1
|
DiNatale JC, McDonough IM, Ellis AC, Douglas JW, Yaffe K, Crowe-White KM. The Drug Burden Index Is Associated With Measures of Cognitive Function Among Older Adults in the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae097. [PMID: 38567391 DOI: 10.1093/gerona/glae097] [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: 08/07/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Anticholinergic and sedative medications affect cognition among older adults. The Drug Burden Index (DBI) is a validated measure of exposure to these medications, with higher DBI scores indicating higher drug burden. This ancillary analysis investigated the association between DBI and cognition assessed by the Modified Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST). METHODS The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults aged 70-79 years at enrollment. Using data from years 1, 5, and 10, DBI was calculated using medication data per participant. Linear mixed modeling was used to assess cross-sectional and longitudinal effects of DBI on 3MS and DSST. Adjusted models included biological sex, race, education level, APOE status, and death. Sensitivity analyses included testing the strength of the associations for each year and testing attrition due to death as a possible confounding factor via Cox-Proportional Hazard models. RESULTS After adjustment, DBI was inversely associated with 3MS and DSST scores. These associations became stronger in each subsequent year. Neither DBI at year 1 nor within-person change in DBI were predictive of longitudinal declines in either cognitive measure. Sensitivity analyses indicated that DBI, 3MS, and DSST were associated with a greater risk of attrition due to death. CONCLUSIONS Results suggest that in years when older adults had a higher DBI scores, they had significantly lower global cognition and slower processing speed. These findings further substantiate the DBI as a useful pharmacological tool for assessing the effect of medication exposure.
Collapse
Affiliation(s)
- Janie C DiNatale
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Ian M McDonough
- Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Amy C Ellis
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Joy W Douglas
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, Alabama, USA
- Department of Psychology, Binghamton University, Binghamton, New York, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, Center for Population Brain Health, University of California San Francisco, San Francisco, California, USA
| | - Kristi M Crowe-White
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, Alabama, USA
| |
Collapse
|
2
|
Arseda A, Pahria T, Kurniawan T. Mapping cognitive function screening instruments for patients with heart failure: A scoping review. BELITUNG NURSING JOURNAL 2024; 10:240-251. [PMID: 38947299 PMCID: PMC11211750 DOI: 10.33546/bnj.3165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/15/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024] Open
Abstract
Background Patients with heart failure (HF) often experience cognitive impairment, which negatively affects their quality of life. An effective screening tool is essential for nurses and healthcare professionals to assess cognitive function as part of HF management. Although many instruments exist, none are specifically designed for patients with HF. Objective This study aimed to map the instruments for screening cognitive function in patients with HF. Design A scoping review. Data Sources Articles published between 2019 and 2023 were searched in PubMed, ScienceDirect, and Google Scholar, with the last search conducted on 27 January 2024. Review Methods The review followed the scoping review framework by Arksey and O'Malley and adhered to PRISMA guidelines for scoping reviews. Results Of the 21 articles meeting inclusion criteria, six cognitive function screening instruments were used across various cognitive domains, effectively identifying cognitive impairment in both inpatient and outpatient HF settings. The Montreal Cognitive Assessment (MoCA) was the most frequently used tool, covering a broad range of cognitive domains. MoCA showed high efficacy with a kappa coefficient of 0.82, Cronbach's alpha reliability of 0.75, sensitivity of 90%, and specificity of 87%. Conclusion Instruments like MoCA, Mini-Cog, and TICS-m show promise for assessing cognitive function in patients with HF, each with specific strengths and limitations. MoCA is notable for its comprehensive coverage despite being time-consuming and having language barriers. Further research is needed to revalidate and improve the existing instruments. It is crucial for nurses and healthcare professionals to integrate these tools into regular patient management, highlighting the need for continued research in their application.
Collapse
Affiliation(s)
- Astuti Arseda
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Tuti Pahria
- Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| | - Titis Kurniawan
- Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia
| |
Collapse
|
3
|
Suchy-Dicey AM, Vo TT, Oziel K, Buchwald DS, Nelson LA, Verney SP, French BF. Psychometric reliability, validity, and generalizability of 3MSE scores among American Indian adults: the Strong Heart Study. J Int Neuropsychol Soc 2024; 30:454-463. [PMID: 38263740 DOI: 10.1017/s1355617723011438] [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] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians. METHODS We recruited 818 American Indians aged 65-95 for 3MSE examinations in 2010-2013; 403 returned for a repeat examination in 2017-2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models. RESULTS This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small. CONCLUSION These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.
Collapse
Affiliation(s)
- Astrid M Suchy-Dicey
- Huntington Medical Research Institutes, Pasadena, CA, USA
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Thao T Vo
- Washington State University, College of Education, Pullman, WA, USA
| | - Kyra Oziel
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Dedra S Buchwald
- Washington State University, Elson S Floyd College of Medicine, Seattle, WA, USA
| | - Lonnie A Nelson
- Washington State University, College of Nursing, Spokane, WA, USA
| | | | - Brian F French
- Washington State University, College of Education, Pullman, WA, USA
| |
Collapse
|
4
|
Chen CYA, Chiu CC, Huang CY, Cheng YC, Huang MC, Kuo PH, Chen WY. Cluster analysis dissecting cognitive deficits in older adults with major depressive disorder and the association with neurofilament light chain. BMC Geriatr 2024; 24:344. [PMID: 38627748 PMCID: PMC11020442 DOI: 10.1186/s12877-024-04960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Cognitive impairment is a growing problem with increasing burden in global aging. Older adults with major depressive disorder (MDD) have higher risk of dementia. Neurofilament light chain (NfL) has been proven as a potential biomarker in neurodegenerative disease, including dementia. We aimed to investigate the association between cognitive deficits and NfL levels in older adults with MDD. METHODS In this cross-sectional study, we enrolled 39 MDD patients and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer's type, as controls, from a tertiary psychiatric hospital. Both groups were over age 65 and with matched Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and each cognitive domain. RESULTS In the MDD group, participants had higher rate of family psychiatry history and current alcohol use habit compared with controls. Control group of neurocognitive disorders showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits clustered with that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster. CONCLUSIONS We noted the negative correlation between NfL levels and cognition in MDD patients clustered with neurodegenerative disorder, Alzheimer's type. NfL could be a promising candidate as a biomarker to predict subtype of patients in MDD to develop cognitive decline. Further longitudinal studies and within MDD cluster analysis are required to validate our findings for clinical implications.
Collapse
Affiliation(s)
- Cynthia Yi-An Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
| | - Ying-Chih Cheng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
| |
Collapse
|
5
|
Liu S, Rosso AL, Baillargeon EM, Weinstein AM, Rosano C, Torres-Oviedo G. Novel attentional gait index reveals a cognitive ability-related decline in gait automaticity during dual-task walking. Front Aging Neurosci 2024; 15:1283376. [PMID: 38274986 PMCID: PMC10808635 DOI: 10.3389/fnagi.2023.1283376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Gait automaticity refers to the ability to walk with minimal recruitment of attentional networks typically mediated through the prefrontal cortex (PFC). Reduced gait automaticity (i.e., greater use of attentional resources during walking) is common with aging, contributing to an increased risk of falls and reduced quality of life. A common assessment of gait automaticity involves examining PFC activation using near-infrared spectroscopy (fNIRS) during dual-task (DT) paradigms, such as walking while performing a cognitive task. However, neither PFC activity nor task performance in isolation measures automaticity accurately. For example, greater PFC activation could be interpreted as worse gait automaticity when accompanied by poorer DT performance, but when accompanied by better DT performance, it could be seen as successful compensation. Thus, there is a need to incorporate behavioral performance and PFC measurements for a more comprehensive evaluation of gait automaticity. To address this need, we propose a novel attentional gait index as an analytical approach that combines changes in PFC activity with changes in DT performance to quantify automaticity, where a reduction in automaticity will be reflected as an increased need for attentional gait control (i.e., larger index). Methods The index was validated in 173 participants (≥65 y/o) who completed DTs with two levels of difficulty while PFC activation was recorded with fNIRS. The two DTs consisted of reciting every other letter of the alphabet while walking over either an even or uneven surface. Results As DT difficulty increases, more participants showed the anticipated increase in the attentional control of gait (i.e., less automaticity) as measured by the novel index compared to PFC activation. Furthermore, when comparing across individuals, lower cognitive function was related to higher attentional gait index, but not PFC activation or DT performance. Conclusion The proposed index better quantified the differences in attentional control of gait between tasks and individuals by providing a unified measure that includes both brain activation and performance. This new approach opens exciting possibilities to assess participant-specific deficits and compare rehabilitation outcomes from gait automaticity interventions.
Collapse
Affiliation(s)
- Shuqi Liu
- Sensorimotor Learning Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
| | - Andrea L. Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Emma M. Baillargeon
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea M. Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gelsy Torres-Oviedo
- Sensorimotor Learning Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
| |
Collapse
|
6
|
Brotto D, Benvegnù F, Colombo A, de Filippis C, Martini A, Favaretto N. Age-related changes in auditory perception. Hearing loss in the elderly: aging ear or aging brain? Aging Clin Exp Res 2023; 35:2349-2354. [PMID: 37833454 PMCID: PMC10627897 DOI: 10.1007/s40520-023-02570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
Hearing loss in the elderly is a very common disease: it is estimated to affect up to a third of the population aged 65 years or more, and 50% of people over 75 years old. There is a growing amount of data concerning the association between hearing loss and cognitive decline. Various possible mechanisms at the basis of this association have been proposed, such as the "common cause hypothesis," the "cascade hypothesis," and the "cognitive load hypothesis."Critically reviewing the data is essential to highlight the features of the relationship between hearing loss and cognitive decline. Most of the hearing tests available should take into account that dementia or even just mild cognitive impairment (MCI) may lead to poor performance during examination. On the other hand, clinicians should also remember that tests used to assess cognitive function require an adequate hearing capacity.In this article we propose to analyze current diagnostic tests, treatment options, auditory processing, and rehabilitation strategies for hearing loss in the elderly in order to facilitate the management of this handicap in this fragile population.
Collapse
Affiliation(s)
- Davide Brotto
- Neurosciences Department, Università degli Studi di Padova, Padua, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - Francesco Benvegnù
- Neurosciences Department, Università degli Studi di Padova, Padua, Italy.
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padua, PD, Italy.
| | - Anna Colombo
- Neurosciences Department, Università degli Studi di Padova, Padua, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - Cosimo de Filippis
- Neurosciences Department, Università degli Studi di Padova, Padua, Italy
| | - Alessandro Martini
- Neurosciences Department, Università degli Studi di Padova, Padua, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - Niccolò Favaretto
- Section of Otorhinolaryngology-Head and Neck Surgery, Azienda ULSS 5 Polesana, Rovigo, Italy
| |
Collapse
|
7
|
Schietzel S, Kressig RW, Huynh-Do U. Screening of cognitive performance in kidney transplant recipients: a mini review. FRONTIERS IN NEPHROLOGY 2023; 3:1238501. [PMID: 37780580 PMCID: PMC10539592 DOI: 10.3389/fneph.2023.1238501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023]
Abstract
Why should we screen? The prevalence of cognitive impairment in kidney transplant recipients (KTRs) is up to 58%. The 10-year graft loss and mortality rates are above 30% and 50%, respectively, and executive malfunctioning increases disadvantageous outcomes. What causes cognitive impairment in KTRs? Strong risk factors are older age and chronic kidney disease. However, causes are multifactorial and include cardiovascular, cerebrovascular, neurodegenerative, inflammatory, uremic, psychiatric, and lifestyle-related susceptibilities. How should we screen? KTR-specific validated instruments or strategies do not exist. The central element should be a multidomain cognitive screening test that is sensitive to mild cognitive impairment, corrects for age and education, and includes executive functions testing. Cognitive trajectories, effects on everyday life and psychiatric comorbidities should be assessed by integrating the perspectives of both patients and knowledgeable informants. When should we screen? Screening should not be postponed if there is suspicion of impaired cognition. Different time points after transplantation tend to have their own characteristics. Who should conduct the screening? Screening should not be limited to specialists. It can be carried out by any healthcare professional who has received a limited amount of training. What are the benefits of screening? Screening does not provide a diagnosis. However, suggestive results change care in multiple ways. Goals are: Initiation of professional dementia work-up, securing of adherence, anticipation of potential complications (delirium, falls, frailty, functional impairment, malnutrition, etc.), mitigation of behavioral disorders, adjustment of diagnostic and therapeutic "load", reduction of caregiver burden and meeting of changing needs. We summarize data on the prevalence, risk factors and sequelae of cognitive impairment in KTRs. We also discuss the requirements for appropriate screening strategies and provide guiding principles regarding appropriate and safe care.
Collapse
Affiliation(s)
- Simeon Schietzel
- Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - Uyen Huynh-Do
- Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
8
|
Khan S, Naeem MK, Tania MH, Refat N, Rahman MA, Patwary M. A modified mental state assessment tool for impact analysis of virtual reality-based therapeutic interventions in patients with cognitive impairment. Digit Health 2023; 9:20552076231203800. [PMID: 38025104 PMCID: PMC10647984 DOI: 10.1177/20552076231203800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This work has developed a modified mental state assessment tool for impact analysis of therapeutic interventions for patients with cognitive impairment. This work includes a pilot study to validate the proposed tool and assess the impact of virtual reality-based interventions on patient well-being, which includes assessment of cognitive ability and mood. Methods The suggested tool's robustness and reliability are assessed in care home facilities with elderly residents over the age of 55. Because of the repetitive nature of the pilot study, test-retest strategy for Cronbach's alpha coefficient is employed to validate the internal consistency of the proposed tool over time. Qualitative and quantitative analyses are performed on the collected data to draw inferences on the impact of virtual reality-based interventions on patients with cognitive impairments. Results The Cronbach's alpha coefficient value shows that the proposed tool's resilience is comparable to that of its pre-intervention counterparts. The Cronbach's alpha coefficient values are determined for Pre-virtual reality and Post-virtual reality interventions, which include 116 virtual reality sessions for 52-participant, and three cohorts of virtual reality sessions for 21 participants. These values for a majority of the interventions remained within the acceptable range of 0.6-0.8. Conclusions The proposed modified mental state assessment tool is observed to be a reliable tool for investigating the impact of virtual reality-based interventions on patients with cognitive impairments. One of the notable significance of the proposed tool is that this allows for resource allocation for such interventions to be tailored to the needs of the patient, leading to greater therapeutic efficacy and resource efficiency.
Collapse
Affiliation(s)
- Samiya Khan
- School of Engineering, Computing and Mathematical Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Muhammad Kamran Naeem
- School of Engineering, Computing and Mathematical Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Marzia Hoque Tania
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Nadia Refat
- School of Engineering, Computing and Mathematical Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Md Arafatur Rahman
- School of Engineering, Computing and Mathematical Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Mohammad Patwary
- School of Engineering, Computing and Mathematical Sciences, University of Wolverhampton, Wolverhampton, UK
| |
Collapse
|
9
|
Alim-Marvasti A, Kuleindiren N, Harvey K, Ciocca M, Lin A, Selim H, Mahmud M. Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study. Front Digit Health 2022; 4:1029810. [PMID: 36620187 PMCID: PMC9811948 DOI: 10.3389/fdgth.2022.1029810] [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: 08/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background The Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60 min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5 min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE. Methods To ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs. Results 72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho = 0.54, p < 0.0001) and impaired cognition on CDR (Mann Whitney U = 187, p < 0.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (p = 0.21). Conclusion Digital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete.
Collapse
Affiliation(s)
- Ali Alim-Marvasti
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,Correspondence: Ali Alim-Marvasti
| | | | - Kirsten Harvey
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Matteo Ciocca
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Aaron Lin
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd., London, United Kingdom
| | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd., London, United Kingdom,Department of Brain Sciences, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
Gómez-Soria I, Marin-Puyalto J, Peralta-Marrupe P, Latorre E, Calatayud E. Effects of multi-component non-pharmacological interventions on cognition in participants with mild cognitive impairment: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 103:104751. [PMID: 35839574 DOI: 10.1016/j.archger.2022.104751] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment (MCI) describes a stage of intermediate cognitive dysfunction where the risk of conversion to dementia is elevated. Given the absence of effective pharmacological treatments for MCI, increasing numbers of studies are attempting to understand how multicomponent non-pharmacological interventions (MNPI) could benefit MCI. The purpose of this systematic review and meta-analysis were to assess the effects of two-component MNPI (simultaneous cognitive intervention based on cognitive stimulation, cognitive training and/or cognitive rehabilitation or combined cognitive and physical interventions) on global cognition and cognitive functions in older adults with MCI and to compare the degree of efficacy between the two interventions. METHODS After searching electronic databases (PubMed, Web of Science, Scopus and Cochrane Central) for randomized controlled trials and clinical trials published from 2010 to 18 January 2021, 562 studies were found. 8 studies were included in this review, with a fair to good quality according to the PEDro scale. RESULTS From a random-effects model meta-analysis, the pooled standardized MMSE mean difference between the intervention and control groups showed a significant small-to-medium effect in global cognition in MMSE score (0.249; 95% CI = [0.067, 0.431]), which seemed to be greater for combined physical and cognitive interventions. However, the meta-analyses did not show any effects regarding specific cognitive functions. CONCLUSION Our analyses support that MNPI could improve the global cognition in older adults with MCI. However, more studies are needed to analyze the potential benefits of MNPI on older adults with MCI.
Collapse
Affiliation(s)
- Isabel Gómez-Soria
- Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain; Institute of Health Research of Aragón (IIS Aragón), Zaragoza, Spain.
| | - Jorge Marin-Puyalto
- Department of Physiatry and Nursing, Faculty of Health and Sport Sciences, Universidad de Zaragoza, C/Pedro Cerbuna, 12, Zaragoza 50009, Spain; Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Arag ́on (IA2), Zaragoza, Spain.
| | - Patricia Peralta-Marrupe
- Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain.
| | - Eva Latorre
- Department of Biochemistry and Molecular and Cell Biology, Faculty of Sciences, Universidad de Zaragoza, Zaragoza, Spain; Institute of Health Research of Aragón (IIS Aragón), Zaragoza, Spain.
| | - Estela Calatayud
- Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain; Institute of Health Research of Aragón (IIS Aragón), Zaragoza, Spain.
| |
Collapse
|
11
|
Sanborn V, Ostrand R, Ciesla J, Gunstad J. Automated assessment of speech production and prediction of MCI in older adults. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1250-1257. [PMID: 33377800 PMCID: PMC8243401 DOI: 10.1080/23279095.2020.1864733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The population of older adults is growing dramatically and, with it comes increased prevalence of neurological disorders, including Alzheimer's disease (AD). Though existing cognitive screening tests can aid early detection of cognitive decline, these methods are limited in their sensitivity and require trained administrators. The current study sought to determine whether it is possible to identify persons with mild cognitive impairment (MCI) using automated analysis of spontaneous speech. Participants completed a brief neuropsychological test battery and a spontaneous speech task. MCI was classified using established research criteria, and lexical-semantic features were calculated from spontaneous speech. Logistic regression analyses compared the predictive ability of a commonly-used cognitive screening instrument (the Modified Mini Mental Status Exam, 3MS) and speech indices for MCI classification. Testing against constant-only logistic regression models showed that both the 3MS [χ2(1) = 6.18, p = .013; AIC = 41.46] and speech indices [χ2(16) = 32.42, p = .009; AIC = 108.41] were able to predict MCI status. Follow-up testing revealed the full speech model better predicted MCI status than did 3MS (p = .049). In combination, the current findings suggest that spontaneous speech may have value as a potential screening measure for the identification of cognitive deficits, though confirmation is needed in larger, prospective studies.
Collapse
Affiliation(s)
- Victoria Sanborn
- Department of Psychological Sciences, Kent State University, Kent, OH, U.S
| | - Rachel Ostrand
- Department of Healthcare & Life Sciences, IBM Research,
Yorktown Heights, NY, U.S
| | - Jeffrey Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, U.S
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, U.S
- Brain Health Research Institute, Kent State University,
Kent, OH U.S
| |
Collapse
|
12
|
Gallegos M, Morgan ML, Cervigni M, Martino P, Murray J, Calandra M, Razumovskiy A, Caycho-Rodríguez T, Gallegos WLA. 45 Years of the mini-mental state examination (MMSE): A perspective from ibero-america. Dement Neuropsychol 2022; 16:384-387. [DOI: 10.1590/1980-5764-dn-2021-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The Mini-Mental State Examination (MMSE) was created by Marshal Folstein et al. in 1975 as an instrument for brief (5–10 min) assessment of mental status in hospitalized patients. It is considered the most widely used test for standardized cognitive assessment in the clinical setting, especially with the elderly population. It has countless translations in different languages, and according to the different international (PubMed) and regional (SciELO, Redalyc, and Dialnet) scientific databases, it has been widely used by the scientific community. This article describes the historical evolution of the MMSE, highlights its evaluative properties, and provides bibliometric data on its impact on scientific publications, with a special focus on Ibero-America.
Collapse
Affiliation(s)
- Miguel Gallegos
- Universidad Católica del Maule, Chile; Pontifícia Universidade Católica de Minas Gerais, Brazil; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
| | | | - Mauricio Cervigni
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
| | - Pablo Martino
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Rosario, Argentina
| | | | | | | | | | | |
Collapse
|
13
|
Pessoa RC, Oliveira-Pessoa GF, Souza BKA, Sampaio VS, Pinto ALCB, Barboza LL, Mouta GS, Silva EL, Melo GC, Monteiro WM, Silva-Filho JH, Lacerda MVG, Baía-da-Silva DC. Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon. Sci Rep 2022; 12:10361. [PMID: 35725784 PMCID: PMC9208538 DOI: 10.1038/s41598-022-14175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
The exact path leading to cognitive impairment that goes beyond malaria is unclear, but it appears to be the result of interactive factors. Time of exposure to disease and recurrences are potentially major determinant variables. Cognitive impairment is described mainly in children, rarely in adults. The disease in high endemic areas usually does not affect elderlies, because of acquired immunity over time. However, this population is relatively more frequently sick in lower endemic areas, such as in the Amazon. This study assessed the effect of Plasmodium vivax malaria on the executive and cognitive functions of elderlies, in the Brazilian Amazon. A cohort study was conducted to evaluate executive and cognitive functions one week (T0), two months (T2) and eight months (T8) after the malaria episode. Mini-Mental State Examination (MMSE), Beck Depression Inventory II (BDI-II), Clock Drawing Test (CDT), Wechsler adult intelligence scale (WAIS-III), and Wisconsin Card Sorting Test (WCST) were used to assess executive and cognitive functions. One hundred-forty elderlies were enrolled (70 with P. vivax malaria and 70 without malaria). P. vivax malaria was associated with impairment of the executive and cognitive functions in elderlies for up to 8 months after acute P. vivax malaria. Prior history of malaria, recurrences and higher parasitemia were independently associated with various surrogates of executive and cognitive impairment. With the increase in life expectancy, elderlies living in malaria endemic areas will deserve more attention from health authorities, to guarantee improvement of their quality of life in the tropics.
Collapse
Affiliation(s)
- Rockson C Pessoa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Brenda K A Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - André Luiz C B Pinto
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Larissa L Barboza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gabriel S Mouta
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Emanuelle Lira Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely C Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Wuelton M Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | | | - Marcus V G Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil.
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.
| | - Djane Clarys Baía-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| |
Collapse
|
14
|
Kanser RJ, VandenBussche Jantz AB, Logan PM, Bailey EK, Kamper JE. Comparing Detection of Alzheimer's and Vascular Disease-Related Cognitive Impairment With Brief Cognitive Screens. J Neuropsychiatry Clin Neurosci 2022; 34:361-366. [PMID: 35578799 DOI: 10.1176/appi.neuropsych.21040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: The study compared the accuracy of the Mini-Mental State Examination (MMSE) with its modified version (3MS) in distinguishing healthy older adults from adults with cognitive impairment due to suspected Alzheimer’s disease (AD) or vascular disease (VaD). Method: Participants were 98 veterans who underwent comprehensive neuropsychological evaluation due to concern for cognitive decline. Participants were selected via retrospective chart review on the basis of diagnosis. They had diagnoses of mild or major neurocognitive disorder due to suspected AD (N=20), mild or major neurocognitive disorder due to suspected VaD (N=44), or no neurocognitive diagnosis (i.e., healthy adult comparisons; HC, N=34). Results: The 3MS demonstrated superior detection of cognitive impairment. The extent of this enhanced detection was influenced by the suspected etiology of cognitive impairment. The 3MS and MMSE had comparable discrimination of AD and HC. With respect to VaD, the 3MS showed superior discriminability compared to the MMSE. Conclusions: Overall, results support the adoption of the 3MS over that of the MMSE. The 3MS is a superior (and free) tool for detecting cognitive impairment in geriatric populations. Its use is recommended for first-line screening of cognitive symptoms in older adult populations, especially those with concern for VaD.
Collapse
Affiliation(s)
- Robert J Kanser
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | | | - Patrick M Logan
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Erin K Bailey
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Joel E Kamper
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| |
Collapse
|
15
|
Ip EH, Chen SH, Rejeski WJ, Bandeen-Roche K, Hayden KM, Hugenschmidt CE, Pierce J, Miller ME, Speiser JL, Kritchevsky SB, Houston DK, Newton RL, Rapp SR, Kitzman DW. Gradient and Acceleration of Decline in Physical and Cognitive Functions in Older Adults: A Disparity Analysis. J Gerontol A Biol Sci Med Sci 2022; 77:1603-1611. [PMID: 35562076 PMCID: PMC9373944 DOI: 10.1093/gerona/glac109] [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: 08/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Substantive previous work has shown that both gait speed and global cognition decline as people age. Rates of their decline, as opposed to cross-sectional measurements, could be more informative of future functional status and other clinical outcomes because they more accurately represent deteriorating systems. Additionally, understanding the sex and racial disparity in the speed of deterioration, if any, is also important as ethnic minorities are at an increased risk of mobility disability and dementia. METHOD Data from 2 large longitudinal intervention studies were integrated. Rates of decline were derived from individual-level measures of gait speed of 400-m walk and scores on the Modified Mini Mental State Examination (3MSE). We also assessed age-associated declines and accelerations in changes across the ages represented in the studies (age range 53-90). RESULTS The mean rate of decline in 400-m gait speed across individuals was 0.03 m/s per year, and multivariable analysis showed a significant acceleration in decline of -0.0013 m/s/y2 (p < .001). Both race and sex moderated the rate of decline. For global cognition, the mean rate of decline was 0.05 of a point per year on the 3MSE scale, and acceleration in the rate of decline was significant (-0.017 point/y2, p < .001), but neither sex nor race moderated the decline. CONCLUSION Rate of decline in physical but not cognitive function appears moderated by sex and race. This finding, as well as rates and accelerations of decline estimated herein, could inform future intervention studies. CLINICAL TRIALS REGISTRATION NUMBER NCT00017953 (Look AHEAD); NCT01410097 (Look AHEAD ancillary); NCT00116194 (LIFE).
Collapse
Affiliation(s)
- Edward H Ip
- Address correspondence to: Edward H. Ip, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA. E-mail:
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - June Pierce
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jaime L Speiser
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert L Newton
- Population and Public Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Dalane W Kitzman
- Sections of Cardiovascular and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | |
Collapse
|
16
|
Spencer RJ, Noyes ET, Bair JL, Ransom MT. Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clin Gerontol 2022; 45:454-466. [PMID: 35107414 DOI: 10.1080/07317115.2022.2032523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This systemic review qualitatively synthesizes existing psychometric support for the Saint Louis University Mental Status (SLUMS) Examination, a cognitive screening measure which presents as a free alternative to other widely used dementia screening measures including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). METHODS A total of 90 peer-reviewed articles on the SLUMS were identified from PsycINFO and PubMed databases. RESULTS Sixty-eight records were identified and reviewed by the lead author for eligibility. Studies that included at least one psychometric property of the SLUMS (n = 20) were included in this review. CONCLUSIONS Support for the SLUMS remains preliminary; however, it appears to have adequate validity, and adequate sensitivity and specificity in detecting cognitive impairment. Numerous shortcomings were identified, including lack of sufficient normative data, information on test-reliability, explored factor structure, and limited application of criterion measures (e.g., imaging studies, biomarkers). Research is needed to establish diverse normative samples and describe the reliability and validity of the SLUMS to strengthen the empirical support for its use. CLINICAL IMPLICATIONS Until its psychometric properties are better established the SLUMS should be used cautiously when screening for cognitive impairment.
Collapse
Affiliation(s)
- Robert J Spencer
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily T Noyes
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jessica L Bair
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Michael T Ransom
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| |
Collapse
|
17
|
Kuhn TA, Gathright EC, Dolansky MA, Gunstad J, Josephson R, Hughes JW. Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:50-55. [PMID: 34581712 PMCID: PMC8648929 DOI: 10.1097/jcn.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Health literacy has predicted mortality in heart failure. However, the role of cognitive functioning in this relationship has not been evaluated. We hypothesized that health literacy would predict all-cause mortality but that cognitive functioning would modify the relationship between health literacy and mortality in heart failure. OBJECTIVE The aim of this study was to examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure. METHODS This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (trial identifier: NCT01461629). Health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Medical Term Recognition Test (METER), and cognitive functioning was evaluated using the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable. RESULTS After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (Ps ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, P < .01; B = -.07; hazard ratio, 0.94 [95% confidence interval, 0.89-0.98]; P < .01) and REALM (Δχ2 = 9.77, P < .01; B = -0.07; hazard ratio, 0.94 [95% confidence interval, 0.90-0.97]; P < .01). Furthermore, adding the 3MS improved model fit. CONCLUSIONS Cognitive functioning predicted mortality in heart failure better than health literacy. Results suggest the need to further evaluate the contribution of cognitive functioning to increased risk of mortality in those with heart failure.
Collapse
|
18
|
Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med 2021; 36:3122-3135. [PMID: 34244959 PMCID: PMC8481403 DOI: 10.1007/s11606-021-06954-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a risk factor for cognitive impairment and dementia in patients with stroke history. However, the association between AF and cognitive impairment in broader populations is less clear. OBJECTIVE To systematically review and quantitatively synthesize the existing evidence regarding the association of AF with cognitive impairment of any severity and etiology and dementia. METHODS Medline, Scopus, and Cochrane Central were searched in order to identify studies investigating the association between AF and cognitive impairment (or dementia) cross-sectionally and longitudinally. Studies encompassing and analyzing exclusively patients with stroke history were excluded. A random-effects model meta-analysis was conducted. Potential sources of between-study heterogeneity were investigated via subgroup and meta-regression analyses. Sensitivity analyses including only studies reporting data on stroke-free patients, vascular dementia, and Alzheimer's disease were performed. RESULTS In total, 43 studies were included. In the pooled analysis, AF was significantly associated with dementia (adjusted OR, 1.6; 95% CI, 1.3 to 2.1; I2, 31%) and the combined endpoint of cognitive impairment or dementia (pooled adjusted OR, 1.5; 95% CI, 1.4 to 1.8; I2, 34%). The results were significant, even when studies including only stroke-free patients were pooled together (unadjusted OR, 2.2; 95% CI, 1.4 to 3.5; I2, 96%), but the heterogeneity rates were high. AF was significantly associated with increased risk of both vascular (adjusted OR, 1.7; 95% CI, 1.2 to 2.3; I2, 43%) and Alzheimer's dementia (adjusted HR, 1.4; 95% CI, 1.2 to 1.6; I2, 42%). CONCLUSION AF increases the risk of cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer's disease. Future studies should employ interventions that may delay or even prevent cognitive decline in AF patients.
Collapse
|
19
|
Coelho-Júnior HJ, Trichopoulou A, Panza F. Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Res Rev 2021; 70:101395. [PMID: 34153553 DOI: 10.1016/j.arr.2021.101395] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults. METHODS We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254). RESULTS Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies. DISCUSSION Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias.
Collapse
|
20
|
Alexopoulos P, Skondra M, Kontogianni E, Vratsista A, Frounta M, Konstantopoulou G, Aligianni SI, Charalampopoulou M, Lentzari I, Gourzis P, Kliegel M, Economou P, Politis A. Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting. J Alzheimers Dis 2021; 83:259-268. [PMID: 34275904 PMCID: PMC8461705 DOI: 10.3233/jad-210477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet. Objective: Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance. Methods: The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test. Results: All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL. Conclusion: COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.
Collapse
Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece.,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Maria Skondra
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Frounta
- Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Suzana Ioanna Aligianni
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Iliana Lentzari
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Matthias Kliegel
- Laboratory of Cognitive Aging, University of Geneva, Geneva, Switzerland
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
| |
Collapse
|
21
|
Ip EH, Pierce J, Chen S, Lovato J, Hughes TM, Hayden KM, Hugenschmidt CE, Craft S, Kitzman D, Rapp S. Conversion between the Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12161. [PMID: 33816754 PMCID: PMC8010479 DOI: 10.1002/dad2.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE) are two commonly used instruments for assessing cognitive function. Although conversion between 3MSE and MMSE is useful in applications such as integrative data analysis, there are limited published reports on the topic. Our objective is to provide a dual tool: (1) an item-level conversion tool to score responses for deriving both 3MSE and MMSE measures, and (2) cross-walk tables to facilitate quick conversion between 3MSE and MMSE. METHODS An SAS program tool allows scoring of 3MSE item-level responses into MMSE score. Using integrated data sets (n = 8346), actual 3MSE and MMSE scores obtained from the same individuals were linked to form cross-walk tables. RESULTS An SAS conversion program was made available. Cross-walk tables were derived. Validation sample shows bias is -0.11 (standard deviation = 1.02) in 3MSE→MMSE; the converse had substantially large bias. DISCUSSION The 3MSE→MMSE conversion table can be used in clinical practice and legacy system data.
Collapse
Affiliation(s)
- Edward H. Ip
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - June Pierce
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Shyh‐Huei Chen
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James Lovato
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christina E. Hugenschmidt
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Suzanne Craft
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Dalane Kitzman
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Internal MedicineSection on Cardiovascular MedicineWinston‐SalemNorth CarolinaUSA
| | - Steve Rapp
- Department of Psychiatry & Behavioral MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| |
Collapse
|
22
|
Efficacy of cognitive intervention programs in amnesic mild cognitive impairment: A systematic review. Arch Gerontol Geriatr 2021; 94:104332. [PMID: 33486120 DOI: 10.1016/j.archger.2020.104332] [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] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Amnesic mild cognitive impairment (aMCI) is considered a prodromal stage of Alzheimer's disease. Given the absence of an effective pharmacological treatment for aMCI, increasing numbers of studies are attempting to understand how cognitive interventions could benefit aMCI patients. The aim of this systematic review was to evaluate the current evidence regarding the efficacy on cognition of cognitive intervention programs in older adults with aMCI. METHODS We searched for randomized controlled trials and clinical trials published until March 2020 on PubMed, Web of Science, Cochrane Library, SCOPUS, and OTseeker. A total of 454 works were identified and 7 studies that met the inclusion criteria, were included in this review. PRISMA guidelines were followed and PEDro scale was included for the measurement of the quality of the selected studies. RESULTS Cognitive interventions showed positive effects on cognition. Cognitive training programs considerably enhanced the Mini Mental State Examination scores. However, no relevant differences in global cognition were found using other assessment tools as DRS-2 or ADAS-Cog Scale. Cognitive training and cognitive rehabilitation programs seemed to improve several cognitive domains as memory, language or executive function in aMCI patients in both post-training and at follow-up analysis. CONCLUSIONS Our findings support that cognitive interventions can be an effective option for people with aMCI. Cognitive interventions improved global cognitive function post-intervention, but also seemed to enhance some cognitive domains post-intervention and at follow-up. However, more studies are needed to analyze the potential benefits of cognitive intervention on aMCI.
Collapse
|
23
|
Choi H, Thacker EL, Longstreth WT, Elkind MSV, Boehme AK. Cognitive decline in older adults with epilepsy: The Cardiovascular Health Study. Epilepsia 2020; 62:85-97. [PMID: 33227164 DOI: 10.1111/epi.16748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cognitive decline is a major concern for older adults with epilepsy. Whether and how much faster older adults with epilepsy experience cognitive decline beyond expected age-related cognitive change remain unclear. We sought to estimate and compare rates of cognitive decline in older adults with and without epilepsy. METHODS The Cardiovascular Health Study is a population-based longitudinal cohort study of 5888 US adults aged 65+. Cognitive function was assessed annually with Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate average rates of decline in 3MS and DSST scores by epilepsy status (prevalent, incident, or no epilepsy), adjusted for risk factors associated with cognitive decline. RESULTS The rate of decline in 3MS was significantly faster in prevalent epilepsy (P < .001) and after incident epilepsy (P = .002) compared with no epilepsy. Prevalent epilepsy and apolipoprotein E gene (APOE) ε4 (ApoE4) had a synergistic interaction, whereby prevalent epilepsy and ApoE4 together were associated with 1.51 points faster annual decline in 3MS than would be expected if prevalent epilepsy and ApoE4 did not interact (P < .001). Older adults with prevalent epilepsy had a significantly lower initial DSST score and faster rate of decline compared to those with no epilepsy (P < .001). SIGNIFICANCE Faster decline in global cognitive ability seen in this study validates concerns of patients. ApoE4 allele status was an effect modifier of the relationship between cognitive decline and prevalent epilepsy. Further research is warranted to explore biological mechanisms and possible interventions to mitigate cognitive decline.
Collapse
Affiliation(s)
- Hyunmi Choi
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | | | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
24
|
Fusion of ULS Group Constrained High- and Low-Order Sparse Functional Connectivity Networks for MCI Classification. Neuroinformatics 2020; 18:1-24. [PMID: 30982183 DOI: 10.1007/s12021-019-09418-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Functional connectivity networks, derived from resting-state fMRI data, have been found as effective biomarkers for identifying mild cognitive impairment (MCI) from healthy elderly. However, the traditional functional connectivity network is essentially a low-order network with the assumption that the brain activity is static over the entire scanning period, ignoring temporal variations among the correlations derived from brain region pairs. To overcome this limitation, we proposed a new type of sparse functional connectivity network to precisely describe the relationship of temporal correlations among brain regions. Specifically, instead of using the simple pairwise Pearson's correlation coefficient as connectivity, we first estimate the temporal low-order functional connectivity for each region pair based on an ULS Group constrained-UOLS regression algorithm, where a combination of ultra-least squares (ULS) criterion with a Group constrained topology structure detection algorithm is applied to detect the topology of functional connectivity networks, aided by an Ultra-Orthogonal Least Squares (UOLS) algorithm to estimate connectivity strength. Compared to the classical least squares criterion which only measures the discrepancy between the observed signals and the model prediction function, the ULS criterion takes into consideration the discrepancy between the weak derivatives of the observed signals and the model prediction function and thus avoids the overfitting problem. By using a similar approach, we then estimate the high-order functional connectivity from the low-order connectivity to characterize signal flows among the brain regions. We finally fuse the low-order and the high-order networks using two decision trees for MCI classification. Experimental results demonstrate the effectiveness of the proposed method on MCI classification.
Collapse
|
25
|
Crespi C, Santi GC, Dodich A, Lupo F, Greco LC, Piccoli T, Lunetta C, Cerami C. Unraveling Moral Reasoning in Amyotrophic Lateral Sclerosis: How Emotional Detachment Modifies Moral Judgment. Front Psychol 2020; 11:2083. [PMID: 32973626 PMCID: PMC7471658 DOI: 10.3389/fpsyg.2020.02083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 01/28/2023] Open
Abstract
In the last decade, scientific literature provided solid evidence of cognitive deficits in amyotrophic lateral sclerosis (ALS) patients and their effects on end-life choices. However, moral cognition and judgment are still poorly investigated in this population. Here we aimed at evaluating both socio-cognitive and socio-affective components of moral reasoning in a sample of 28 ALS patients. Patients underwent clinical and neuropsychological evaluation including basic cognitive and social cognition measures. Additionally, we administered an experimental task including moral dilemmas, with instrumental and incidental conditions. Patients’ performances were compared with a control group [healthy control (HC)], including 36 age-, gender-, and education-matched healthy subjects. Despite that the judgment pattern was comparable in ALS and HC, patients resulted less prone to carry out a moral transgression compared to HC. Additionally, ALS patients displayed higher levels of moral permissibility and lower emotional arousal, with similar levels of engagement in both instrumental and incidental conditions. Our findings expanded the current literature about cognitive deficits in ALS, showing that in judging moral actions, patients may present non-utilitarian choices and emotion flattening. Such a decision-making profile may have relevant implications in applying moral principles in real-life situations and for the judgment of end-of-life treatments and care in clinical settings.
Collapse
Affiliation(s)
- Chiara Crespi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Alessandra Dodich
- CeRiN, Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Federica Lupo
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | | | - Tommaso Piccoli
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Chiara Cerami
- Istituto Universitario di Studi Superiori, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
26
|
Kyriazis M. Aging as “Time-Related Dysfunction”: A Perspective. Front Med (Lausanne) 2020; 7:371. [PMID: 32850891 PMCID: PMC7397818 DOI: 10.3389/fmed.2020.00371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
|
27
|
Wang B, Sahyoun NR, Shao K, Dutta E, Clarke J. Assessment of the Dose-Response Relationship Between Folate Exposure and Cognitive Impairment: Synthesizing Data from Documented Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:276-293. [PMID: 31536147 DOI: 10.1111/risa.13404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
The dose-response relationship between folate levels and cognitive impairment among individuals with vitamin B12 deficiency is an essential component of a risk-benefit analysis approach to regulatory and policy recommendations regarding folic acid fortification. Epidemiological studies provide data that are potentially useful for addressing this research question, but the lack of analysis and reporting of data in a manner suitable for dose-response purposes hinders the application of the traditional evidence synthesis process. This study aimed to estimate a quantitative dose-response relationship between folate exposure and the risk of cognitive impairment among older adults with vitamin B12 deficiency using "probabilistic meta-analysis," a novel approach for synthesizing data from observational studies. Second-order multistage regression was identified as the best-fit model for the association between the probability of cognitive impairment and serum folate levels based on data generated by randomly sampling probabilistic distributions with parameters estimated based on summarized information reported in relevant publications. The findings indicate a "J-shape" effect of serum folate levels on the occurrence of cognitive impairment. In particular, an excessive level of folate exposure is predicted to be associated with a higher risk of cognitive impairment, albeit with greater uncertainty than the association between low folate exposure and cognitive impairment. This study directly contributes to the development of a practical solution to synthesize observational evidence for dose-response assessment purposes, which will help strengthen future nutritional risk assessments for the purpose of informing decisions on nutrient fortification in food.
Collapse
Affiliation(s)
- Bing Wang
- Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Nadine R Sahyoun
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA
| | - Kan Shao
- Department of Environmental and Occupational Health, Indiana University, Bloomington, IN, USA
| | - Enakshy Dutta
- Department of Statistics, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Jennifer Clarke
- Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
- Department of Statistics, University of Nebraska-Lincoln, Lincoln, NE, USA
| |
Collapse
|
28
|
Osadchiy V, Mayer EA, Bhatt R, Labus JS, Gao L, Kilpatrick LA, Liu C, Tillisch K, Naliboff B, Chang L, Gupta A. History of early life adversity is associated with increased food addiction and sex-specific alterations in reward network connectivity in obesity. Obes Sci Pract 2019; 5:416-436. [PMID: 31687167 PMCID: PMC6819979 DOI: 10.1002/osp4.362] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neuroimaging studies have identified obesity-related differences in the brain's resting state activity. An imbalance between homeostatic and reward aspects of ingestive behaviour may contribute to obesity and food addiction. The interactions between early life adversity (ELA), the reward network and food addiction were investigated to identify obesity and sex-related differences, which may drive obesity and food addiction. METHODS Functional resting state magnetic resonance imaging was acquired in 186 participants (high body mass index [BMI]: ≥25: 53 women and 54 men; normal BMI: 18.50-24.99: 49 women and 30 men). Participants completed questionnaires to assess ELA (Early Traumatic Inventory) and food addiction (Yale Food Addiction Scale). A tripartite network analysis based on graph theory was used to investigate the interaction between ELA, brain connectivity and food addiction. Interactions were determined by computing Spearman rank correlations, thresholded at q < 0.05 corrected for multiple comparisons. RESULTS Participants with high BMI demonstrate an association between ELA and food addiction, with reward regions playing a role in this interaction. Among women with high BMI, increased ELA was associated with increased centrality of reward and emotion regulation regions. Men with high BMI showed associations between ELA and food addiction with somatosensory regions playing a role in this interaction. CONCLUSIONS The findings suggest that ELA may alter brain networks, leading to increased vulnerability for food addiction and obesity later in life. These alterations are sex specific and involve brain regions influenced by dopaminergic or serotonergic signalling.
Collapse
Affiliation(s)
- V. Osadchiy
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - E. A. Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Ahmanson‐Lovelace Brain Mapping CenterUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - R. Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - J. S. Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Gao
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. A. Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - C. Liu
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - K. Tillisch
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - B. Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Chang
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - A. Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| |
Collapse
|
29
|
The Impact of Adherence to the Traditional Mediterranean Diet and Sex Differences on Global Cognitive Functioning: a Systematic Review and Meta-analysis. JOURNAL OF COGNITIVE ENHANCEMENT 2019. [DOI: 10.1007/s41465-019-00143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|