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Rosales-Lagarde A, Cubero-Rego L, Menéndez-Conde F, Rodríguez-Torres EE, Itzá-Ortiz B, Martínez-Alcalá C, Vázquez-Tagle G, Vázquez-Mendoza E, Eraña Díaz ML. Dissociation of Arousal Index Between REM and NREM Sleep in Elderly Adults with Cognitive Impairment, No Dementia: A Pilot Study. J Alzheimers Dis 2023; 95:477-491. [PMID: 37574730 DOI: 10.3233/jad-230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Sleep disruption in elderly has been associated with an increased risk of cognitive impairment and its transition into Alzheimer's disease (AD). High arousal indices (AIs) during sleep may serve as an early-stage biomarker of cognitive impairment non-dementia (CIND). OBJECTIVE Using full-night polysomnography (PSG), we investigated whether CIND is related to different AIs between NREM and REM sleep stages. METHODS Fourteen older adults voluntarily participated in this population-based study that included Mini-Mental State Examination, Neuropsi battery, Katz Index of Independence in Activities of Daily Living, and single-night PSG. Subjects were divided into two groups (n = 7 each) according to their results in Neuropsi memory and attention subtests: cognitively unimpaired (CU), with normal results; and CIND, with -2.5 standard deviations in memory and/or attention subtests. AIs per hour of sleep during N1, N2, N3, and REM stages were obtained and correlated with Neuropsi total score (NTS). RESULTS AI (REM) was significantly higher in CU group than in CIND group. For the total sample, a positive correlation between AI (REM) and NTS was found (r = 0.68, p = 0.006), which remained significant when controlling for the effect of age and education. In CIND group, the AI (N2) was significantly higher than the AI (REM) . CONCLUSION In CIND older adults, this attenuation of normal arousal mechanisms in REM sleep are dissociated from the relative excess of arousals observed in stage N2. We propose as probable etiology an early hypoactivity at the locus coeruleus noradrenergic system, associated to its early pathological damage, present in the AD continuum.
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Affiliation(s)
- Alejandra Rosales-Lagarde
- CONACyT Chairs, National Council of Science and Technology, Mexico
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico
| | - Lourdes Cubero-Rego
- Neurodevelopmental Research Unit, Institute of Neurobiology, National Autonomous University of Mexico, Campus Juriquilla-Queretaro, Querétaro, México
| | | | | | - Benjamín Itzá-Ortiz
- Mathematics Research Center, Autonomous University of the State of Hidalgo, Mexico
| | - Claudia Martínez-Alcalá
- CONACyT Chairs, National Council of Science and Technology, Mexico
- Institute of Health Sciences, Autonomous University of the State of Hidalgo, Mexico
| | | | | | - Marta L Eraña Díaz
- Center for Research in Engineering and Applied Sciences, Autonomous University of the State of Morelos, Mexico
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Rosales-Lagarde A, Rodriguez-Torres EE, Itzá-Ortiz BA, Miramontes P, Vázquez-Tagle G, Enciso-Alva JC, García-Muñoz V, Cubero-Rego L, Pineda-Sánchez JE, Martínez-Alcalá CI, Lopez-Noguerola JS. The Color of Noise and Weak Stationarity at the NREM to REM Sleep Transition in Mild Cognitive Impaired Subjects. Front Psychol 2018; 9:1205. [PMID: 30065684 PMCID: PMC6056768 DOI: 10.3389/fpsyg.2018.01205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/22/2018] [Indexed: 11/21/2022] Open
Abstract
In Older Adults (OAs), Electroencephalogram (EEG) slowing in frontal lobes and a diminished muscle atonia during Rapid Eye Movement sleep (REM) have each been effective tracers of Mild Cognitive Impairment (MCI), but this relationship remains to be explored by non-linear analysis. Likewise, data provided by EEG, EMG (Electromyogram) and EOG (Electrooculogram)—the three required sleep indicators—during the transition from REM to Non-REM (NREM) sleep have not been related jointly to MCI. Therefore, the main aim of the study was to explore, with results for Detrended Fluctuation Analysis (DFA) and multichannel DFA (mDFA), the Color of Noise (CN) at the NREM to REM transition in OAs with MCI vs. subjects with good performances. The comparisons for the transition from NREM to REM were made for each group at each cerebral area, taking bilateral derivations to evaluate interhemispheric coupling and anteroposterior and posterior networks. In addition, stationarity analysis was carried out to explore if the three markers distinguished between the groups. Neuropsi and the Mini-Mental State Examination (MMSE) were administered, as well as other geriatric tests. One night polysomnography was applied to 6 OAs with MCI (68.1 ± 3) and to 7 subjects without it (CTRL) (64.5 ± 9), and pre-REM and REM epochs were analyzed for each subject. Lower scores for attention, memory and executive funcions and a greater index of arousals during sleep were found for the MCI group. Results confirmed that EOGs constituted significant markers of MCI, increasing the CN for the MCI group in REM sleep. The CN of the EEG from the pre-REM to REM was higher for the MCI group vs. the opposite for the CTRL group at frontotemporal areas. Frontopolar interhemispheric scaling values also followed this trend as well as right anteroposterior networks. EMG Hurst values for both groups were lower than those for EEG and EOG. Stationarity analyses showed differences between stages in frontal areas and right and left EOGs for both groups. These results may demonstrate the breakdown of fractality of areas especially involved in executive functioning and the way weak stationarity analyses may help to distinguish between sleep stages in OAs.
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Affiliation(s)
- Alejandra Rosales-Lagarde
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico.,Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico
| | | | | | - Pedro Miramontes
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | | | - José E Pineda-Sánchez
- Área Académica de Psicología, Universidad Autónoma del Estado de Hidalgo, San Agustín Tlaxiaca, Mexico
| | - Claudia I Martínez-Alcalá
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico.,Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico
| | - Jose S Lopez-Noguerola
- Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico.,Division of Molecular Psychiatry, Department of Psychiatry and Psychotherapy, University of Medicine, Goettingen, Germany
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Apolinario D, Lichtenthaler DG, Magaldi RM, Soares AT, Busse AL, Amaral JRDG, Jacob-Filho W, Brucki SMD. Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS). Int J Geriatr Psychiatry 2016; 31:4-12. [PMID: 25779210 DOI: 10.1002/gps.4282] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/15/2015] [Accepted: 02/17/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES A screening strategy composed of three-item temporal orientation and three-word recall has been increasingly used for detecting cognitive impairment. However, the intervening task administered between presentation and recall has varied. We evaluated six brief tasks that could be useful as intervening distractors and possibly provide incremental accuracy: serial subtraction, clock drawing, category fluency, letter fluency, timed visual detection, and digits backwards. METHODS Older adults (n = 230) consecutively referred for suspected cognitive impairment underwent a comprehensive assessment for gold-standard diagnosis, of whom 56 (24%) presented cognitive impairment not dementia and 68 (30%) presented dementia. Among those with dementia, 87% presented very mild or mild stages (Clinical Dementia Rating 0.5 or 1). The incremental value of each candidate intervening task in a model already containing orientation and word recall was assessed. RESULTS Category fluency (animal naming) presented the highest incremental value among the six candidate intervening tasks. Reclassification analyses revealed a net gain of 12% among cognitively impaired and 17% among normal participants. A four-point scaled score of the animal naming task was added to three-item temporal orientation and three-word recall to compose the 10-point Cognitive Screener. The education-adjusted 10-point Cognitive Screener outperformed the longer Mini-Mental State Examination for detecting both cognitive impairment (area under the curve 0.85 vs 0.77; p = 0.027) and dementia (area under the curve 0.90 vs 0.83; p = 0.015). CONCLUSIONS Based on empirical data, we have developed a brief and easy-to-use screening strategy with higher accuracy and some practical advantages compared with commonly used tools.
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Affiliation(s)
- Daniel Apolinario
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Gomes Lichtenthaler
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Regina Miksian Magaldi
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Aline Thomaz Soares
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Leopold Busse
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Renato das Gracas Amaral
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sonia Maria Dozzi Brucki
- Division of Behavioral and Cognitive Neurology, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Apolinario D, Brucki SMD, Ferretti REDL, Farfel JM, Magaldi RM, Busse AL, Jacob-Filho W. Estimating premorbid cognitive abilities in low-educated populations. PLoS One 2013; 8:e60084. [PMID: 23555894 PMCID: PMC3605367 DOI: 10.1371/journal.pone.0060084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an informant-based instrument that would provide a valid estimate of premorbid cognitive abilities in low-educated populations. Methods A questionnaire was drafted by focusing on the premorbid period with a 10-year time frame. The initial pool of items was submitted to classical test theory and a factorial analysis. The resulting instrument, named the Premorbid Cognitive Abilities Scale (PCAS), is composed of questions addressing educational attainment, major lifetime occupation, reading abilities, reading habits, writing abilities, calculation abilities, use of widely available technology, and the ability to search for specific information. The validation sample was composed of 132 older Brazilian adults from the following three demographically matched groups: normal cognitive aging (n = 72), mild cognitive impairment (n = 33), and mild dementia (n = 27). The scores of a reading test and a neuropsychological battery were adopted as construct criteria. Post-mortem inter-informant reliability was tested in a sub-study with two relatives from each deceased individual. Results All items presented good discriminative power, with corrected item-total correlation varying from 0.35 to 0.74. The summed score of the instrument presented high correlation coefficients with global cognitive function (r = 0.73) and reading skills (r = 0.82). Cronbach's alpha was 0.90, showing optimal internal consistency without redundancy. The scores did not decrease across the progressive levels of cognitive impairment, suggesting that the goal of evaluating the premorbid state was achieved. The intraclass correlation coefficient was 0.96, indicating excellent inter-informant reliability. Conclusion The instrument developed in this study has shown good properties and can be used as a valid estimate of premorbid cognitive abilities in low-educated populations. The applicability of the PCAS, both as an estimate of premorbid intelligence and cognitive reserve, is discussed.
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Affiliation(s)
- Daniel Apolinario
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
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Matioli MNPS, Caramelli P. NEUROPSI battery subtest profile in subcortical vascular dementia and Alzheimer's disease. Dement Neuropsychol 2012; 6:170-174. [PMID: 29213792 PMCID: PMC5618965 DOI: 10.1590/s1980-57642012dn06030010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the diagnostic value of subtests of the NEUROPSI battery for
differentiating subcortical vascular dementia (SVaD) from Alzheimer's
disease (AD). Methods Thirteen patients with mild SVaD, 15 patients with mild probable AD, and 30
healthy controls, matched for age, education and dementia severity (in the
case of patients), were submitted to the Mini-Mental State Examination
(MMSE) and NEUROPSI battery. The performance of AD and SVaD groups on
NEUROPSI subtests was compared. The statistical analyses were performed
using Kruskal-Wallis, Chi-square and Mann-Whitney tests. The results were
interpreted at the 5% significance level (p<0.05). Bonferroni's
correction was applied to multiple comparisons (α=0.02). Results SVaD and AD patients showed no statistical difference in MMSE scores
(SVaD=20.8 and AD=21.0; p=1.0) or in NEUROPSI total score (SVaD=65.0 and
AD=64.3; p=0.56), suggesting a similar severity of dementia. The AD group
performed worse on memory recall (<0.01) and SVaD group was worse in
verbal fluency subtests (p=0.02). Conclusion NEUROPSI's memory and language subtests can be an auxiliary tool for
differentiating SVaD from AD.
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Affiliation(s)
- Maria Niures P S Matioli
- Department of Geriatrics, Lusíada University School of Medicine, Santos SP, Brazil.,Post-Graduate Program, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Paulo Caramelli
- Post-Graduate Program, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil.,Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil
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Matioli MNP, Caramelli P. Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:185-8. [DOI: 10.1590/s0004-282x2010000200006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/01/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia (VaD) from Alzheimer's disease (AD). METHOD: Fifteen patients with mild VaD, 15 patients with mild probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drawing and copy), category and letter fluency, delayed recall test of figures and the EXIT 25 battery. RESULTS: VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, ROC curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. CONCLUSION: Although the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited.
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Affiliation(s)
| | - Paulo Caramelli
- University of São Paulo School of Medicine, Brazil; the Federal University of Minas Gerais, Brazil
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