic meta-analysis. RESULTS Thirty studies (N = 8602) were included. FCD patients were younger, more educated, and more likely to have a family history of older onset dementia, abrupt symptom onset, and higher rates of anxiety, depression and sleep disturbance. Promising language profiles include longer duration of spoken answer, elaborated examples of memory failures, ability to answer compound and personal questions, and demonstration of working memory during interaction. The pooled analysis of clinical accuracy of different signs revealed that attending alone and bringing a handwritten list of problems particularly increase the odds of a FCD diagnosis. Current evidence from neuropsychometric studies in FCD is scarce. CONCLUSIONS Our systematic review reinforces that positive signs contribute for an early differentiation between FCD and neurodegeneration in patients presenting with memory complaints. It is the first to attain quantitative value to clinical observations. These results will inform future diagnostic decision tools and intervention testing.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Chang HT, Chiu PY. Development of a simple screening tool for determining cognitive status in Alzheimer's disease. PLoS One 2023; 18:e0280178. [PMID: 36634049 PMCID: PMC9836308 DOI: 10.1371/journal.pone.0280178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Cognitive screening is often a first step to document cognitive status of patients suspected having Alzheimer's disease (AD). Unfortunately, screening neuropsychological tests are often insensitivity in the detection. The goal of this study was to develop a simple and sensitive screening neuropsychological test to facilitate early detection of AD. This study recruited 761 elderly individuals suspected of having AD and presenting various cognitive statuses (mean age: 77.69 ± 8.45 years; proportion of females: 65%; cognitively unimpaired, CU, n = 133; mild cognitive impairment, MCI, n = 231; dementia of Alzheimer's type, DAT, n = 397). This study developed a novel screening neuropsychological test incorporating assessments of the core memory deficits typical of early AD and an interview on memory function with an informant. The proposed History-based Artificial Intelligence-Show Chwan Assessment of Cognition (HAI-SAC) was assessed in terms of psychometric properties, test time, and discriminative ability. The results were compared with those obtained using other common screening tests, including Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), and an extracted Mini-Mental State Examination score from CASI. HAI-SAC demonstrated acceptable internal consistency. Factor analysis revealed two factors: memory (semantic and contextual) and cognition-related information from informants. The assessment performance of HAI-SAC was strongly correlated with that of the common screening neuropsychological tests addressed in this study. HAI-SAC outperformed the other tests in differentiating CU individuals from patients with MCI (sensitivity: 0.87; specificity: 0.58; area under the curve [AUC]: 0.78) or DAT (sensitivity: 0.99; specificity: 0.89; AUC: 0.98). Performance of HAI-SAC on differentiating MCI from DAT was on par with performances of other tests (sensitivity: 0.78; specificity: 0.84; AUC: 0.87), while the test time was less than one quarter that of CASI and half that of MoCA. HAI-SAC is psychometrically sound, cost-effective, and sensitive in discriminating the cognitive status of AD.
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Affiliation(s)
- Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan, Taiwan
- Research Assistance Center, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Taiwan
- Department of Applied Mathematics, College of Science, Tunghai University, Taichung, Taiwan
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Farhani F, Shahrbanian S, Auais M, Hekmatikar AHA, Suzuki K. Effects of Aerobic Training on Brain Plasticity in Patients with Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials. Brain Sci 2022; 12:brainsci12060732. [PMID: 35741616 PMCID: PMC9221120 DOI: 10.3390/brainsci12060732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/01/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to systematically review to find if aerobic exercise compared to no exercise or any other intervention affects brain plasticity among people with mild cognitive impairment (MCI). Searches were conducted in the Scopus, SciELO, PubMed, Web of Science, Science Direct, and Google Scholar databases. The included studies were randomized control trials (RCTs) written in English comprising individuals with MCI that evaluated the effects of aerobic training on brain-derived neurotrophic factor (BDNF), brain structures, or brain activity. The quality of trials was evaluated using the PEDro scale for RCTs. Twelve studies with medium to high quality were included, of which five studies focused on brain-derived neurotrophic factor (four articles reported elevation and one article reported no changes in BDNF levels following the aerobic exercise), two studies focused on brain structures (both reported increases in hippocampus volume following the aerobic exercise), and five studies focused on brain activity (four articles reported positive changes, and one article reported no changes in brain activity following the aerobic exercise). Research regarding the effects of aerobic training on brain plasticity in people with MCI is in its infancy. Still, aerobic exercise seems to be a promising therapy in people with MCI.
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Affiliation(s)
- Farid Farhani
- Department of Sport Science, Faculty of Humanities, Tarbiat Modares University, Tehran P.O. Box 14115-111, Iran; (F.F.); (A.H.A.H.)
| | - Shahnaz Shahrbanian
- Department of Sport Science, Faculty of Humanities, Tarbiat Modares University, Tehran P.O. Box 14115-111, Iran; (F.F.); (A.H.A.H.)
- Correspondence: (S.S.); (K.S.); Tel.: +98(21)82885063 (S.S.); +81-4-2947-6898 (K.S.)
| | - Mohammad Auais
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Amir Hossein Ahmadi Hekmatikar
- Department of Sport Science, Faculty of Humanities, Tarbiat Modares University, Tehran P.O. Box 14115-111, Iran; (F.F.); (A.H.A.H.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (S.S.); (K.S.); Tel.: +98(21)82885063 (S.S.); +81-4-2947-6898 (K.S.)
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Blair EM, Zahuranec DB, Forman J, Reale BK, Langa KM, Giordani B, Fagerlin A, Kollman C, Whitney RT, Levine DA. Physician Diagnosis and Knowledge of Mild Cognitive Impairment. J Alzheimers Dis 2021; 85:273-282. [PMID: 34806602 DOI: 10.3233/jad-210565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older adults with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for multiple health conditions than those with normal cognition. Reasons for this disparity are unclear. OBJECTIVE To better understand this disparity, we describe physician understanding and experience with patient MCI, particularly physician identification of MCI, ability to distinguish between MCI and dementia, and perspectives on education and training in MCI and dementia. METHODS As part of a mixed-methods study assessing the influence of patient MCI on physician recommendations for acute myocardial infraction and stroke treatments, we conducted a descriptive qualitative study using semi-structured interviews of physicians from three specialties. Key question topics included participants' identification of MCI, impressions of MCI and dementia awareness within their practice specialty, and perspectives on training and education in MCI. RESULTS The study included 22 physicians (8 cardiologists, 7 neurologists, and 7 internists). We identified two primary themes: There is 1) a lack of adequate understanding of the distinction between MCI and dementia; and 2) variation in physician approaches to identifying whether an older adult has MCI. CONCLUSION These findings suggest that physicians have a poor understanding of MCI. Our results suggest that interventions that improve physician knowledge of MCI are needed.
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Affiliation(s)
- Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Darin B Zahuranec
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA
| | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT, USA
| | | | - Rachael T Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Mbizvo GK, Larner AJ. Receiver operating characteristic plot and area under the curve with binary classifiers: pragmatic analysis of cognitive screening instruments. Neurodegener Dis Manag 2021; 11:353-360. [PMID: 34569851 DOI: 10.2217/nmt-2021-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: To examine whether receiver operating characteristic plots and area under the curve (AUC) values may be potentially misleading when assessing cognitive screening instruments as binary predictors rather than as categorical or continuous scales. Materials & methods: AUC was calculated using different methods (rank-sum, diagnostic odds ratio) using data from test accuracy studies of two binary classifiers of cognitive status (applause sign, attended with sign), a screener producing categorical data (Codex), and a continuous scale screening test (Mini-Addenbrooke's Cognitive Examination). Results: For all screeners, AUC calculated using diagnostic odds ratio method was greater than using rank-sum method. When Codex and Mini-Addenbrooke's Cognitive Examination were analyzed as binary (single fixed threshold) tests, AUC using rank-sum method was lower than when screeners were analyzed as categorical or continuous scales, respectively. Conclusion: If cognitive screeners producing categorical or continuous measures are dichotomized, calculated AUC may be an underestimate, thus affecting screening test accuracy.
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Affiliation(s)
- Gashirai K Mbizvo
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
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Rego-García I, Medina Gámez JA, Valderrama-Martín C, Guillén Martínez V, Vílchez Carrillo R, Carnero-Pardo C. "Don't know" sign: description and evaluation of its diagnostic accuracy for cognitive impairment. Neurol Sci 2021; 43:993-997. [PMID: 34286410 DOI: 10.1007/s10072-021-05439-0] [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: 04/27/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients in neurology clinics are sometimes not aware of the reason for the consultation, and we have called this circumstance the "Don't know" sign (DKS). Our objective was to define this new sign and its modalities and to evaluate its prevalence and its diagnostic accuracy for cognitive impairment (CI) in comparison to other observation-based signs. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional prospective study included all new outpatients evaluated by the authors at neurology consultation. MEASUREMENTS We recorded observation-based signs. The Global Deterioration Scale (GDS) was used to assess the cognitive status of patients, based on clinical history, caregiver interview, and cognitive test results. We analyzed the prevalence and the diagnostic accuracy for CI of DKS, "head turning sign," "attending with," verbal repetition, and combinations, calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). RESULTS We enrolled 673 consecutive patients (62% female) with a mean ± SD age of 59.3 ± 20.2 years. DKS was positive in 94 patients (14%) and was strongly associated with GDS score. DKS had a Se of 0.41, Sp of 0.98, PPV of 0.89, and NPV of 0.79 for CI diagnosis. The presence of at least two positive observation signs yielded a Se of 0.50, Sp of 0.97, PPV of 0.86, and NPV of 0.81. CONCLUSIONS DKS is frequently observed in neurology outpatients. It has low sensitivity but high specificity and PPV for CI diagnosis. It does not require additional consultation time, and its use can be recommended in combination with other observation-based signs.
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Affiliation(s)
- Iago Rego-García
- Neurology Unit, Hospital Universitario Virgen de Las Nieves, Granada, Spain.
| | | | | | | | | | - Cristóbal Carnero-Pardo
- Neurology Unit, Hospital Universitario Virgen de Las Nieves, Granada, Spain.,FIDYAN Neurocenter, Granada, Spain
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7
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The Relationship Between Dementia Subtypes and Nutritional Parameters in Older Adults. J Am Med Dir Assoc 2020; 21:1430-1435. [DOI: 10.1016/j.jamda.2020.06.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
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8
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Soysal P. Comment on "Patient-reported cognitive complaints in older adults with gastrointestinal malignancies at diagnosis- Results from the CARE study". J Geriatr Oncol 2020; 12:171. [PMID: 32546366 DOI: 10.1016/j.jgo.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Adnan Menderes Bulvarı (Vatan Street), 34093 Fatih, Istanbul, Turkey.
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9
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Comment on “The concept of frailty should not be limited to malnutrition”. Clin Nutr 2020; 39:1974. [DOI: 10.1016/j.clnu.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
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10
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Daté Y, Sugiyama D, Tabuchi H, Saito N, Konishi M, Eguchi Y, Momota Y, Yoshizaki T, Mashima K, Mimura M, Nakahara J, Ito D. The utility of simple questions to evaluate cognitive impairment. PLoS One 2020; 15:e0233225. [PMID: 32407392 PMCID: PMC7224527 DOI: 10.1371/journal.pone.0233225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/30/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives As the population of patients with cognitive decline grows, physicians and caregivers need brief screening tools. Comprehensive neurocognitive batteries require special training and time for evaluation. We focused on accessibility and compared the diagnostic power of several easy questions. Design “Attended With” (AW) and “Head-Turning Sign” (HTS) factors and participants’ replies to following questions were recorded: “Do you feel that you have more difficulties in your daily life than you used to?”, [no consciousness (C-) or consciousness+ (C+)], “Could you tell me about your daily pleasures or pastimes?” [no pleasure (P-) or pleasure + (P+)], “What are notable current/recent news/topics?” [no news (N-) or news+ (N+)]. Setting This took place in our Memory Clinic between May 2016 and July 2019. Participants We enrolled 162 consecutive cases (44 cognitive normal (CN), 55 amnestic mild cognitive impairment (aMCI), and 48 Alzheimer’s disease (AD)). Measurements The sensitivity and specificity of each battery were calculated, and on account of those numbers, the population attributable risk percent % (PAR%) of (AW and HTS+), (C- and P-), (C- and N-), (P- and N-) as analysis of combination of questions, respectively, were calculated. Results AW had high sensitivity, 87.4, 95.8% (CN vs aMCI + AD, CN + aMCI vs AD) but the sensitivity of HTS was only 46.4, 57.7%, and HTS showed high specificity, 100.0, 71.8%. C- had high sensitivity, 80.6, 87.5%, whereas P- and N- had high specificity, both 83.9% in CN vs aMCI + AD, 88.1% and 75.9% in CN + aMCI vs AD, respectively. In combination analysis, the PAR% of (C- and N-) were as high as (AW and HTS+). Conclusions The combination of (C- and N-) is as powerful as (AW and HTS+) in screening AD. Our findings provide novel insights for screening utility of brief questions “Consciousness of Impairment” and “Recent News.”
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Affiliation(s)
- Yugaku Daté
- Departments of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Hajime Tabuchi
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naho Saito
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mika Konishi
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoko Eguchi
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuki Momota
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takahito Yoshizaki
- Departments of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kyoko Mashima
- Departments of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaru Mimura
- Departments of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jin Nakahara
- Departments of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Ito
- Departments of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- * E-mail:
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Larner AJ. The 'attended alone' and 'attended with' signs in the assessment of cognitive impairment: a revalidation. Postgrad Med 2020; 132:595-600. [DOI: 10.1080/00325481.2020.1739416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- AJ Larner
- Consultant Neurologist, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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12
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McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: a systematic review. Lancet Psychiatry 2020; 7:191-207. [PMID: 31732482 DOI: 10.1016/s2215-0366(19)30405-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.
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Affiliation(s)
- Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Koc Okudur S, Dokuzlar O, Kaya D, Soysal P, Isik AT. Triple Test Plus Rapid Cognitive Screening Test: A Combination of Clinical Signs and A Tool for Cognitive Assessment in Older Adults. Diagnostics (Basel) 2019; 9:diagnostics9030097. [PMID: 31443203 PMCID: PMC6787612 DOI: 10.3390/diagnostics9030097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022] Open
Abstract
Less time-consuming, easy-to-apply and more reliable cognitive screening tests are essential for use in primary care. The aim of this study was to investigate the diagnostic value of the Turkish version of the Rapid Cognitive Screen (RCS-T) and Triple Test individually and the combination of RCS-T with each sign and Triple Test to screen elderly patients for cognitive impairment (CI). A total of 357 outpatients aged 60 or older, who underwent comprehensive geriatric assessment, were included in the study. Presence or absence of attended alone sign (AAS), head-turning sign, and applause sign was investigated. The mean age of the patients was 74.29 ± 7.46. Of those, 61 patients (28 men, 33 women) had Alzheimer’s disease (AD), 59 patients had mild cognitive impairment (MCI) (29 men, 30 women), and 237 (80 men, 157 women) were cognitively robust. The sensitivity of the combination of RCS-T and negative for AAS for CI, AD and MCI is 0.79, 0.86 and 0.61, respectively; the specificity was 0.92, 0.93 and 0.92, respectively; and the positive and negative predictive values revealed good diagnostic accuracy. The combination of RCS-T and negative for AAS is a simple, effective and rapid way to identify possible CI in older adults.
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Affiliation(s)
- Saadet Koc Okudur
- Department of Geriatric Medicine, Manisa State Hospital, Manisa 45040, Turkey
| | - Ozge Dokuzlar
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Derya Kaya
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Ahmet Turan Isik
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey.
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The AD8 (Dementia Screening Interview) is a valid and reliable screening scale not only for dementia but also for mild cognitive impairment in the Turkish geriatric outpatients. Int Psychogeriatr 2019; 31:223-229. [PMID: 29923472 DOI: 10.1017/s1041610218000674] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED ABSTRACTIntroduction:There is still a need for short, practical, and daily-appropriate scales to distinguish between normal cognitive aging, mild cognitive impairment (MCI), or dementia for patients with memory complaints. This study aimed to determine validity and reliability of AD8 (Dementia Screening Interview) to detect both MCI and dementia in Turkish geriatric outpatients. METHODS Comprehensive geriatric assessment was performed in 334 patients, who attended with their informants to the geriatric outpatient clinic for memory complaints. In addition to the AD8, they were screened using Clinical Dementia Rating scale (CDR) and Mini-Mental State Examination. The diagnosis of dementia and MCI was made according to the Diagnostic and Statistical Manual of Mental Disorders - fifth edition (DSM-5) criteria. RESULTS The mean age of the patients was 74.5±8.5. Of them, 156 were considered as non-cognitive impairment, 60 as MCI, and 118 as dementia. Cronbach's α value of the AD8 was 0.928. The total AD8 scores were found to be negatively correlated with the MMSE scores (r = -0.801), and positively correlated with CDR score (r = 0.879) (p < 0.001, for each). The area under the receiver-operating characteristics curve was 0.979 for cognitive impairment, and 0.999 for dementia. We found that AD8 can show dementia and MCI when the cut-off values are ≥5 and 3-4, respectively, with a sensitivity of 100% and 81.67% and specificity of 96.3% and 93.59%. CONCLUSION AD8 is one of the fast, simple, and sensitive screening methods for detecting both minor and major cognitive impairments. With regard to these features, it can be used in older adults attending the primary care settings with memory complaints.
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16
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Koc Okudur S, Dokuzlar O, Usarel C, Soysal P, Isik AT. Validity and Reliability of Rapid Cognitive Screening Test for Turkish Older Adults. J Nutr Health Aging 2019; 23:68-72. [PMID: 30569071 DOI: 10.1007/s12603-018-1107-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Practical cognitive screening tests, brief and easy-to-administer are needed for primary care. The Rapid Cognitive Screen (RCS) is one of the cognitive screening tests used. The present study aimed to establish the validity and reliability of the Turkish version of RCS (RCS-T) in patients with impaired cognitive status. DESIGN Prospective validation study. SETTING AND PARTICIPANTS Total 323 outpatients aged 60 or older, who were performed comprehensive geriatric assessment, were included in the study. MEASUREMENTS Patients were screened by RCS-T, Turkish version of Saint Louis University Mental Status Examination (SLUMS-T), Mini-Mental State Examination (MMSE) and clock drawing test for cognitive impairment (CI). RESULTS The mean age of the patients was 72.2±7.4. Out of the patients, 217 were considered as cognitively intact, 54 as mild cognitive impairment (MCI), and 52 as Alzheimer's disease (AD). Cronbach's alpha value of the RCS-T was 0.674 for AD and 0.713 for CI. The total RCS-T scores were positively correlated with MMSE and SLUMS-T scores (r = 0.647 and r = 0.864, respectively) (p < .001, for each). The area under the receiver-operating characteristics curve (95% confidence interval) was 0.96 for AD, 0.92 for CI and 0.856 for MCI. The sensitivity and specificity for RCS-T for cut-off point of 6 and 4 were 85.85 (%) and 87.56 (%) for CI and 84.62 (%) and 91.14 (%) for AD, respectively. CONCLUSIONS In a bedside consultation and primary care practice, RCS-T, a simple, quick and sensitive tool for screening CI, seems to be a useful screening test for older patients with CI.
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Affiliation(s)
- S Koc Okudur
- Ahmet Turan ISIK, M.D., Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, 35340, Balcova, Izmir, Turkey, Phone: +90 232 412 43 41, Fax: +90 232 412 43 39,
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Abstract
We read with interest the comment by Williamson and Larner on our recent study titled "Attended With and Head-Turning Sign can be clinical markers of cognitive impairment in older adults" (Soysal et al., 2017). After the authors read the study, they re-examined their data according to the presence of Attended With (AW) and Head-Turning Sign (HTS), and compared their results with ours (Larner, 2014). Then, they found that while the sensitivity, specificity, positive predictive value, and negative predictive value of AW in detecting cognitive impairment were similar to ours, HTS had lower sensitivity (80.95% vs. 65.0%) and higher specificity (64.7% vs. 95.0%) than our results (Larner, 2014; Soysal et al., 2017). We think that some methodological and cultural differences may explain these discrepancies between the two.
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Attended with and head-turning sign can be clinical markers of cognitive impairment in older adults. Int Psychogeriatr 2018; 30:1569. [PMID: 29606176 DOI: 10.1017/s1041610218000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We read the paper by Soysal et al. (2017) with interest as we have experience of both the Attended With (AW) and the Head-Turning Sign (HTS) in a neurology-led cognitive disorders clinic.
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Larner AJ. Number Needed to Diagnose, Predict, or Misdiagnose: Useful Metrics for Non-Canonical Signs of Cognitive Status? Dement Geriatr Cogn Dis Extra 2018; 8:321-327. [PMID: 30386368 PMCID: PMC6206963 DOI: 10.1159/000492783] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background/Aims “Number needed to” metrics may hold more intuitive appeal for clinicians than standard diagnostic accuracy measures. The aim of this study was to calculate “number needed to diagnose” (NND), “number needed to predict” (NNP), and “number needed to misdiagnose” (NNM) for neurological signs of possible value in assessing cognitive status. Methods Data sets from pragmatic diagnostic accuracy studies examining easily observed and dichotomised neurological signs (“attended alone” sign, “attended with” sign, head turning sign, applause sign, la maladie du petit papier) were analysed to calculate the NND, NNP, and NNM. Results All measures of discrimination showed broad ranges. The range of NND and NNP suggested that these signs were, with a single exception, of value for correctly diagnosing or predicting cognitive status (presence or absence of cognitive impairment) when between 2 and 4 patients were examined. However, NNM showed similar values (range 1–5 patients) suggesting risk of misdiagnosis. Conclusion NND, NNP, and NNM may be useful, intuitive, metrics in assessing the utility of diagnostic tests in day-to-day clinical practice. A ratio of NNM to either NND or NNP, termed the likelihood to diagnose or misdiagnose, may clarify the utility or inutility of diagnostic tests.
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Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
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Isik AT, Soysal P, Kaya D, Usarel C. Triple test, a diagnostic observation, can detect cognitive impairment in older adults. Psychogeriatrics 2018; 18:98-105. [PMID: 29409161 DOI: 10.1111/psyg.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/13/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND A simple, quick, and efficient screening tool for detecting mild cognitive impairment (MCI) and Alzheimer's disease (AD) is essential, especially in the primary care setting. In this study, we examined the neuropsychological profiles of elderly patients and aimed to assess the diagnostic value of the triple test, comprised of the attended alone sign (AAS), head-turning sign, and applause sign (AS), for detecting MCI and AD. METHOD Comprehensive geriatric assessment was performed in 354 elderly outpatients, and the presence or absence of AS, AAS and HTS was investigated. RESULTS Of the 354 patients, 93 patients were considered to be cognitively impaired (MCI: 30; AD: 63); the remaining 261 were cognitively healthy. Relative to those without AS, patients with AS had significantly lower scores on the Mini-Mental State Examination, the clock-drawing test, Instrumental Activities of Daily Living Scale, and Basic Activities of Daily Living Scale (P < 0.001, for each). Similar significant differences were found between patients who were positive and negative for the HTS (P < 0.001) and between those who attended the clinic alone and those who were accompanied (P < 0.001). The sensitivity of the triple test for identifying cognitively impairment (CI), MCI, and AD was 0.61, 0.30, and 0.72, respectively; the specificity was 0.85, 0.68, and 0.83, respectively; and the positive and negative predictive values were 0.69, 0.09, and 0.59, respectively, and 0.79, 0.90, and 0.89, respectively. CONCLUSIONS The present study suggests that the triple test is a simple, quick, and efficient screening tool for detecting cognitive impairment, and the results may reflect deterioration in patients' activities of daily living. Additionally, it could be advantageous in clinical practice because educational level does not affect the test outcome. Therefore, it may be an appropriate test to screen for cognitive impairment in the elderly, both as a bedside diagnostic test and in daily clinical practice, especially in the primary care setting.
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Affiliation(s)
- Ahmet T Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cansu Usarel
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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