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Marshall AJ, Gaubert A, Kapoor A, Tan A, McIntosh E, Jang JY, Yew B, Ho JK, Blanken AE, Dutt S, Sible IJ, Li Y, Rodgers K, Nation DA. Blood-Derived Progenitor Cells Are Depleted in Older Adults with Cognitive Impairment: A Role for Vascular Resilience? J Alzheimers Dis 2023; 93:1041-1050. [PMID: 37154177 PMCID: PMC10258882 DOI: 10.3233/jad-220269] [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] [Accepted: 03/23/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Depletion of blood-derived progenitor cells, including so called "early endothelial progenitor cells", has been observed in individuals with early stage Alzheimer's disease relative to matched older control subjects. These findings could implicate the loss of angiogenic support from hematopoietic progenitors or endothelial progenitors in cognitive dysfunction. OBJECTIVE To investigate links between progenitor cell proliferation and mild levels of cognitive dysfunction. METHODS We conducted in vitro studies of blood-derived progenitor cells using blood samples from sixty-five older adults who were free of stroke or dementia. Peripheral blood mononuclear cells from venous blood samples were cultured in CFU-Hill media and the number of colony forming units were counted after 5 days in vitro. Neuropsychological testing was administered to all participants. RESULTS Fewer colony forming units were observed in samples from older adults with a Clinical Dementia Rating global score of 0.5 versus 0. Older adults whose samples developed fewer colony forming units exhibited worse performance on neuropsychological measures of memory, executive functioning, and language ability. CONCLUSION These data suggest blood progenitors may represent a vascular resilience marker related to cognitive dysfunction in older adults.
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Affiliation(s)
- Anisa J. Marshall
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Aimee Gaubert
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Arunima Kapoor
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Alick Tan
- Department of Clinical Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Elissa McIntosh
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jung Yun Jang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Belinda Yew
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean K. Ho
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Shubir Dutt
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Yanrong Li
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Daniel A. Nation
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
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Khate K, Chaudhary V, Longkumer I, Saraswathy KN, Devi NK. Gender-specific association of blood lipids and reproductive trajectory with cognitive impairment: A community based cross-sectional study from India. Front Psychol 2023; 14:1107152. [PMID: 36923148 PMCID: PMC10008908 DOI: 10.3389/fpsyg.2023.1107152] [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: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Background Abnormal blood lipid levels in the general population and adverse reproductive events among women have been associated with cognitive impairment (CI). However, their relationship has not been extensively studied in community settings. Hence, this study aims to explore the association of CI with blood lipid levels in both sexes and reproductive events/trajectory among women. Methods A cross-sectional study was conducted among a North Indian rural population. A total of 808 adults were recruited through door-to-door household survey. Data on socio-demographic variables, reproductive profile of women, and cognitive impairment status were collected. Fasting blood sample was collected to estimate serum lipid profile. Multivariate logistic regression was performed to test for association. Results The study demonstrated a lack of association between lipid profile and cognitive impairment among males. Surprisingly, low HDL-C among females was found to be protective against moderate/severe cognitive impairment (value of p = 0.049). Further, menopausal women and those having five or higher live births were found to be at higher risk of CI than pre-menopausal women and those with 1-2 live births, respectively. Conclusion The present study hints toward a gender-specific association of blood lipid levels with CI. Further, higher live births and menopause appear to be important risk factors for CI among women.
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Affiliation(s)
- Kevingu Khate
- Department of Anthropology, University of Delhi, New Delhi, India
| | - Vineet Chaudhary
- Department of Anthropology, University of Delhi, New Delhi, India
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Cerebrovascular function and its association with systemic artery function and stiffness in older adults with and without mild cognitive impairment. Eur J Appl Physiol 2022; 122:1843-1856. [PMID: 35522276 PMCID: PMC9287231 DOI: 10.1007/s00421-022-04956-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/15/2022] [Indexed: 01/23/2023]
Abstract
PURPOSE Our aim was to compare cerebrovascular and systemic vascular function between older adults with and without mild cognitive impairment (MCI), and to determine which measures of vascular function best predict the presence of MCI. METHODS In 41 adults with MCI and 33 adults without MCI (control) we compared middle cerebral artery velocity (MCAv) and cerebrovascular pulsatility index (PI) at rest, cerebrovascular reactivity to CO2, and responsiveness to changes in blood pressure (%∆MCAv/%∆MAP). Systemic vascular function was assessed by flow-mediated dilation (FMD) and stiffness by pulse wave velocity (PWV). RESULTS Cerebrovascular PI was higher in MCI compared with control (mean ± SD: 1.17 ± 0.27 vs. 1.04 ± 0.21), and MCI exhibited a lower %∆MCAv/%∆MAP (1.26 ± 0.44 vs. 1.50 ± 0.55%). Absolute (p = 0.76) and relative cerebrovascular reactivity to CO2 (p = 0.34) was similar between MCI and control. When age was included as a covariate the significant difference in cerebral PI between groups was lost. PWV was higher (13.2 ± 2.2 vs. 11.3 ± 2.5 m s-1) and FMD% (4.41 ± 1.70 vs. 5.43 ± 2.15%) was lower in MCI compared with control. FMD% was positively associated with PI across the cohort. Logistic regression analysis indicated that FMD and PWV significantly discriminated between MCI and controls, independent of age, whereas the inclusion of cerebrovascular measures did not improve the predictive accuracy of the model. CONCLUSION These findings raise the possibility that early changes in systemic vascular stiffness and endothelial function may contribute to altered cerebrovascular haemodynamics and impaired cognitive function, and present potential targets for prevention and treatment strategies in people with MCI.
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Feter N, Dumith SC, Smith EC, da Cunha LL, Cassuriaga J, Leite JS, Alt R, Coombes JS, Rombaldi AJ. Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study. J Psychiatr Res 2021; 141:1-8. [PMID: 34171758 DOI: 10.1016/j.jpsychires.2021.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.
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Affiliation(s)
- Natan Feter
- Neuroscience and Physical Activity Research Group, Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil; Centre of Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Samuel C Dumith
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Brazil
| | - Emily C Smith
- Centre of Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Larissa L da Cunha
- Neuroscience and Physical Activity Research Group, Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Júlia Cassuriaga
- Neuroscience and Physical Activity Research Group, Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Jayne S Leite
- Postgraduate Program in Health Sciences, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Alt
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Jeff S Coombes
- Centre of Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Airton J Rombaldi
- Neuroscience and Physical Activity Research Group, Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
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Piccininni C, Quaranta D, Gainotti G, Lacidogna G, Guglielmi V, Giovannini S, Marra C. The Destiny of Multiple Domain Amnesic Mild Cognitive Impairment: Effect of Alternative Neuropsychological Definitions and Their Adjunctive Role in Respect of Memory Impairment. Arch Clin Neuropsychol 2021; 36:702-710. [PMID: 33313637 DOI: 10.1093/arclin/acaa094] [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: 09/13/2019] [Revised: 05/19/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Mild cognitive impairment is the main risk factor of dementia. Previous evidence has claimed that subjects with memory disturbances associated with impairment of other cognitive domains (multiple domain amnesic MCI) are at the highest risk of developing dementia. To date, a shared definition of amnesic MCI multiple domain (aMCI-MD) is still lacking. METHOD 163 subjects with aMCI were enrolled and followed-up for 2 years. They underwent a baseline comprehensive neuropsychological battery. The cut-off point for each test was set at 1, 1.5, and 2 SD below the mean obtained in normative studies; aMCI-MD was defined as the occurrence of abnormal scores on at least one, two, or three tests not assessing memory. The Episodic Memory Score (EMS), that measures the severity of memory impairment, was determined. Logistic regressionand Cox's proportional hazard risk models were carried out. The adjunctive effect of the definitions of aMCI-MD on the severity of memory impairment was assessed. RESULTS Fifty-four subjects progressed to dementia. Only restrictive definitions of aMCI-MD (at least three tests below 1.5 SD; at least two tests below 2 SD) predicted conversion to dementia in both logistic regression and survival analysis. None of the conditions showed a significant adjunctive effect on the EMS. CONCLUSIONS The predictive effect of impairment in tests assessing cognitive domains other than memory depends on its psychometric definition. The use of a restrictive definition would be of some usefulness, but the adjunctive effect of such a definition on an integrated analysis of memory impairment may be questionable.
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Affiliation(s)
- Chiara Piccininni
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Davide Quaranta
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Guido Gainotti
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Giordano Lacidogna
- Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Valeria Guglielmi
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia Giovannini
- Institute of Geriatrics, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Camillo Marra
- Departement of Neuroscience, Università Cattolica del Sacro Cuore, Roma, Italy.,Institute of Neurology, IRCCS Policlinico Universitario "A. Gemelli", Roma, Italy
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6
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Quaranta D, Piccininni C, Caprara A, Malandrino A, Gainotti G, Marra C. Semantic Relations in a Categorical Verbal Fluency Test: An Exploratory Investigation in Mild Cognitive Impairment. Front Psychol 2019; 10:2797. [PMID: 31920840 PMCID: PMC6927990 DOI: 10.3389/fpsyg.2019.02797] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/27/2019] [Indexed: 01/23/2023] Open
Abstract
Categorical verbal fluency tests (CFT) are commonly used to assess the integrity of semantic memory in individuals with brain damage. Persons with Dementia of the Alzheimer's Type display a reduced output on CFT, and a similar pattern has been reported in persons with amnesic Mild Cognitive Impairment (aMCI). The aims of the present study were to assess whether the semantic relations between lexical entries produced on a categorical fluency test were different between healthy persons and those with aMCI, and whether this difference was more pronounced in individuals who converted to dementia during a 3-year follow-up period. Methods We recruited 34 individuals with aMCI and 29 matched healthy persons. During the follow-up period, 10 individuals converted to Dementia (aMCI-conv). Two measures assessing semantic relations between consecutively produced word pairs (Path length and Extended Gloss Overlap) were obtained from the Wordnet database. Results The number of word pairs analyzed among the healthy participants (HP) and persons with aMCI were 498 (birds: 262; pieces of furniture: 236) and 395 (birds: 174; pieces of furniture: 221), respectively. Path length was lower in aMCI-conv than in HP (p = 0.035), but no differences were found between stable aMCI and HP, and between aMCI-stable and aMCI-conv. The ANOVA for lexical entries belonging to the "birds" category showed a significant effect of group (F = 5.630; p = 0.004); the post hoc analysis showed a significant difference between HP and aMCI-conv (p = 0.003). The "pieces of furniture" category was significantly affected by group (F = 4.107; p = 0.017); the post hoc test showed significant differences between aMCI-conv and healthy individuals (p = 0.049), and between aMCI-conv and stable aMCI (p = 0.001). Discussion Individuals with aMCI who convert to dementia show a deterioration in the semantic relations between lexical entries, produced on a CFT. This phenomenon may be interpreted as a marker of a very early disruption of semantic memory.
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Affiliation(s)
- Davide Quaranta
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Piccininni
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessia Caprara
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Malandrino
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Gainotti
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy.,Department of Clinical and Behavioral Neurology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Camillo Marra
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
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7
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García-Herranz S, Díaz-Mardomingo MC, Venero C, Peraita H. Accuracy of verbal fluency tests in the discrimination of mild cognitive impairment and probable Alzheimer's disease in older Spanish monolingual individuals. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:826-840. [PMID: 31822214 DOI: 10.1080/13825585.2019.1698710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The main objetive was to analyze the accuracy of different verbal fluency tests (VFTs) in discriminating cognitively healthy subjects from individuals with mild cognitive impairment (MCI) and probable Alzheimer's disease (AD) in a cohort of older Spanish speaking adults. As a result, we aimed to identify the VFT that best predicts conversion from MCI to probable AD. 287 subjects: 170 controls (HC), 90 stable MCI and 27 patients with MCI that evolved into probable AD (MCI-AD) were assessed with a neuropsychological battery test and five VFTs. The animal fluency test produced the best differentiation of HC from MCI (p < .001), of HC from MCI-AD (p < .001) and of MCI from MCI-AD converters (p < .001), with sensitivities 98.8%, 98.8% and 75.6%, respectively. Logistic regression showed that the animal fluency test (p < 0.001) appears to be the most useful and neuropsychological VFT to predict conversion to probable dementia.
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Affiliation(s)
- S García-Herranz
- Department of Basic Psychology II, Universidad Nacional de Educación a Distancia , Madrid, Spain.,Instituto Mixto de Investigación-Escuela Nacional de Sanidad (IMIENS) , Madrid, Spain
| | - M C Díaz-Mardomingo
- Instituto Mixto de Investigación-Escuela Nacional de Sanidad (IMIENS) , Madrid, Spain.,Department of Basic Psychology I, Universidad Nacional de Educación a Distancia , Madrid, Spain
| | - C Venero
- Instituto Mixto de Investigación-Escuela Nacional de Sanidad (IMIENS) , Madrid, Spain.,Department of Psychobiology, Universidad Nacional de Educación a Distancia , Madrid, Spain
| | - H Peraita
- Department of Basic Psychology I, Universidad Nacional de Educación a Distancia , Madrid, Spain
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Richardson C, Stephan BCM, Robinson L, Brayne C, Matthews FE. Two-decade change in prevalence of cognitive impairment in the UK. Eur J Epidemiol 2019; 34:1085-1092. [PMID: 31489532 PMCID: PMC6861197 DOI: 10.1007/s10654-019-00554-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
Identification of individuals at high risk of dementia has usually focused attention on the clinical concept of mild cognitive impairment (MCI), which captures an intermediate state between normal cognitive ageing and dementia. In many countries age specific risk of dementia has declined, but whether this is also the case for subclinical cognitive impairment is unknown. This has important implications for prevention, planning and policy. Here we describe subclinical cognitive impairment and mild dementia prevalence changes, in the UK, over 2 decades. The Cognitive Function and Ageing Studies have examined the full spectrum of cognition, from normal to dementia, in representative populations of people aged ≥ 65 years in the UK over the last 2 decades 7635 participants were interviewed in CFAS I in Cambridgeshire, Newcastle, and Nottingham in 1991, with 1457 being diagnostically assessed. In the same geographical areas, the CFAS II investigators interviewed 7796 individuals in 2011. Using established criteria, the population was categorised into seven groups: no cognitive impairment, Mild cognitive Impairment (defined using consensus criteria), other cognitive impairment no dementia without functional impairment, OCIND with functional impairment, cognitive impairment (MMSE < 24 and no functional impairment), mild dementia (MMSE < 24 with functional impairment, not captured by CFAS dementia criteria), and CFAS dementia criteria. Multinomial logistic regression, adjusted for age and sex, was used to estimate the prevalence of impairment in both studies. Results were standardized to the age-sex specific UK and global population. There is a clear increase in the prevalence of other cognitive Impairment no Dementia (without functional impairment), with the purer MCI remaining stable. In the UK, mild dementia is estimated to fall from 520,704 cases (5.7%, 95% CI 3.8, 8.1) in 1991 to 315,142 (3.0%, 95% CI 2.4, 3.8) in 2011, cognitive impairment, has fallen from 1,225,984 (13.5%, 95% CI 10.1, 17.5) to 654,436 (6.3%, 95% CI 5.4, 7.3) cases. Using additional categories which reflect the continuum of cognitive decline and impairment in populations we see that the mildest dementia declines, but that there is stability in estimates of those who meet MCI criteria. Increases were found in the Other Cognitive Impairment no Dementia group. The decline observed in severe impairment thus seems to have resulted in larger proportions of the population in milder forms, seen alongside physical illnesses.
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Affiliation(s)
- Connor Richardson
- Newcastle University Institute for Ageing and Institute for Health and Society, Newcastle University, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
| | - Blossom C M Stephan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Nottingham, NG7 2TU, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute for Health and Society, Newcastle University, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Fiona E Matthews
- Newcastle University Institute for Ageing and Institute for Health and Society, Newcastle University, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK.
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Wada-Isoe K, Kikuchi T, Umeda-Kameyama Y, Mori T, Akishita M, Nakamura Y. Global Clinical Dementia Rating Score of 0.5 May Not Be an Accurate Criterion to Identify Individuals with Mild Cognitive Impairment. J Alzheimers Dis Rep 2019; 3:233-239. [PMID: 31754655 PMCID: PMC6839533 DOI: 10.3233/adr-190126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many studies use the global clinical dementia rating (CDR) of 0.5 as a criterion for mild cognitive impairment, but past studies have not fully discussed its validity. The authors developed the ABC Dementia Scale (ABC-DS) to accurately monitor the changes in activities for daily living, behavioral and psychological symptoms of dementia, and cognitive function. When we carried out a cluster analysis of ABC-DS scores of 110 individuals for whom global CDR was 0.5, there were three groups with different levels of activities for daily living and cognitive function. O’Bryant et al. proposed a new guideline to stage dementia using the CDR sum of boxes scores (CDR-SOB). We used their proposal and ABC-DS scores to evaluate the validity of CDR 0.5 as a definition of mild cognitive impairment (MCI). We concluded that the CDR-SOB scores and ABC-DS score are more accurate than global CDR of 0.5 for specifying individuals with MCI.
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Affiliation(s)
- Kenji Wada-Isoe
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
| | - Takashi Kikuchi
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
| | - Yumi Umeda-Kameyama
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Mori
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Nakamura
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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10
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Alegret M, Peretó M, Pérez A, Valero S, Espinosa A, Ortega G, Hernández I, Mauleón A, Rosende-Roca M, Vargas L, Rodríguez-Gómez O, Abdelnour C, Berthier ML, Bak TH, Ruíz A, Tárraga L, Boada M. The Role of Verb Fluency in the Detection of Early Cognitive Impairment in Alzheimer's Disease. J Alzheimers Dis 2019; 62:611-619. [PMID: 29480180 DOI: 10.3233/jad-170826] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Verb fluency (VF) is the less commonly used fluency test, despite several studies suggesting its potential as a neuropsychological assessment tool. OBJECTIVE To investigate the presence of VF deficits in mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) dementia; to assess the usefulness of VF in the detection of cognitively healthy (CH) people who will convert to MCI, and from MCI to dementia; and to establish the VF cut-offs useful in the cognitive assessment of Spanish population. METHODS 568 CH, 885 MCI, and 367 mild AD dementia individuals were administered the VF test and a complete neuropsychological battery. Longitudinal analyses were performed in 231 CH and 667 MCI subjects to search for VF predictors of diagnosis conversion. RESULTS A worsening on VF performance from CH, MCI to AD dementia groups was found. Lower performances on VF were significantly related to conversion from CH to MCI/MCI to dementia. When the effect of time to conversion was analyzed, a significant effect of VF was found on the faster conversion from CH to MCI, but not from MCI to dementia. Moreover, VF cut-off scores and sensitivity/specificity values were calculated for 6 conditions (3 age ranges by 2 educational levels). CONCLUSION The VF test may be a useful tool for the differential diagnosis of cognitive failure in the elderly. Since VF deficits seem to take place in early stages of the disease, it is a suitable neuropsychological tool for the detection not only of CH people who will convert to MCI, but also from MCI to dementia.
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Affiliation(s)
- Montserrat Alegret
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Mar Peretó
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.,Mental Health Research Group, IMIM (Hospital del Mar Research Institute), CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Alba Pérez
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Sergi Valero
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Espinosa
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Gemma Ortega
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Isabel Hernández
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Ana Mauleón
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Maitée Rosende-Roca
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Liliana Vargas
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Octavio Rodríguez-Gómez
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Carla Abdelnour
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES) and Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Malaga, Spain
| | - Thomas H Bak
- Department of Psychology and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Agustín Ruíz
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lluís Tárraga
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Mercè Boada
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
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Cersonsky TEK, Morgan S, Kellner S, Robakis D, Liu X, Huey ED, Louis ED, Cosentino S. Evaluating Mild Cognitive Impairment in Essential Tremor: How Many and Which Neuropsychological Tests? J Int Neuropsychol Soc 2018; 24:1084-1098. [PMID: 30303051 DOI: 10.1017/s1355617718000747] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Essential tremor (ET) confers an increased risk for developing both amnestic and non-amnestic mild cognitive impairment (MCI). Yet, the optimal measures for detecting mild cognitive changes in individuals with this movement disorder have not been established. We sought to identify the cognitive domains and specific motor-free neuropsychological tests that are most sensitive to mild deficits in cognition as defined by a Clinical Dementia Rating (CDR) of 0.5, which is generally associated with a clinical diagnosis of MCI. METHODS A total of 196 ET subjects enrolled in a prospective, longitudinal, clinical-pathological study underwent an extensive motor-free neuropsychological test battery and were assigned a CDR score. Logistic regression analyses were performed to identify the neuropsychological tests which best identified individuals with CDR of 0.5 (mild deficits in cognition) versus 0 (normal cognition). RESULTS In regression models, we identified five tests in the domains of Memory and Executive Function which best discriminated subjects with CDR of 0.5 versus 0 (86.9% model classification accuracy). These tests were the California Verbal Learning Test II Total Recall, Logical Memory II, Verbal-Paired Associates I, Category Switching Fluency, and Color-Word Inhibition. CONCLUSIONS Mild cognitive difficulty among ET subjects is best predicted by combined performance on five measures of memory and executive function. These results inform the nature of cognitive dysfunction in ET and the creation of a brief cognitive battery to assess patients with ET for cognitively driven dysfunction in life that could indicate the presence of MCI. (JINS, 2018, 24, 1084-1098).
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Affiliation(s)
- Tess E K Cersonsky
- 1Division of Movement Disorders,Department of Neurology,Yale School of Medicine,Yale University,New Haven,Connecticut
| | - Sarah Morgan
- 1Division of Movement Disorders,Department of Neurology,Yale School of Medicine,Yale University,New Haven,Connecticut
| | - Sarah Kellner
- 1Division of Movement Disorders,Department of Neurology,Yale School of Medicine,Yale University,New Haven,Connecticut
| | - Daphne Robakis
- 1Division of Movement Disorders,Department of Neurology,Yale School of Medicine,Yale University,New Haven,Connecticut
| | - Xinhua Liu
- 2Department of Biostatistics,Mailman School of Public Health,Columbia University,New York,New York
| | - Edward D Huey
- 3Department of Psychiatry,College of Physicians and Surgeons,Columbia University,New York,New York
| | - Elan D Louis
- 1Division of Movement Disorders,Department of Neurology,Yale School of Medicine,Yale University,New Haven,Connecticut
| | - Stephanie Cosentino
- 4Department of Neurology,College of Physicians and Surgeons,Columbia University,New York,New York
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Oboshi Y, Kikuchi M, Terada T, Yoshikawa E, Bunai T, Ouchi Y. Alterations in Phase-Related Prefrontal Activation During Cognitive Tasks and Nicotinic α4β2 Receptor Availability in Alzheimer's Disease. J Alzheimers Dis 2018; 53:817-30. [PMID: 27258412 DOI: 10.3233/jad-151165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence shows that the cholinergic system plays an important role in regulating working memory and that working memory-related prefrontal activation decreases with age and neuronal degeneration, such as Alzheimer's disease (AD). However, the relation between attention-related α4β2 nicotinic cholinergic function and task-induced prefrontal activation especially time course-related activation remains to be explored. OBJECTIVE We aimed to elucidate the relationship between changes in task-induced oxy-hemoglobin concentration (cerebral blood flow, CBF) in the prefrontal cortex and the availability of α4β2 nicotinic receptors in the brain of AD patients in light of their task performance. METHODS Eleven mild-to-moderate AD patients and eleven normal elderly subjects underwent the near-infrared spectroscopy during easy and difficult working memory tasks for estimating prefrontal CBF changes and positron emission tomography with the α4β2 tracer [18F]2FA-85380 ([18F]2FA) for measuring the α4β2 nicotinic receptor binding. RESULTS Significant correlations between mean oxy-hemoglobin concentration in the channels with significant [group] main effects and prefrontal [18F]2FA binding were observed during the early easy task period in the normal group and during the late difficult task in the AD group. In addition, those prefrontal CBF responses were significantly correlated with not correct performance but the execution time to spend. CONCLUSION The α4β2 nicotinic acetylcholine receptors in the prefrontal cortex play an important role in increasing prefrontal activation when attending to novel stimuli, irrespective of the accuracy of the outcome. A delay in the cholinergic-induced increase in prefrontal activation in AD patients might explain their delayed responses in the cognitive task.
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Affiliation(s)
- Yumi Oboshi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mitsuru Kikuchi
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Tatsuhiro Terada
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Etsuji Yoshikawa
- Central Research Laboratory, Hamamatsu Photonics K.K., Hamamatsu, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Acosta I, Borges G, Aguirre-Hernandez R, Sosa AL, Prince M. Neuropsychiatric symptoms as risk factors of dementia in a Mexican population: A 10/66 Dementia Research Group study. Alzheimers Dement 2017; 14:271-279. [PMID: 29028481 PMCID: PMC5869051 DOI: 10.1016/j.jalz.2017.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 12/23/2022]
Abstract
Introduction Cognitive and/or memory impairment are the main clinical markers currently used to identify subjects at risk of developing dementia. This study aimed to explore the relationship between the presence of neuropsychiatric symptoms and dementia incidence. Methods We analyzed the association between neuropsychiatric symptoms and incident dementia in a cohort of 1355 Mexican older adults from the general population over 3 years of follow-up, modeling cumulative incidence ratios using Poisson models. Results Five neuropsychiatric symptoms were associated with incident dementia: delusions, hallucinations, anxiety, aberrant motor behavior, and depression. The simultaneous presence of two symptoms had a relative risk, adjusted for mild cognitive impairment, diabetes, indicators of cognitive function, and sociodemographic factors, of 1.9 (95% confidence interval, 1.2–2.9), whereas the presence of three to five, similarly adjusted, had a relative risk of 3.0 (95% confidence interval, 1.9–4.8). Discussion Neuropsychiatric symptoms are common in predementia states and may independently contribute as risk factors for developing dementia. Not only cognitive impairment and cognitive features are useful in identifying older adults at risk for developing dementia. Of the 12 neuropsychiatric symptoms evaluated, 5 were associated with incident dementia (delusions, hallucinations, depression, anxiety, and aberrant motor behavior) in a 3-year follow-up. The evaluation of neuropsychiatric symptoms, along with other simple, practical, and inexpensive features, may be useful in identifying subjects at risk of dementia in community health settings and by general practitioners.
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Affiliation(s)
- Isaac Acosta
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Guilherme Borges
- Departament of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muniz, Mexico City, Mexico
| | - Rebeca Aguirre-Hernandez
- Department of Pharmacology, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Luisa Sosa
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Martin Prince
- Department of Health Service and Population Research, King's College London (Institute of Psychiatry), London, UK
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Tsolaki M, Gkioka M, Verykouki E, Galoutzi N, Kavalou E, Pattakou-Parasyri V. Prevalence of Dementia, Depression, and Mild Cognitive Impairment in a Rural Area of the Island of Crete, Greece. Am J Alzheimers Dis Other Demen 2017; 32:252-264. [PMID: 28468554 PMCID: PMC10852845 DOI: 10.1177/1533317517698789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The studies on the prevalence of dementia, depression, and mild cognitive impairment (MCI) in Greece are sparse and show major variations of prevalence depending on geographical areas, nutritional habits, and the way of living. The aim of this door-to-door study was to find the prevalence of dementia, depression, and MCI in a rural Greek population. Four hundred and forty-three individuals older than 61years following the application of specific criteria were diagnosed with: normal cognition, depression, MCI with and without depression, and dementia with and without depression. Four diagnostic methods were used, 2 of which included Mungas correction for age and education. After Mungas adjustment, the results were as follows-depression: 33.9%; MCI: 15.3%; MCI with depression: 8.6%; dementia: 2.0%; and dementia with depression: 7.2%. Dementia is less prevalent compared to global data and other Greek areas. Mild cognitive impairment is more prevalent than dementia. High percentages of depression may be related to low education.
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Affiliation(s)
- Magda Tsolaki
- Department of Neurology, “G.H. Papanikolaou”, School of Medicine, Aristotle University of Thessaloniki, Greece
- Greek Alzheimer Association and Related Disorders, Thessaloniki, Greece (GAARD)
| | - Mara Gkioka
- Department of Neurology, “G.H. Papanikolaou”, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleni Verykouki
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Laboratory of Hygiene, School of Medicine, Aristotle University of Thessaloniki, Greece
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Predictors That a Diagnosis of Mild Cognitive Impairment Will Remain Stable 3 Years Later. Cogn Behav Neurol 2017; 30:8-15. [PMID: 28323681 DOI: 10.1097/wnn.0000000000000119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE In half to two thirds of patients who are diagnosed with mild cognitive impairment (MCI), the diagnosis neither converts to dementia nor reverts to normal cognition; however, little is known about predictors of MCI stability. Our study aimed to identify those predictors. METHODS We obtained 3-year longitudinal data from the National Alzheimer's Coordinating Center Uniform Data Set for patients with a baseline diagnosis of MCI. To predict MCI stability, we used the patients' baseline data to conduct three logistic regression models: demographics, global function, and neuropsychological performance. RESULTS Our final sample had 1059 patients. At the end of 3 years, 596 still had MCI and 463 had converted to dementia. The most reliable predictors of stable MCI were higher baseline scores on delayed recall, processing speed, and global function; younger age; and absence of apolipoprotein E4 alleles. CONCLUSIONS Not all patients with MCI progress to dementia. Of the protective factors that we identified from demographic, functional, and cognitive data, the absence of apolipoprotein E4 alleles best predicted MCI stability. Our predictors may help clinicians better evaluate and treat patients, and may help researchers recruit more homogeneous samples for clinical trials.
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Brodaty H, Aerts L, Crawford JD, Heffernan M, Kochan NA, Reppermund S, Kang K, Maston K, Draper B, Trollor JN, Sachdev PS. Operationalizing the Diagnostic Criteria for Mild Cognitive Impairment: The Salience of Objective Measures in Predicting Incident Dementia. Am J Geriatr Psychiatry 2017; 25:485-497. [PMID: 28110876 DOI: 10.1016/j.jagp.2016.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia. DESIGN Six-year longitudinal study, part of the Sydney Memory and Ageing Study. SETTING Community-based. PARTICIPANTS 873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded. MEASUREMENTS Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals. RESULTS Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy. CONCLUSIONS Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals.
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Affiliation(s)
- Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia.
| | - Liesbeth Aerts
- Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Megan Heffernan
- Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kate Maston
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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Farias ST, Lau K, Harvey D, Denny KG, Barba C, Mefford AN. Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment. J Am Geriatr Soc 2017; 65:1152-1158. [PMID: 28306147 DOI: 10.1111/jgs.14835] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI. DESIGN As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing. SETTING Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center. PARTICIPANTS Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324). MEASUREMENTS Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains. RESULTS Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3-3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4-3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations. CONCLUSION Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults.
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Affiliation(s)
- Sarah Tomaszewski Farias
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Karen Lau
- Department of Psychiatry, Marin/Sonoma Service Area, Kaiser Permanente Northern California, The Permanente Medical Group, San Rafael, California
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California
| | - Katherine G Denny
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Cheyanne Barba
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Anthony N Mefford
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
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McGuinness B, Fuchs M, Barrett SL, Passmore AP, Johnston JA. Platelet Membrane β-Secretase Activity in Mild Cognitive Impairment and Conversion to Dementia: a Longitudinal Study. J Alzheimers Dis 2016; 49:1095-103. [PMID: 26639974 PMCID: PMC4927817 DOI: 10.3233/jad-150795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A blood-based biomarker to complement the clinical and neuropsychological assessments used to evaluate the risk of individuals with mild cognitive impairment (MCI) developing Alzheimer’s disease (AD) would be invaluable. Previous pilot studies by our group identified elevated platelet membrane β-secretase activity in patients with AD and MCI, as compared to controls, and this activity was influenced by membrane cholesterol levels. The present study investigated baseline platelet membrane β-secretase activity and cholesterol levels in 97 MCI participants and 85 controls and explored whether these parameters differed in individuals with stable MCI, as compared to those who subsequently developed AD. To evaluate signal specificity, β-secretase activity assays were conducted in the presence and absence of beta-site amyloid-β protein precursor-cleaving enzyme (BACE) inhibitors. Baseline platelet membrane β-secretase activity did not differ significantly in MCI participants, as compared to controls, and platelet membrane cholesterol levels were significantly lower in the MCI group. The longitudinal study indicated that the activities inhibited by two different BACE inhibitors did not predict conversion to AD; however, the activity that was not affected by BACE inhibitors was significantly (40%) higher in individuals with stable MCI, as compared with those who subsequently developed AD. These findings indicated that further research into the source of this activity could contribute to a measure facilitating prediction of the risk of conversion from MCI to AD.
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Affiliation(s)
- Bernadette McGuinness
- Correspondence to: Dr. Bernadette McGuinness, Room 03.019 Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Grosvenor Road, Belfast BT12 6BA, N. Ireland. Tel.: +44 28 90 632638; Fax: +44 28 90 235900; E-mail:
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Alzheimer's disease--subcortical vascular disease spectrum in a hospital-based setting: Overview of results from the Gothenburg MCI and dementia studies. J Cereb Blood Flow Metab 2016; 36. [PMID: 26219595 PMCID: PMC4702291 DOI: 10.1038/jcbfm.2015.148] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The ability to discriminate between Alzheimer's disease (AD), subcortical vascular disease, and other cognitive disorders is crucial for diagnostic purposes and clinical trial outcomes. Patients with primarily subcortical vascular disease are unlikely to benefit from treatments targeting the AD pathogenic mechanisms and vice versa. The Gothenburg mild cognitive impairment (MCI) and dementia studies are prospective, observational, single-center cohort studies suitable for both cross-sectional and longitudinal analysis that outline the cognitive profiles and biomarker characteristics of patients with AD, subcortical vascular disease, and other cognitive disorders. The studies, the first of which started in 1987, comprise inpatients with manifest dementia and patients seeking care for cognitive disorders at an outpatient memory clinic. This article gives an overview of the major published papers (neuropsychological, imaging/physiology, and neurochemical) of the studies including the ongoing Gothenburg MCI study. The main findings suggest that subcortical vascular disease with or without dementia exhibit a characteristic neuropsychological pattern of mental slowness and executive dysfunction and neurochemical deviations typical of white matter changes and disturbed blood-brain barrier function. Our findings may contribute to better healthcare for this underrecognized group of patients. The Gothenburg MCI study has also published papers on multimodal prediction of dementia, and cognitive reserve.
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The Prevalence of Mild Cognitive Impairment in Diverse Geographical and Ethnocultural Regions: The COSMIC Collaboration. PLoS One 2015; 10:e0142388. [PMID: 26539987 PMCID: PMC4634954 DOI: 10.1371/journal.pone.0142388] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background Changes in criteria and differences in populations studied and methodology have produced a wide range of prevalence estimates for mild cognitive impairment (MCI). Methods Uniform criteria were applied to harmonized data from 11 studies from USA, Europe, Asia and Australia, and MCI prevalence estimates determined using three separate definitions of cognitive impairment. Results The published range of MCI prevalence estimates was 5.0%–36.7%. This was reduced with all cognitive impairment definitions: performance in the bottom 6.681% (3.2%–10.8%); Clinical Dementia Rating of 0.5 (1.8%–14.9%); Mini-Mental State Examination score of 24–27 (2.1%–20.7%). Prevalences using the first definition were 5.9% overall, and increased with age (P < .001) but were unaffected by sex or the main races/ethnicities investigated (Whites and Chinese). Not completing high school increased the likelihood of MCI (P ≤ .01). Conclusion Applying uniform criteria to harmonized data greatly reduced the variation in MCI prevalence internationally.
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McGuinness B, Barrett SL, McIlvenna J, Passmore AP, Shorter GW. Predicting conversion to dementia in a memory clinic: A standard clinical approach compared with an empirically defined clustering method (latent profile analysis) for mild cognitive impairment subtyping. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 1:447-54. [PMID: 27239523 PMCID: PMC4879478 DOI: 10.1016/j.dadm.2015.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction Mild cognitive impairment (MCI) has clinical value in its ability to predict later dementia. A better understanding of cognitive profiles can further help delineate who is most at risk of conversion to dementia. We aimed to (1) examine to what extent the usual MCI subtyping using core criteria corresponds to empirically defined clusters of patients (latent profile analysis [LPA] of continuous neuropsychological data) and (2) compare the two methods of subtyping memory clinic participants in their prediction of conversion to dementia. Methods Memory clinic participants (MCI, n = 139) and age-matched controls (n = 98) were recruited. Participants had a full cognitive assessment, and results were grouped (1) according to traditional MCI subtypes and (2) using LPA. MCI participants were followed over approximately 2 years after their initial assessment to monitor for conversion to dementia. Results Groups were well matched for age and education. Controls performed significantly better than MCI participants on all cognitive measures. With the traditional analysis, most MCI participants were in the amnestic multidomain subgroup (46.8%) and this group was most at risk of conversion to dementia (63%). From the LPA, a three-profile solution fit the data best. Profile 3 was the largest group (40.3%), the most cognitively impaired, and most at risk of conversion to dementia (68% of the group). Discussion LPA provides a useful adjunct in delineating MCI participants most at risk of conversion to dementia and adds confidence to standard categories of clinical inference.
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Affiliation(s)
- Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Suzanne L Barrett
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - John McIlvenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Anthony Peter Passmore
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Gillian W Shorter
- National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia; All Ireland Hub for Trials Methodology Research, Ulster University, Londonderry, Northern Ireland
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Early Cognitively Based Functional Limitations Predict Loss of Independence in Instrumental Activities of Daily Living in Older Adults. J Int Neuropsychol Soc 2015; 21:688-98. [PMID: 26391766 PMCID: PMC5540650 DOI: 10.1017/s1355617715000818] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults with early forms of neurodegenerative disease are at risk for functional disability, which is often defined by the loss of independence in instrumental activities of daily living (IADLs). The current study investigated the influence of mild changes in everyday functional abilities (referred to as functional limitations) on risk for development of incident functional disability. A total of 407 participants, who were considered cognitively normal or diagnosed with mild cognitive impairment (MCI) at baseline, were followed longitudinally over an average 4.1 years (range=0.8-9.2 years). Informant-based ratings from the Everyday Cognition (ECog; Farias et al., 2008) and the Instrumental Activities of Daily Living (Lawton & Brody, 1969) scales assessed the degree of functional limitations and incident IADL disability, respectively. Cox proportional hazards models revealed that more severe functional limitations (as measured by the Total ECog score) at baseline were associated with approximately a four-fold increased risk of developing IADL disability a few years later. Among the ECog domains, functional limitations in Everyday Planning, Everyday Memory, and Everyday Visuospatial domains were associated with the greatest risk of incident functional disability. These results remained robust even after controlling for participants' neuropsychological functioning on tests of executive functions and episodic memory. Current findings indicate that early functional limitations have prognostic value in identifying older adults at risk for developing functional disability. Findings highlight the importance of developing interventions to support everyday abilities related to memory, executive function, and visuospatial skills in an effort to delay loss of independence in IADLs.
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Alegret M, Cuberas-Borrós G, Espinosa A, Valero S, Hernández I, Ruíz A, Becker JT, Rosende-Roca M, Mauleón A, Sotolongo O, Castell-Conesa J, Roca I, Tárraga L, Boada M. Cognitive, genetic, and brain perfusion factors associated with four year incidence of Alzheimer's disease from mild cognitive impairment. J Alzheimers Dis 2015; 41:739-48. [PMID: 24685632 DOI: 10.3233/jad-132516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a range of factors that predict the development of Alzheimer's disease (AD) dementia among patients with amnestic mild cognitive impairment (MCI). OBJECTIVES To identify the neuropsychological, genetic, and functional brain imaging data that best predict conversion to AD dementia in patients with amnestic MCI. METHODS From an initial group of 42 amnestic MCI patients assessed with neurological, neuropsychological, and brain SPECT, 39 (25 converters, 14 non-converters) were followed for 4 years, and 36 had APOE ε4 genotyping. Baseline neuropsychological data and brain SPECT data were used to predict which of the MCI patients would develop dementia by the end of the 4 years of observation. RESULTS The MCI patients who had converted to AD dementia had poorer performance on long-term visual memory and Semantic Fluency tests. The MCI subjects who developed dementia were more likely to carry at least one copy of the APOE ε4 allele (Hazard Risk = 4.22). There was lower brain perfusion in converters than non-converters, mainly in postcentral gyrus. An additional analysis of the SPECT data found differences between the MCI subjects and controls in the posterior cingulate gyrus and the basal forebrain. When the brain imaging and neuropsychological test data were combined in the same Cox regression model, only the neuropsychological test data were significantly associated with time to dementia. CONCLUSION Although the presence of reduced brain perfusion in postcentral gyrus and basal forebrain indicated an at-risk condition, it was the extent of memory impairment that was linked to the speed of decline from MCI to AD.
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Affiliation(s)
- Montserrat Alegret
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Gemma Cuberas-Borrós
- Nuclear Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Hospital Universitari Vall d'Hebron-Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Ana Espinosa
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Sergi Valero
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Hernández
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Agustín Ruíz
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - James T Becker
- Departments of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Departments of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Departments of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maitée Rosende-Roca
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Ana Mauleón
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Oscar Sotolongo
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Joan Castell-Conesa
- Nuclear Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Hospital Universitari Vall d'Hebron-Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Isabel Roca
- Nuclear Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Hospital Universitari Vall d'Hebron-Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Lluís Tárraga
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Mercè Boada
- Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
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García-Herranz S, Díaz-Mardomingo MC, Peraita H. Neuropsychological predictors of conversion to probable Alzheimer disease in elderly with mild cognitive impairment. J Neuropsychol 2015; 10:239-55. [PMID: 25809316 DOI: 10.1111/jnp.12067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/18/2014] [Indexed: 12/31/2022]
Abstract
In the field of neuropsychology, it is essential to determine which neuropsychological tests predict Alzheimer's disease (AD) in people with mild cognitive impairment (MCI) and which cut-off points should be used to identify people at greater risk for converting to dementia. The aim of the present study was to analyse the predictive value of the cognitive tests included in a neuropsychological battery for conversion to AD among MCI participants and to analyse the influence of some sociodemographic variables - sex, age, schooling - and others, such as follow-up time and emotional state. A total of 105 participants were assessed with a neuropsychological battery at baseline and during a 3-year follow-up period. For the present study, the data were analysed at baseline. During the follow-up period, 24 participants (22.85%) converted to dementia (2.79 ± 1.14 years) and 81 (77.14%) remained as MCI. The logistic regression analysis determined that the long delay cued recall and the performance time of the Rey figure test were the best predictive tests of conversion to dementia after an MCI diagnosis. Concerning the sociodemographic factors, sex had the highest predictive power. The results reveal the relevance of the neuropsychological data obtained in the first assessment. Specifically, the data obtained in the episodic verbal memory tests and tests that assess visuospatial and executive components may help to identify people with MCI who may develop AD in an interval not longer than 4 years, with the masculine gender being an added risk factor.
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Affiliation(s)
- Sara García-Herranz
- Department of Psychology Basic I, National University of Distance Education (UNED), Madrid, Spain
| | - M Carmen Díaz-Mardomingo
- Department of Psychology Basic I, National University of Distance Education (UNED), Madrid, Spain
| | - Herminia Peraita
- Department of Psychology Basic I, National University of Distance Education (UNED), Madrid, Spain
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25
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Cruz-Oliver DM, Malmstrom TK, Roegner M, Tumosa N, Grossberg GT. Cognitive Deficit Reversal as Shown by Changes in the Veterans Affairs Saint Louis University Mental Status (SLUMS) Examination Scores 7.5 Years Later. J Am Med Dir Assoc 2014; 15:687.e5-10. [DOI: 10.1016/j.jamda.2014.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
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26
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Bertola L, Mota NB, Copelli M, Rivero T, Diniz BS, Romano-Silva MA, Ribeiro S, Malloy-Diniz LF. Graph analysis of verbal fluency test discriminate between patients with Alzheimer's disease, mild cognitive impairment and normal elderly controls. Front Aging Neurosci 2014; 6:185. [PMID: 25120480 PMCID: PMC4114204 DOI: 10.3389/fnagi.2014.00185] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/09/2014] [Indexed: 12/26/2022] Open
Abstract
Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment-subtypes amnestic (aMCI) and amnestic multiple domain (a+mdMCI)-and patients with Alzheimer's disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGA). The individuals were compared when divided in three (NC-MCI-AD) and four (NC-aMCI-a+mdMCI-AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.
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Affiliation(s)
- Laiss Bertola
- Laboratory of Clinical Neuroscience Investigations, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Natália B Mota
- Brain Institute, Federal University of Rio Grande do Norte Natal, Brazil
| | - Mauro Copelli
- Physics Department, Federal University of Pernambuco Recife, Brazil
| | - Thiago Rivero
- Laboratory of Clinical Neuroscience Investigations, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Breno Satler Diniz
- Laboratory of Clinical Neuroscience Investigations, Federal University of Minas Gerais Belo Horizonte, Brazil ; Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Marco A Romano-Silva
- Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil ; Faculty of Medicine, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Sidarta Ribeiro
- Brain Institute, Federal University of Rio Grande do Norte Natal, Brazil
| | - Leandro F Malloy-Diniz
- Laboratory of Clinical Neuroscience Investigations, Federal University of Minas Gerais Belo Horizonte, Brazil ; Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
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Abstract
This virtual issue consists of studies previously published in the Journal of the International Neuropsychological Society and selected on the basis of their content related to one of the most highly researched concepts in behavioral neurology and neuropsychology over the past decade: mild cognitive impairment (MCI). The reliance on cognitive screening measures, staging-based rating scales, and limited neuropsychological testing in diagnosing MCI across most research studies may miss individuals with subtle cognitive declines or mis-diagnose MCI in those who are otherwise cognitively normal on a broader neuropsychological battery of tests. The assembled articles highlight the perils of relying on these conventional criteria for MCI diagnosis and reveal how the reliability of diagnosis is improved when sound neuropsychological approaches are adopted. When these requirements are met, we illustrate with a second series of articles that neuropsychological measures associate strongly with biomarkers and often reflect pathology beyond or instead of typical AD distributions. The final set of articles reveal that people with MCI demonstrate mild but identifiable functional difficulties, and a challenge for neuropsychology is how to incorporate this information to better define MCI and distinguish it from early dementia. Neuropsychology is uniquely positioned to improve upon the state of the science in MCI research and practice by providing critically important empirical information on the specific cognitive domains affected by the predominant neurodegenerative disorders of late life as well as on the diagnostic decision-making strategies used in studies. When such efforts to more comprehensively assess neuropsychological functions are undertaken, better characterizations of spared and impaired cognitive and functional abilities result and lead to more convincing associations with other biomarkers as well as to prediction of clinical outcomes.
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Alencar MA, Dias JMD, Figueiredo LC, Dias RC. Frailty and cognitive impairment among community-dwelling elderly. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:362-7. [DOI: 10.1590/0004-282x20130039] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/16/2012] [Indexed: 11/21/2022]
Abstract
The aim was to evaluate associations between frailty status and cognitive decline and the incidence of cognitive impairment over 12-month period. Two hundred seven older adults were assessed. Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low level of activity. Cognitive decline was assessed using the Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Relative risk (RR) was calculated with a 95% confidence interval (CI). Frailty was associated with subsequent cognitive decline in 12-month when assessed using the MMSE (p=;0.005; RR=;4.6; 95%CI 1.93–11.2). No association was found between frailty and cognitive decline measured by the CDR (p=;0.393; RR=;2.1; 95%CI 0.68–6.7) or between frailty and the incidence of cognitive impairment (p=;0.675; RR=;1.2; 95%CI 0.18–8.3). These findings reveal an association between frailty and subsequent cognitive decline when measured by the MMSE, even within a short period of time.
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Seelye AM, Schmitter-Edgecombe M, Cook DJ, Crandall A. Naturalistic assessment of everyday activities and prompting technologies in mild cognitive impairment. J Int Neuropsychol Soc 2013; 19:442-52. [PMID: 23351284 PMCID: PMC4144192 DOI: 10.1017/s135561771200149x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Older adults with mild cognitive impairment (MCI) often have difficulty performing complex instrumental activities of daily living (IADLs), which are critical to independent living. In this study, amnestic multi-domain MCI (N = 29), amnestic single-domain MCI (N = 18), and healthy older participants (N = 47) completed eight scripted IADLs (e.g., cook oatmeal on the stove) in a smart apartment testbed. We developed and experimented with a graded hierarchy of technology-based prompts to investigate both the amount of prompting and type of prompts required to assist individuals with MCI in completing the activities. When task errors occurred, progressive levels of assistance were provided, starting with the lowest level needed to adjust performance. Results showed that the multi-domain MCI group made more errors and required more prompts than the single-domain MCI and healthy older adult groups. Similar to the other two groups, the multi-domain MCI group responded well to the indirect prompts and did not need a higher level of prompting to get back on track successfully with the tasks. Need for prompting assistance was best predicted by verbal memory abilities in multi-domain amnestic MCI. Participants across groups indicated that they perceived the prompting technology to be very helpful.
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Affiliation(s)
- Adriana M Seelye
- Washington State University, Department of Psychology, Pullman, WA 99164-4820, USA.
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30
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Wolk DA, Mancuso L, Kliot D, Arnold SE, Dickerson BC. Familiarity-based memory as an early cognitive marker of preclinical and prodromal AD. Neuropsychologia 2013; 51:1094-102. [PMID: 23474075 DOI: 10.1016/j.neuropsychologia.2013.02.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 02/21/2013] [Accepted: 02/27/2013] [Indexed: 11/19/2022]
Abstract
There is great interest in the development of cognitive markers that differentiate "normal" age-associated cognitive change from that of Alzheimer's disease (AD) in its prodromal (i.e., mild cognitive impairment; MCI) or even preclinical stages. Dual process models posit that recognition memory is supported by the dissociable processes of recollection and familiarity. Familiarity-based memory has generally been considered to be spared during normal aging, but it remains controversial whether this type of memory is impaired in early AD. Here, we describe findings of estimates of recollection and familiarity in young adults (YA), cognitively normal older adults (CN), and patients with amnestic-MCI (a-MCI). These measures in the CN and a-MCI patients were then related to a structural imaging biomarker of AD that has previously been demonstrated to be sensitive to preclinical and prodromal AD, the Cortical Signature of AD (ADsig). Consistent with much work in the literature, recollection, but not familiarity, was impaired in CN versus YA. Replicating our prior findings, a-MCI patients displayed impairment in both familiarity and recollection. Finally, the familiarity measure was correlated with the ADsig biomarker across the CN and a-MCI group, as well as within the CN adults alone. No other standard psychometric measure was as highly associated with the ADsig, suggesting that familiarity may be a sensitive biomarker of AD-specific brain changes in preclinical and prodromal AD and that it may offer a qualitatively distinct measure of early AD memory impairment relative to normal age-associated change.
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Affiliation(s)
- David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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31
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Bigler ED, Farrer TJ, Pertab JL, James K, Petrie JA, Hedges DW. Reaffirmed Limitations of Meta-Analytic Methods in the Study of Mild Traumatic Brain Injury: A Response to Rohling et al. Clin Neuropsychol 2013; 27:176-214. [DOI: 10.1080/13854046.2012.693950] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Erin D. Bigler
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- b Neuroscience Center, Brigham Young University , Provo , UT , USA
- c Department of Psychiatry , University of Utah , Salt Lake City , UT , USA
- d The Brain Institute of Utah, University of Utah , Salt Lake City , UT , USA
| | - Thomas J. Farrer
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Jon L. Pertab
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- e Veterans Administration Hospital , Salt Lake City , UT , USA
| | - Kelly James
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Jo Ann Petrie
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Dawson W. Hedges
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- b Neuroscience Center, Brigham Young University , Provo , UT , USA
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Aretouli E, Tsilidis KK, Brandt J. Four-year outcome of mild cognitive impairment: the contribution of executive dysfunction. Neuropsychology 2012; 27:95-106. [PMID: 23106114 DOI: 10.1037/a0030481] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The contribution of executive cognition (EC) to the prediction of incident dementia remains unclear. This prospective study examined the predictive value of EC for subsequent cognitive decline in persons with mild cognitive impairment (MCI) over a 4-year period. METHOD One hundred forty-one persons with MCI (amnestic and nonamnestic, single- and multiple-domain) received a baseline and two biennial follow-up assessments. Eighteen tests, assessing six different aspects of EC, were administered at baseline and at 2-year follow-up, together with screening cognitive and daily functioning measures. Longitudinal logistic regression models and generalized estimating equations (GEE) were used to examine whether EC could predict progression to a Clinical Dementia Rating Scale (CDR; C. P. Hughes, L. Berg, W. L. Danziger, L. A. Coben, & R. L. Martin, 1982, A new clinical scale for the staging of dementia, British Journal of Psychiatry, Vol. 140, pp. 566-572) score of 1 or more over the 4-year period, first at the univariate level and then in the context of demographic and clinical characteristics, daily functioning measures, and other neurocognitive factors. RESULTS Over the 4-year period, 56% of MCI patients remained stable, 35% progressed to CDR ≥ 1, and 8% reverted to normal (CDR = 0). Amnestic MCI subtypes were not associated with higher rates of progression to dementia, whereas subtypes with multiple impairments were so associated. Eight out of the 18 EC measures, including all three measures assessing inhibition of prepotent responses, predicted MCI outcome at the univariate level. However, the multivariate GEE model indicated that age, daily functioning, and overall cognitive functioning best predicted progression to dementia. CONCLUSION Measures of EC (i.e., inhibitory control) are associated with MCI outcome. However, age and global measures of cognitive and functional impairment are better predictors of incident dementia.
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Affiliation(s)
- Eleni Aretouli
- Departments of Psychiatry and Behavioral Sciences and Neurology, Johns Hopkins University School of Medicine
| | | | - Jason Brandt
- Departments of Psychiatry and Behavioral Sciences and Neurology, Johns Hopkins University School of Medicine
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Cadar D, Pikhart H, Mishra G, Stephen A, Kuh D, Richards M. The role of lifestyle behaviors on 20-year cognitive decline. J Aging Res 2012; 2012:304014. [PMID: 22988508 PMCID: PMC3440944 DOI: 10.1155/2012/304014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/27/2012] [Accepted: 07/03/2012] [Indexed: 11/17/2022] Open
Abstract
This study examined the association between smoking, physical activity and dietary choice at 36 and 43 years, and change in these lifestyle behaviors between these ages, and decline in verbal memory and visual search speed between 43 and 60-64 years in 1018 participants from MRC National Survey of Health and Development (NSHD, the British 1946 birth cohort). ANCOVA models were adjusted for sex, social class of origin, childhood cognition, educational attainment, adult social class, and depression; then the lifestyle behaviors were additionally mutually adjusted. Results showed that healthy dietary choice and physical activity were associated, respectively, with slower memory and visual search speed decline over 20 years, with evidence that increasing physical activity was important. Adopting positive health behaviors from early midlife may be beneficial in reducing the rate of cognitive decline and ultimately reducing the risk of dementia.
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Affiliation(s)
- D. Cadar
- MRC Unit for Lifelong Health and Ageing, London WC1B 5JU, UK
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - H. Pikhart
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - G. Mishra
- School of Population Health, University of Queensland, Herston, QLD 4006, Australia
| | - A. Stephen
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, UK
| | - D. Kuh
- MRC Unit for Lifelong Health and Ageing, London WC1B 5JU, UK
| | - M. Richards
- MRC Unit for Lifelong Health and Ageing, London WC1B 5JU, UK
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34
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Costa A, Caltagirone C, Carlesimo GA. Prospective Memory Impairment in Mild Cognitive Impairment: An Analytical Review. Neuropsychol Rev 2011; 21:390-404. [DOI: 10.1007/s11065-011-9172-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 06/30/2011] [Indexed: 10/18/2022]
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Silverberg NB, Ryan LM, Carrillo MC, Sperling R, Petersen RC, Posner HB, Snyder PJ, Hilsabeck R, Gallagher M, Raber J, Rizzo A, Possin K, King J, Kaye J, Ott BR, Albert MS, Wagster MV, Schinka JA, Cullum CM, Farias ST, Balota D, Rao S, Loewenstein D, Budson AE, Brandt J, Manly JJ, Barnes L, Strutt A, Gollan TH, Ganguli M, Babcock D, Litvan I, Kramer JH, Ferman TJ. Assessment of cognition in early dementia. Alzheimers Dement 2011; 7:e60-e76. [PMID: 23559893 PMCID: PMC3613863 DOI: 10.1016/j.jalz.2011.05.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Better tools for assessing cognitive impairment in the early stages of Alzheimer's disease (AD) are required to enable diagnosis of the disease before substantial neurodegeneration has taken place and to allow detection of subtle changes in the early stages of progression of the disease. The National Institute on Aging and the Alzheimer's Association convened a meeting to discuss state of the art methods for cognitive assessment, including computerized batteries, as well as new approaches in the pipeline. Speakers described research using novel tests of object recognition, spatial navigation, attentional control, semantic memory, semantic interference, prospective memory, false memory and executive function as among the tools that could provide earlier identification of individuals with AD. In addition to early detection, there is a need for assessments that reflect real-world situations in order to better assess functional disability. It is especially important to develop assessment tools that are useful in ethnically, culturally and linguistically diverse populations as well as in individuals with neurodegenerative disease other than AD.
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Affiliation(s)
- Nina B Silverberg
- Division of Neuroscience, National Institute on Aging, National Institutes of Health, Bethesda MD
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