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Karamacoska D, Chan DKY, Leung I, Liu JX, Brodaty H, Fahey PP, Bensoussan A, Chang DH. Study protocol for a phase III randomised controlled trial of Sailuotong (SLT) for vascular dementia and Alzheimer's disease with cerebrovascular disease. PLoS One 2023; 18:e0265285. [PMID: 36920949 PMCID: PMC10016672 DOI: 10.1371/journal.pone.0265285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/22/2022] [Indexed: 03/16/2023] Open
Abstract
Vascular dementia (VaD) accounts for 15-20% of all dementia cases. It is a syndrome of acquired cognitive impairment with a complex pathophysiological basis. A novel herbal formulation (Sailuotong; SLT) consisting of Panax ginseng C.A Mey, Ginkgo biloba L and Crocus sativus L extracts was developed to treat VaD. Preclinical animal studies found significant improvements in memory and in pathogenic biochemical parameters. Appropriate safety of SLT was shown in acute and chronic toxicity studies, and early clinical trials of SLT demonstrated enhancements in cognition in VaD patients. A fully powered study with a long intervention period is needed to confirm the efficacy and safety of this novel intervention. A rigorous phase III clinical trial was developed with the aim of recruiting 238 patients diagnosed with mild to moderate probable VaD, or VaD mixed with Alzheimer's disease (where cerebrovascular disease is the clinical dominant contributor to dementia, abbreviated as CVD+AD). Using a permuted block strategy, participants will be randomly allocated to receive SLT (120 mg bd) or placebo capsules for an intervention period of 52 weeks and will be followed-up for an additional 13 weeks. The primary outcome measures are the Vascular Dementia Assessment Scale-cognitive subscale and Alzheimer's Disease Cooperative Study-Activities of Daily Living scale. Secondary outcome measures include the Clinician's Interview Based Impression of Change-Plus, CLOX, EXIT-25, Neuropsychiatric Inventory-Clinician rating scale, and Dementia Quality of Life questionnaire. Safety is assessed through adverse event reports and liver, renal, and coagulation studies. Primary and secondary outcome measures will be compared between treatment and placebo groups, using intention to treat and per protocol analyses. We hypothesise that a 52-week treatment of SLT will be clinically effective and well tolerated in participants with VaD or AD+CVD. This project will provide vital efficacy and safety data for this novel treatment approach to VaD.
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Affiliation(s)
- Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Daniel K. Y. Chan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Isabella Leung
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jian-xun Liu
- Research Center, Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Paul P. Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Dennis H. Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- * E-mail:
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Shehata F, Elwishy A, A. Kishk N, M. Ahmed G. Clinical Prediction Rules for Using Aerobic Exercises on Executive Functions in Parkinson's Patients. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2018.157.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sun MK. Executive functioning: perspectives on neurotrophic activity and pharmacology. Behav Pharmacol 2018; 29:592-604. [PMID: 30179884 DOI: 10.1097/fbp.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, Morgantown, West Virginia, USA
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Matsuoka T, Kato Y, Imai A, Fujimoto H, Shibata K, Nakamura K, Yamada K, Narumoto J. Differences in the neural correlates of frontal lobe tests. Psychogeriatrics 2018; 18:42-48. [PMID: 29372597 DOI: 10.1111/psyg.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/03/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Executive Interview (EXIT25), the executive clock-drawing task (CLOX1), and the Frontal Assessment Battery (FAB) are used to assess executive function at the bedside. These tests assess distinct psychometric properties. The aim of this study was to examine differences in the neural correlates of the EXIT25, CLOX1, and FAB based on magnetic resonance imaging. METHODS Fifty-eight subjects (30 with Alzheimer's disease, 10 with mild cognitive impairment, and 18 healthy controls) participated in this study. Multiple regression analyses were performed to examine the brain regions correlated with the EXIT25, CLOX1, and FAB scores. Age, gender, and years of education were included as covariates. Statistical thresholds were set to uncorrected P-values of 0.001 at the voxel level and 0.05 at the cluster level. RESULTS The EXIT25 score correlated inversely with the regional grey matter volume in the left lateral frontal lobe (Brodmann areas 6, 9, 44, and 45). The CLOX1 score correlated positively with the regional grey matter volume in the right orbitofrontal cortex (Brodmann area 11) and the left supramarginal gyrus (Brodmann area 40). The FAB score correlated positively with the regional grey matter volume in the right precentral gyrus (Brodmann area 6). The left lateral frontal lobe (Brodmann area 9) and the right lateral frontal lobe (Brodmann area 46) were identified as common brain regions that showed association with EXIT25, CLOX1, and FAB based only a voxel-level threshold. CONCLUSIONS The results of this study suggest that the EXIT25, CLOX1, and FAB may be associated with the distinct neural correlates of the frontal cortex.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Fujimoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keisuke Shibata
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Moreira HS, Costa AS, Castro SL, Lima CF, Vicente SG. Assessing Executive Dysfunction in Neurodegenerative Disorders: A Critical Review of Brief Neuropsychological Tools. Front Aging Neurosci 2017; 9:369. [PMID: 29170636 PMCID: PMC5684643 DOI: 10.3389/fnagi.2017.00369] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
Executive function (EF) has been defined as a multifaceted construct that involves a variety of high-level cognitive abilities such as planning, working memory, mental flexibility, and inhibition. Being able to identify deficits in EF is important for the diagnosis and monitoring of several neurodegenerative disorders, and thus their assessment is a topic of much debate. In particular, there has been a growing interest in the development of neuropsychological screening tools that can potentially provide a reliable quick measure of EF. In this review, we critically discuss the four screening tools of EF currently available in the literature: Executive Interview-25 (EXIT 25), Frontal Assessment Battery (FAB), INECO Frontal Screening (IFS), and FRONTIER Executive Screen (FES). We first describe their features, and then evaluate their psychometric properties, the existing evidence on their neural correlates, and the empirical work that has been conducted in clinical populations. We conclude that the four screening tools generally present appropriate psychometric properties, and are sensitive to impairments in EF in several neurodegenerative conditions. However, more research will be needed mostly with respect to normative data and neural correlates, and to determine the extent to which these tools add specific information to the one provided by global cognition screening tests. More research directly comparing the available tools with each other will also be important to establish in which conditions each of them can be most useful.
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Affiliation(s)
- Helena S Moreira
- Faculty of Psychology and Education Sciences, Centre for Psychology, University of Porto, Porto, Portugal
| | - Ana S Costa
- Neurology Department, Hospital de Braga, Braga, Portugal
| | - São L Castro
- Faculty of Psychology and Education Sciences, Centre for Psychology, University of Porto, Porto, Portugal
| | - César F Lima
- Faculty of Psychology and Education Sciences, Centre for Psychology, University of Porto, Porto, Portugal.,Institute of Cognitive Neuroscience, University College London, London, United Kingdom.,Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Selene G Vicente
- Faculty of Psychology and Education Sciences, Centre for Psychology, University of Porto, Porto, Portugal
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Royall DR, Palmer RF, Matsuoka T, Kato Y, Taniguchi S, Ogawa M, Fujimoto H, Okamura A, Shibata K, Nakamura K, Nakaaki S, Koumi H, Mimura M, Fukui K, Narumoto J. Greater than the Sum of Its Parts: δ can be Constructed from Item Level Data. J Alzheimers Dis 2016; 49:571-9. [PMID: 26444760 DOI: 10.3233/jad-150250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
"δ", a latent variable constructed from cognitive performance and functional status measures, can accurately diagnose dementia. The minimal assessment needed is unknown. We have constructed a δ homolog, "dTEXAS", from Telephone Executive Assessment Scale (TEXAS) items, and validated it in a convenience sample of Japanese persons (n = 176). dTEXAS scores correlated strongly with both Instrumental Activities of Daily Living (IADL) (r = -0.86, p < 0.001) and Clinical Dementia Rating Scale (CDR) (r = 0.71, p < 0.001). Constructed independently of their diagnoses, dTEXAS scores accurately distinguished dementia versus controls (area under the receiver operating curve [(AUC; ROC) = 0.92], dementia versus mild cognitive impairment (MCI) (AUC = 0.80) and controls versus MCI (AUC = 0.74). These AUCs are higher than those of multiple observed executive measures, as reported recently by Matsuoka et al., 2014. A dTEXAS score of -0.58 best discriminated between dementia versus controls with 90.1% sensitivity and 80.0% specificity.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | | | - Mayu Ogawa
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroshi Fujimoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | | | | | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shutaro Nakaaki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Koumi
- Department of Clinical Psychology, Faculty of Social Welfare, Hanazono University, Nishinokyo, Nakagyo-ku, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
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Dao E, Hsiung GYR, Sossi V, Jacova C, Tam R, Dinelle K, Best JR, Liu-Ambrose T. Exploring the effects of coexisting amyloid in subcortical vascular cognitive impairment. BMC Neurol 2015; 15:197. [PMID: 26459220 PMCID: PMC4604093 DOI: 10.1186/s12883-015-0459-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/04/2015] [Indexed: 01/18/2023] Open
Abstract
Background Mixed pathology, particularly Alzheimer’s disease with cerebrovascular lesions, is reported as the second most common cause of dementia. Research on mixed dementia typically includes people with a primary AD diagnosis and hence, little is known about the effects of co-existing amyloid pathology in people with vascular cognitive impairment (VCI). The purpose of this study was to understand whether individual differences in amyloid pathology might explain variations in cognitive impairment among individuals with clinical subcortical VCI (SVCI). Methods Twenty-two participants with SVCI completed an 11C Pittsburgh compound B (PIB) position emission tomography (PET) scan to quantify global amyloid deposition. Cognitive function was measured using: 1) MOCA; 2) ADAS-Cog; 3) EXIT-25; and 4) specific executive processes including a) Digits Forward and Backwards Test, b) Stroop-Colour Word Test, and c) Trail Making Test. To assess the effect of amyloid deposition on cognitive function we conducted Pearson bivariate correlations to determine which cognitive measures to include in our regression models. Cognitive variables that were significantly correlated with PIB retention values were entered in a hierarchical multiple linear regression analysis to determine the unique effect of amyloid on cognitive function. We controlled for age, education, and ApoE ε4 status. Results Bivariate correlation results showed that PIB binding was significantly correlated with ADAS-Cog (p < 0.01) and MOCA (p < 0.01); increased PIB binding was associated with worse cognitive function on both cognitive measures. PIB binding was not significantly correlated with the EXIT-25 or with specific executive processes (p > 0.05). Regression analyses controlling for age, education, and ApoE ε4 status indicated an independent association between PIB retention and the ADAS-Cog (adjusted R-square change of 15.0 %, Sig F Change = 0.03). PIB retention was also independently associated with MOCA scores (adjusted R-Square Change of 27.0 %, Sig F Change = 0.02). Conclusion We found that increased global amyloid deposition was significantly associated with greater memory and executive dysfunctions as measured by the ADAS-Cog and MOCA. Our findings point to the important role of co-existing amyloid deposition for cognitive function in those with a primary SVCI diagnosis. As such, therapeutic approaches targeting SVCI must consider the potential role of amyloid for the optimal care of those with mixed dementia. Trial registration NCT01027858
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Affiliation(s)
- Elizabeth Dao
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada.
| | - Ging-Yuek Robin Hsiung
- Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC, V6T 1Z1, Canada. .,UBC PET, Brain Research Centre, 2211 Westboork Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Claudia Jacova
- School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Hillsboro, OR, 97123, USA.
| | - Roger Tam
- Department of Radiology, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1 M9, Canada. .,MS/MRI Research Group, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada.
| | - Katie Dinelle
- UBC PET, Brain Research Centre, 2211 Westboork Mall, Vancouver, BC, V6T 2B5, Canada.
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6S 0A9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Jahn DR, Dressel JA, Gavett BE, O'Bryant SE. An item response theory analysis of the Executive Interview and development of the EXIT8: A Project FRONTIER Study. J Clin Exp Neuropsychol 2015; 37:229-42. [PMID: 25748691 DOI: 10.1080/13803395.2014.1002757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The Executive Interview (EXIT25) is an effective measure of executive dysfunction, but may be inefficient due to the time it takes to complete 25 interview-based items. The current study aimed to examine psychometric properties of the EXIT25, with a specific focus on determining whether a briefer version of the measure could comprehensively assess executive dysfunction. METHOD The current study applied a graded response model (a type of item response theory model for polytomous categorical data) to identify items that were most closely related to the underlying construct of executive functioning and best discriminated between varying levels of executive functioning. Participants were 660 adults ages 40 to 96 years living in West Texas, who were recruited through an ongoing epidemiological study of rural health and aging, called Project FRONTIER. The EXIT25 was the primary measure examined. Participants also completed the Trail Making Test and Controlled Oral Word Association Test, among other measures, to examine the convergent validity of a brief form of the EXIT25. RESULTS Eight items were identified that provided the majority of the information about the underlying construct of executive functioning; total scores on these items were associated with total scores on other measures of executive functioning and were able to differentiate between cognitively healthy, mildly cognitively impaired, and demented participants. In addition, cutoff scores were recommended based on sensitivity and specificity of scores. CONCLUSION A brief, eight-item version of the EXIT25 may be an effective and efficient screening for executive dysfunction among older adults.
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Affiliation(s)
- Danielle R Jahn
- a Department of Psychological Sciences , Texas Tech University , Lubbock , TX , USA
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Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people. Int Psychogeriatr 2014; 26:1387-97. [PMID: 24832196 DOI: 10.1017/s104161021400088x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. METHODS The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). RESULTS Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. CONCLUSIONS J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.
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The Executive Interview (EXIT25) as a tool for assessing executive functioning in older medical and surgical inpatients referred to a psychiatry service: feasibility of creating a brief version. Int Psychogeriatr 2014; 26:935-41. [PMID: 24588924 DOI: 10.1017/s104161021400026x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Most neuropsychological tests of executive function are time-consuming and otherwise unsuitable for routine bedside assessment, particularly in older people admitted to a general hospital. After introducing the Executive Interview (EXIT25) in our routine clinical practice, we hypothesized that it would be possible to shorten it for easier administration in our group of patients while maintaining or improving properties of the scale. METHODS The EXIT25 was applied in 122 clinically stable medical and surgical inpatients aged 65 years and over referred to the Liaison Psychiatry Service for Older People. Individual items were initially tested for floor and ceiling effects, inter-rater and test-retest reliability, and item-total correlations. Items were then selected for retention in the brief scale on the basis of adequate item-total correlation and inter-rater and test-retest reliability. The construct validity of the original and brief versions of the EXIT25 scale was assessed. RESULTS The original EXIT25 scale was found to lack desirable scaling properties either as a classical or hierarchical scale. The study confirmed a possibility to reduce the number of items to nine out of the original 25 while improving internal consistency, test-retest and inter-rater reliability, and maintaining high correlation with the original EXIT25 score, and moderate inverse correlation with the Mini-Mental State Examination score. CONCLUSIONS There is potential to abbreviate the original EXIT25, and improve internal consistency and hierarchical scaling properties. Future research is necessary to focus on piloting these brief measures of executive function in relevant clinical settings, when administered en bloc, rather than with items interspersed in the original longer version.
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Yamada M, Takechi H, Mori S, Aoyama T, Arai H. Global brain atrophy is associated with physical performance and the risk of falls in older adults with cognitive impairment. Geriatr Gerontol Int 2012; 13:437-42. [PMID: 22935103 DOI: 10.1111/j.1447-0594.2012.00927.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Falls are common in patients with cognitive disorder. The purpose of this study was to determine whether global brain atrophy is associated with cognitive function, physical performance and fall incidents in older adults with mild cognitive disorder. METHODS A total of 31 older adults with mild cognitive disorders (mean age 78.9 ± 7.3 years) were studied, and 10 of them had experienced falls and the others had not in the past 1 year. Cognitive function and physical performance were measured in these patients. Global brain atrophy was determined by the Voxel-Based Specific Regional Analysis System for Alzheimer's Disease software. RESULTS Fallers showed significantly worse scores than the non-fallers in the Global Brain Atrophy Index, Clock Drawing Test (CDT), Verbal Fluency Test (animal), maximum walking time and Timed Up & Go (TUG) Test. The Global Brain Atrophy Index was correlated with the Verbal Fluency Test (animal; r = -0.522), the Verbal Fluency Test with letter (ka; r = -0.337), CDT (r = -0.547), TUG (r = 0.276) and Five Chair Stands Test (r = 0.303) by age-adjusted correlation analyses. Stepwise regression analysis showed that the Global Brain Atrophy Index (β = 1.265, 95% CI 1.022-1.567) was a significant and independent determinant of falls (R(2) = 0.356, P = 0.003). CONCLUSION Global brain atrophy might be indicated as one of the risk factors for falls in older adults with mild cognitive disorders.
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Affiliation(s)
- Minoru Yamada
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Thabit H, Kennelly SM, Bhagarva A, Ogunlewe M, McCormack PME, McDermott JH, Sreenan S. Utilization of Frontal Assessment Battery and Executive Interview 25 in assessing for dysexecutive syndrome and its association with diabetes self-care in elderly patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2009; 86:208-12. [PMID: 19783061 DOI: 10.1016/j.diabres.2009.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 04/20/2009] [Accepted: 09/07/2009] [Indexed: 01/21/2023]
Abstract
AIMS Executive function (EF) comprises a set of cognitive skills that controls the execution of complex activities. In the context of diabetes, this may include patients' self-monitoring and daily management of their condition. We compared two different measures of EF in a population of elderly patients with type 2 diabetes mellitus (T2DM) and studied its relationship with diabetes self-care. METHODS Fifty patients (34 males) had EF assessed using Frontal Assessment Battery (FAB) and Executive Interview 25 (EXIT25). Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Haemoglobin A1c (HbA1c), lipid levels, blood pressure and diabetes duration were recorded. RESULTS The mean age of the patients was 67.0+/-7.5 years and mean duration of diabetes was 8.1+/-6.4 years. Mean HbA1c was 7.0+/-1.2%, and mean fasting plasma glucose, cholesterol and LDL-C were 7.0+/-1.7mM, 4.0+/-0.9mM and 2.1+/-0.7mM respectively. Mean EXIT25 score was 9.5+/-4.6 in the range of normal EF (14% had EXIT25 score>15, indicating impaired EF). Mean FAB score was 13.7+/-3.3 (48% having scores<15, indicating impaired EF), suggesting a degree of dysexecutive syndrome involving frontal lobe functions. EXIT25 score was inversely correlated with SDSCA (r=-0.3, p<0.05) but no significant correlation between FAB and SDSCA or HbA1c, diabetes duration, lipid levels and blood pressure with EXIT25, FAB or SDCSA was found. CONCLUSION A substantial proportion of elderly patients with T2DM may have dysexecutive syndrome and impairment in EF may impact on self-care in this group.
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Affiliation(s)
- H Thabit
- Department of Endocrinology and Diabetes Mellitus, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin 15, Ireland
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Kochunov P, Robin DA, Royall DR, Coyle T, Lancaster J, Kochunov V, Schlosser AE, Fox PT. Can structural MRI indices of cerebral integrity track cognitive trends in executive control function during normal maturation and adulthood? Hum Brain Mapp 2009; 30:2581-94. [PMID: 19067326 DOI: 10.1002/hbm.20689] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We explored the relationship between structural neuroimaging-based indices of cerebral integrity and executive control function (ECF) in two groups of healthy subjects: A maturing group (33 subjects; 19-29 years) and a senescing group (38 adults; 30-90 years). ECF was assessed using the Executive Interview (EXIT) battery. Cortical indices of cerebral integrity included GM thickness, intergyral span, and sulcal span, each measured for five cortical regions per hemisphere. Subcortical indices included fractional anisotropy (FA), measured using track-based-spatial-statistics (TBSS), and the volume of T2-hyperintense WM (HWM). In the maturing group, no significant relationships between neuroanatomical changes and ECF were found; however, there were hints that late-term maturation of cerebral WM influenced variability in ECF. In the senescing group, the decline in ECF corresponded to atrophic changes in cerebral WM (sulcal and intergyral span) primarily in the superior frontal and anterior cingulate regions. A large fraction of the variability in ECF (62%) can be explained by variability in the structural indices from these two regions.
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Affiliation(s)
- Peter Kochunov
- Research Imaging Center, University of Texas Health Science Center at San Antonio, Texas 78284, USA.
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Abstract
OBJECTIVE Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with and without suicidal ideation and attempts. DESIGN Case-control study. SETTING University-affiliated psychiatric hospital. PARTICIPANTS We compared 32 suicidal depressed participants aged 60 and older with 32 non-suicidal depressed participants equated for age, education, and gender. MEASUREMENTS We assessed global cognitive function and executive function with the Dementia Rating Scale (DRS) and the Executive Interview (EXIT25), respectively. RESULTS Suicidal and non-suicidal depressed groups were comparable in terms of severity of depression and burden of physical illness. Suicidal participants performed worse on the EXIT25, and on the DRS total scale, as well as on Memory and Attention subscales. The differences were not explained by the presence of dementia, substance use, medication exposure, or brain injury from suicide attempts. CONCLUSIONS Poor performance on tests of executive function, attention, and memory is associated with suicidal behavior in late-life depression.
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Chan SMS, Chiu FKH, Lam CWL. Correlational study of the Chinese version of the executive interview (C-EXIT25) to other cognitive measures in a psychogeriatric population in Hong Kong Chinese. Int J Geriatr Psychiatry 2006; 21:535-41. [PMID: 16645939 DOI: 10.1002/gps.1521] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study is designed to pilot test the feasibility and correlational properties of the adapted Chinese version of Executive Interview (C-EXIT25) to other cognitive measures in a psychogeriatric population in Hong Kong Chinese. METHOD Eighty-five community dwelling elders from different levels of residential care facilities were assessed with C-EXIT25, Cantonese version of Mini-Mental State Examination (C-MMSE), Chinese version of Mattis Dementia Rating Scale (CDRS) and Nelson's Modified Card Sorting Test (MCST). RESULTS The C-EXIT25 has high internal consistency (Cronbach's alpha = 0.7995) and inter-rater reliability (r = 0.91). The C-EXIT25 has superior correlational property to performance indices of MCST than the C-MMSE and CDRS, after adjusting for age, gender and educational level. It also discriminates among subjects at different stages on Clinical Dementia Rating. CONCLUSIONS The C-EXIT25 is a potentially feasible and valid bedside tool for assessment of executive cognitive functions in the psychogeriatric population in Hong Kong Chinese.
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Stokholm J, Vogel A, Gade A, Waldemar G. The Executive Interview as a Screening Test for Executive Dysfunction in Patients with Mild Dementia. J Am Geriatr Soc 2005; 53:1577-81. [PMID: 16137290 DOI: 10.1111/j.1532-5415.2005.53470.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To validate the Executive Interview (EXIT25) as a screening instrument for executive cognitive dysfunction in patients with mild dementia. DESIGN Validation using group comparison and correlation studies. SETTING The Copenhagen University Hospital Memory Clinic, a multidisciplinary outpatient clinic based in a neurological setting. PARTICIPANTS Thirty-three patients with mild dementia (MMSE score > or =20) and 30 healthy controls. MEASUREMENTS The EXIT25, a 25-item screening instrument for executive dysfunction, was administered to all participants. Global cognitive function was measured using the MMSE. Patients were evaluated using traditional neuropsychological tests for executive dysfunction (Wisconsin Card Sorting Test, Trail Making Part B, Stroop Test, verbal fluency, design fluency, and verbal abstraction). Changes in behavior and functional impairment in activities of daily living were assessed using the Frontal Behavioral Inventory (FBI) and the Disability Assessment for Dementia Scale. RESULTS EXIT25 scores were significantly higher in patients than in the healthy controls; MMSE scores could not account for the differences. Thirteen of the 25 items separated the two groups. EXIT25 was found to correlate significantly with the Stroop Test, the verbal fluency tests, and the FBI. CONCLUSION The EXIT25 is able to capture executive cognitive deficits not primarily related to the general level of intellectual reduction in patients with mild dementia. In clinical practice, the EXIT25 might be a valuable supplement to the MMSE.
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Affiliation(s)
- Jette Stokholm
- Memory Disorders Research Unit, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Royall DR, Palmer R, Chiodo LK, Polk MJ. Declining Executive Control in Normal Aging Predicts Change in Functional Status: The Freedom House Study. J Am Geriatr Soc 2004; 52:346-52. [PMID: 14962147 DOI: 10.1111/j.1532-5415.2004.52104.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the contribution of executive control function (ECF) to functional status. DESIGN Three-year longitudinal cohort study. SETTING A comprehensive-care retirement community. PARTICIPANTS Five hundred forty-seven noninstitutionalized septuagenarians. MEASUREMENTS The Mini-Mental State Examination (MMSE) and Executive Interview (EXIT25). Functional status was assessed using instrumental activities of daily living (IADLs). Latent growth curves of MMSE, EXIT25, and IADL were modeled. The rate of change in IADLs (DeltaIADL), adjusted for baseline IADLs and cognition, was regressed on the rate of change in each cognitive measure (adjusted for baseline cognition). Models were also adjusted for baseline age, level of care, and comorbid illnesses. RESULTS Baseline test scores were within normal ranges, but mean EXIT25 scores reached the impaired range by the second follow-up. There was significant variability around the baseline means and slopes for all variables. The rate of change in EXIT25 was strongly correlated with DeltaIADL (r=-0.57, P<.001). This remained significant after adjusting for baseline EXIT25 scores, IADLs, age, comorbid disease, and level of care. The effect of the EXIT25 on DeltaIADL was stronger than those of age, baseline IADLs, comorbid disease, or level of care. The rate of change in MMSE scores was not significantly associated with DeltaIADL. CONCLUSION ECF is a significant and independent correlate of functional status in normal aging. Traditional dementia case finding is likely to underestimate cognition-related disability. Neither a normal baseline MMSE score nor stable MMSE scores over time preclude functionally significant changes in ECF.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, South Texas Veterans' Health System Audie L. Murphy Division GRECC, and the University of Texas Health Science Center, San Antonio, Texas 78284, USA.
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Royall DR, Chiodo LK, Polk MJ. Executive dyscontrol in normal aging: normative data, factor structure, and clinical correlates. Curr Neurol Neurosci Rep 2004; 3:487-93. [PMID: 14565903 DOI: 10.1007/s11910-003-0052-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although there is ample evidence of frontal system dysfunction in old age, the clinical significance of these impairments has not been well studied. In this article, we examine the factor structure of putative executive measures in a sample of well elderly subjects. Three stable factors emerged, but only one was associated with measures of functional status. This factor was most strongly associated with relatively simple bedside executive measures that might prove useful in dementia screening. In contrast, a second factor, dominated by the Wisconsin Card Sorting Task, was weakly associated with disability. These data suggest that certain executive measures may be more relevant to functional outcomes, and hence dementia case finding, than others. Moreover, associations with functional status should not be casually extrapolated from regional frontal clinical correlations, particularly with the dorsolateral prefrontal cortex.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA.
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Rugo HS, Ahles T. The impact of adjuvant therapy for breast cancer on cognitive function: current evidence and directions for research. Semin Oncol 2003; 30:749-62. [PMID: 14663776 DOI: 10.1053/j.seminoncol.2003.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Available evidence supports the hypothesis that adjuvant chemotherapy for breast cancer can produce cognitive deficits, and that these deficits may have a significant impact on patients' quality of life. Studies have generally compared the results of a variety of cognitive measures performed following treatment to standardized population-based norms or to cancer patients who received local therapy, rather than to the individual's baseline level of functioning. Several longitudinal studies are in progress or in the planning stages to better quantify and understand the incidence and impact of cognitive effects of adjuvant chemotherapy, and to identify possible susceptibility factors in subgroups. Although the neurocognitive changes appear to be subtle, there may be enough data to consider discussing the possibility of cognitive dysfunction as an adverse effect when assessing the risks and benefits of adjuvant chemotherapy. Likewise, as the aromatase inhibitors are increasingly given to larger numbers of women in the adjuvant setting, it will be important to understand the cognitive impact of estrogen deprivation. Finally, there is interest in examining supportive pharmacologic or behavioral measures that might prevent or decrease cognitive effects in this setting. Herein, the data on cognitive changes associated with chemotherapy for breast cancer, current and future research directions, as well as possible treatments are reviewed.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine, University of California Comprehensive Cancer Center, San Francisco 94115, USA
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Royall DR, Palmer R, Chiodo LK, Polk MJ. Decline in learning ability best predicts future dementia type: the Freedom House Study. Exp Aging Res 2003; 29:385-406. [PMID: 12959874 DOI: 10.1080/03610730303700] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors studied longitudinal change in learning efficiency as a predictor of future dementia type among healthy, well-educated, noninstitutionalized elderly retirees. Serial assessments of memory were obtained using the California Verbal Learning Test (CVLT). Latent growth (LG) models were developed from the slopes of the subjects' performance over the first five CVLT learning trials at each of three serial administrations (e.g., cohort inception [i.e., baseline] [CVLT1], 18 months [CVLT2] and 36 months [CVLT3]). The resulting growth curves were incorporated into a higher order LG model representing the dynamic change in learning efficiency over time (DeltaCVLT). DeltaCVLT was used to predict each subject's "dementia type" (i.e., clinical state) at 36 months (e.g., no dementia, Type 1 [Alzheimer type] dementia or Type 2 [non-Alzheimer type] dementia), after adjusting for CVLT1, baseline age, and baseline dementia type. Nonlinear (logarithmic) LG models of CVLT1-CVLT3 and DeltaCVLT best fit the data. There was significant variability about both CVLT1 and DeltaCVLT, suggesting subgroups in the sample with significantly different baseline memory function, and different rates of deterioration in learning efficiency. Age, baseline dementia type, and DeltaCVLT made significant independent contributions to final dementia type. CVLT1 did not predict final dementia type independently of the other covariates. These data suggest that baseline memory performance in noninstitutionalized elderly retirees does not predict future dementia type independently of the dynamic rate of change in memory measures. Serial administrations of memory tests may help identify nondemented persons at greater or lesser risk for conversion to frank dementia in the near-term.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas 78284-7792, USA.
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Schillerstrom JE, Deuter MS, Wyatt R, Stern SL, Royall DR. Prevalence of executive impairment in patients seen by a psychiatry consultation service. PSYCHOSOMATICS 2003; 44:290-7. [PMID: 12832594 DOI: 10.1176/appi.psy.44.4.290] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The prevalence of impairment of executive function among 50 medical inpatients referred for psychiatric consultation was assessed by using the Executive Interview (EXIT25) and an executive clock-drawing task (CLOX). The Mini-Mental Status Examination (MMSE) was also administered to assess general cognition. The percentage of patients who failed each test was calculated. Seventy-two percent failed at least one measure of executive function, whereas only 30% failed the MMSE. The results suggest that impairment of executive function is common among inpatients referred for psychiatric consultation. Because impairment of executive function has been specifically associated with behavioral and functional disability, routine assessment of executive function should be integrated into psychiatric case management.
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Affiliation(s)
- Jason E Schillerstrom
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc 2003; 51:459-65. [PMID: 12657064 DOI: 10.1046/j.1532-5415.2003.51153.x] [Citation(s) in RCA: 390] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether cardiorespiratory fitness at baseline is associated with maintenance of cognitive function over 6 years or with level of cognitive function on tests performed 6 years later in a longitudinal study of healthy older people. DESIGN Prospective cohort. SETTING Community-based study of noninstitutionalized adults aged 55 and older living in Sonoma, California. PARTICIPANTS Three hundred forty-nine cohort members without evidence of cardiovascular disease, musculoskeletal disability, or cognitive impairment at baseline. MEASUREMENTS Cardiorespiratory fitness measures were based on a standard treadmill exercise test protocol and included peak oxygen consumption (peak VO2), treadmill exercise duration, and oxygen uptake efficiency slope (OUES). Cognitive function was evaluated at baseline with a modified Mini-Mental State Examination (mMMSE) and after 6 years of follow-up with a detailed cognitive test battery that included the full MMSE, three tests of attention/executive function, two measures of verbal memory, and two tests of verbal fluency. RESULTS Participants with worse cardiorespiratory fitness at baseline experienced greater decline on the mMMSE over 6 years (mean mMMSE decline (95% confidence interval) by baseline peak VO2 tertile: lowest = -0.5 (-0.8 to -0.3), middle = -0.2 (-0.5-0.0), highest = 0.0 (-0.3-0.2), P =.002 for trend over tertiles). Participants with worse baseline cardiorespiratory fitness also performed worse on all cognitive tests conducted 6 years later. Results were similar for analyses based on peak VO2, treadmill exercise duration, and OUES. After adjustment for demographic and health-related covariates, measures of cardiorespiratory fitness were associated most strongly with measures of global cognitive function and attention/executive function. CONCLUSION Baseline measures of cardiorespiratory fitness are positively associated with preservation of cognitive function over a 6-year period and with levels of performance on cognitive tests conducted 6 years later in healthy older adults. High cardiorespiratory fitness may protect against cognitive dysfunction in older people.
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Affiliation(s)
- Deborah E Barnes
- Department of Epidemiology, University of California at Berkeley, Berkeley, California, USA.
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Royall DR, Espino DV, Polk MJ, Verdeja R, Vale S, Gonzales H, Palmer RR, Markides KP. Validation of a Spanish translation of the CLOX for use in Hispanic samples: the Hispanic EPESE study. Int J Geriatr Psychiatry 2003; 18:135-41. [PMID: 12571822 DOI: 10.1002/gps.804] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Clock drawing tests (CDT) appear to be less vulnerable to linguistic, cultural, or educational bias than traditional dementia screening instruments. We investigated a Spanish language translation of CLOX: an executive CDT, in a community sample of Hispanic elders. METHODS In-home CLOX evaluations of 1309 Mexican-American elders were reviewed. RESULTS Both CLOX1 (an executive CDT) and CLOX2 (a constructional CDT) showed good internal consistency (Chronbach's alpha; both alpha = 0.82). Cultural-demographic variables had little effect on CLOX scores. Although language had a significant effect on CLOX1 failure rates, this was not mediated by age, education, acculturation or income. CONCLUSIONS These results suggest that the Spanish CLOX can be validly administered to community-based Hispanic elder samples regardless of education or acculturation.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7792, USA.
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