Predictors of cognitive decline in the early stages of Parkinson's disease: a brief cognitive assessment longitudinal study

CCCDTD5 recommendations on early non cognitive markers of dementia: A Canadian consensus

Introduction

Cognitive impairment is the hallmark of Alzheimer's disease (AD) and related dementias. However, motor decline has been recently described as a prodromal state that can help to detect at‐risk individuals. Similarly, sensory changes, sleep and behavior disturbances, and frailty have been associated with higher risk of developing dementia. These clinical findings, together with the recognition that AD pathology precedes the diagnosis by many years, raises the possibility that non‐cognitive changes may be early and non‐invasive markers for AD or, even more provocatively, that treating non‐cognitive aspects may help to prevent or treat AD and related dementias.

Methods

A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia reviewed areas of emerging evidence for non‐cognitive markers of dementia. We examined the literature for five non‐cognitive domains associated with future dementia: motor, sensory (hearing, vision, olfaction), neuro‐behavioral, frailty, and sleep. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assign the strength of the evidence and quality of the recommendations. We provide recommendations to primary care clinics and to specialized memory clinics, answering the following main questions: (1) What are the non‐cognitive and functional changes associated with risk of developing dementia? and (2) What is the evidence that sensory, motor, behavioral, sleep, and frailty markers can serve as potential predictors of dementia?

Results

Evidence supported that gait speed, dual‐task gait speed, grip strength, frailty, neuropsychiatric symptoms, sleep measures, and hearing loss are predictors of dementia. There was insufficient evidence for recommending assessing olfactory and vision impairments as a predictor of dementia.

Conclusions

Non‐cognitive markers can assist in identifying people at risk for cognitive decline or dementia. These non‐cognitive markers may represent prodromal symptoms and several of them are potentially amenable to treatment that might delay the onset of cognitive decline.

Longitudinal volume changes of hippocampal subfields and cognitive decline in Parkinson's disease

Background

Neuropathological studies have shown that the hippocampus is affected in Parkinson's disease (PD) with cognitive impairment. Our goal was to assess the longitudinal volume change of different hippocampal subfields in PD patients with and without cognitive decline using magnetic resonance imaging (MRI).

Methods

A total of 28 nondemented PD patients and 27 neurologically unimpaired elderly controls were enrolled in this study, and three-dimensional (3D) T1-weighted MRI was performed. All PD patients that were followed up and rescanned after 2 years were divided into two groups: PD without cognitive decline (n=15) and PD with cognitive decline (n=13). A Bayesian model implemented in FreeSurfer was used to segment the hippocampal subfields automatically. Scale for global cognitive status included the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

Results

In the cross sectional study, the bilateral hippocampal volume was smaller in PD patients compared to healthy controls, and the bilateral subiculum, CA2/3, CA4, and molecular layer (ML) subfields, and the right granule cell layer of the dentate gyrus (GC-DG) subfield, were significantly decreased in the PD patients. Significant correlations were found between the MoCA score and total hippocampus volume in PD patients. In the follow-up group, bilateral CA4, ML, and GC-DG subfields, and left CA2/3 and right presubiculum subfields, were significantly smaller in PD patients with cognitive decline compared to PD patients without cognitive decline. Significant correlations were found between the longitudinal change of the MMSE or MoCA scores and percent change rate of total bilateral hippocampal, bilateral ML, and right CA4 in all PD patients.

Conclusions

Our results demonstrated the selective regional vulnerability of the hippocampus in the progression of PD. These findings corroborate neuropathological findings and add novel information about the involvement of the hippocampus in the cognitive dysfunction of PD.

The Beneficial Effects of Cognitive Training With Simple Calculation and Reading Aloud (SCRA) in the Elderly Postoperative Population: A Pilot Randomized Controlled Trial

Background: There has been little research conducted regarding cognitive treatments for the elderly postsurgical population. Patients aged ≥60 years have an increased risk of postoperative cognitive decline, a condition in which cognitive functions are negatively affected. This cognitive decline can lead to a decline in quality of life. In order to maintain a high quality of life, the elderly postsurgical population may benefit from treatment to maintain and/or improve their cognitive functions. This pilot study investigates the effect of simple calculation and reading aloud (SCRA) cognitive training in elderly Japanese postsurgical patients.

Methods: Elderly patients undergoing non-cardiovascular thoracic surgery under general anesthesia were recruited (n = 12). Subjects were randomly divided into two groups—one that receives 12 weeks of SCRA intervention, and a waitlisted control group. Before and after the intervention, we measured cognitive function [Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), computerized Cogstate Brief Battery (CBB)] and emotional state [General Health Questionnaire-12 (GHQ-12), Geriatric Depression Scale (GDS), Quality of Life Scale-5 (QOL-5)].

Results: Group difference analyses using ANCOVA with permutation test showed that the intervention SCRA group had a significant improvement in FAB motor programming sub-score, GDS, and QOL-5 compared to the control group. Within-group analyses using Wilcoxon signed-rank test to compare baseline and follow-up showed that the SCRA intervention group total FAB scores, FAB motor programming sub-scores, and QOL-5 scores were significantly improved.

Discussion: This pilot study showed that there are important implications for the beneficial effects of SCRA intervention on cognitive function and emotional state in the postoperative elderly population; however, further investigations are necessary to reach any conclusions.

Trial registration: This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN000019832).

Indication of Cognitive Change and Associated Risk Factor after Thoracic Surgery in the Elderly: A Pilot Study

Background: This pilot study investigated the effects of partial pulmonary lobectomy lung surgery on cognitive functions of elderly Japanese patients. It is recognized that elderly patients undergoing surgery have increased risk of Postoperative Cognitive Decline (POCD), a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery is aging.

Methods: Cognitive function was measured for all subjects (n = 12) before and after surgery using three different cognitive tests: Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), and a computerized Cogstate Brief Battery (CBB). Changes in these measures indicate changes in cognitive function. In addition, the 12-item General Health Questionnaire (GHQ-12), the Geriatric Depression Scale (GDS), and the 5-item Quality of Life questionnaire (QOL-5) were administered at each time point to measure mental and emotional state. Changes in outcome measures were analyzed via Wilcoxon signed-rank test. Exploratory correlation analysis was conducted using Spearman’s rho.

Results: Data show a decline in detection (DET; p = 0.045) and identification (IDN; p = 0.038). Spearman’s correlation coefficient show a significant correlation between postoperative DET scores and postoperative IDN scores (ρ = 0.78, p = 0.005), a significant correlation between change in IDN and baseline GHQ-12 scores (ρ = -0.595, p = 0.027), and a significant correlation between change in one-back (OBK) scores and duration of anesthesia (ρ = -0.72, p = 0.012).

Discussion: This was the first report to examine cognitive decline after major thoracic surgery in Japanese patients. Previous studies have evidenced that POCD is a common phenomenon after surgery, and that age is a major risk factor. The CCB measured significant change in two cognitive domains: attention and psycomotor function. This study clarified that decline in cognition is detectable in certain measures after thoracic surgery in the elderly Japanese patient population. Additionally, longer anesthetic exposure may negatively impact attention and working memory, and preoperative mental wellbeing is a possible predictor of POCD. These preliminary results have important implications and support the need for future studies.

Non-Motor symptoms in Portuguese Parkinson's Disease patients: correlation and impact on Quality of Life and Activities of Daily Living

The prevalence of non-motor symptoms (NMS) in Parkinson’s Disease (PD) has varied between studies. Their interrelation isn’t totally understood. Also, the relative importance of each symptom, regarding its impact on activities of daily living (ADL) and health related quality of life (HRQL), remains debatable. We assessed all PD patients attending a Portuguese tertiary movement disorders center during one year (n = 134), with ADL, HRQL and other clinical scales approved for identifying the most relevant NMS in PD. All patients had at least one NMS. Sleep/fatigue, affect/cognition, attention/memory were the most frequent complaints, and their prevalence, above 80%, was higher than in most studies. There were significantly correlations between: sleepiness, psychosis and cognition; gastrointestinal, cardiovascular symptoms and pain; depression and apathy; anxiety and insomnia; olfaction, weight and hyperhidrosis. Depression/apathy exerted the strongest influence on HRQL and non-tremor motor dysfunction on ADL. Compared to studies in other countries, we found a higher prevalence of NMS, which could be specific of this population. The interrelation between NMS could be related to degeneration of different brain structures. NMS exert a stronger influence than MS in HRQL, which should be taken in account regarding treatment options.

The beneficial effects of cognitive training with simple calculation and reading aloud in an elderly postsurgical population: study protocol for a randomized controlled trial

Background

This project proposes a pilot study to investigate the positive healing effects of cognitive training with simple arithmetic and reading aloud on elderly postsurgical patients. Elderly patients undergoing surgery have an increased risk of Postoperative Cognitive Decline (POCD), a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery has aged. Little effort has been expended, however, to find treatments for POCD. Learning therapy, which consists of a combination of reading aloud and solving simple arithmetic problems, was developed in Japan as a treatment for Alzheimer’s Disease to improve cognitive functions. Because patients with Alzheimer’s Disease experience similar issues as those with POCD in learning, memory, and processing speed, a cognitive intervention based on the learning-therapy treatments used for Alzheimer’s Disease could show advantageous outcomes for those at risk of POCD.

Methods/design

Cognitive function will be measured before and after surgery using three different tests (Mini-Mental Status Exam, Frontal Assessment Battery, and Cogstate computerized tests). Subjects will be randomly divided into two groups—one that receives a Simple Calculation and Reading Aloud intervention (SCRA) and a waitlisted control group that does not receive SCRA. To measure cognition before and after the intervention, the previously mentioned three tests will be used. The obtained data will be analyzed using statistical tests such as ANCOVA to indicate whether the cognitive intervention group has made improvements in their cognitive functions. In addition, questionnaires will also be administered to collect data on mental and emotional statuses.

Discussion

This report will be the first pilot study to investigate the beneficial effects of SCRA on elderly surgical patients. Previous studies have shown sufficient evidence on the effectiveness of learning therapy in healthy elderly people and in those with Dementia. Therefore, this study will clarify whether SCRA can improve cognitive function in the more specialized group of elderly surgical patients.

Trial registration

University Hospital Medical Information Network Clinical Trial Registry, UMIN000019832. Registered on 18 November 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1476-0) contains supplementary material, which is available to authorized users.

Effect of attentional interference on balance recovery in older adults

Since most working memory (WM) tasks used in dual-task (DT) postural paradigms include both storage and processing of information, it is difficult to determine the extent to which each of these contributes to interference with balance control. In the current study, a change-detection task (changes in colored squares between two presentation events) that estimates visual working memory capacity (VWMC) was paired with tasks of increasing postural demand (stance, perturbation) in young adults (YAs) and older adults (OAs) and performance compared between the two postural conditions and across the two populations. The change-detection task was selected as it requires storage of information without updating or manipulation; 34 YAs, 34 OAs, and five frail OAs were recruited. A significant reduction in VWMC occurred with increasing postural demand during the perturbation condition for both YAs (p < 0.01) and OAs (p < 0.001). VWMC was also significantly lower for OAs than YAs in the control condition (1.8 ± 0.7 vs. 2.8 ± 0.6) (p < 0.001). OAs showed a significant increase in the number of trials in which steps or rise to toes occurred during recovery between single-task (ST) and DT (p < 0.05; p < 0.05). OAs also showed a significant increase in normalized tibialis anterior amplitude (p < 0.001) following perturbations. YAs showed an increase in normalized area under the center of pressure trajectory and in AP forces (nAcopx1: p < 0.001; nFap1: p < 0.05) during the DT condition.