A retrospective analysis of the sentence writing component of the Mini Mental State Examination: cognitive and affective aspects

Characteristics of Drawing Process Differentiate Alzheimer’s Disease and Dementia with Lewy Bodies

Background: Early differential diagnosis of Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) is important for treatment and disease management, but it remains challenging. Although computer-based drawing analysis may help differentiate AD and DLB, it has not been extensively studied. Objective: We aimed to identify the differences in features characterizing the drawing process between AD, DLB, and cognitively normal (CN) individuals, and to evaluate the validity of using these features to identify and differentiate AD and DLB. Methods: We collected drawing data with a digitizing tablet and pen from 123 community-dwelling older adults in three clinical diagnostic groups of mild cognitive impairment or dementia due to AD (n = 47) or Lewy body disease (LBD; n = 27), and CN (n = 49), matched for their age, sex, and years of education. We then investigated drawing features in terms of the drawing speed, pressure, and pauses. Results: Reduced speed and reduced smoothness in speed and pressure were observed particularly in the LBD group, while increased pauses and total durations were observed in both the AD and LBD groups. Machine-learning models using these features achieved an area under the receiver operating characteristic curve (AUC) of 0.80 for AD versus CN, 0.88 for LBD versus CN, and 0.77 for AD versus LBD. Conclusion: Our results indicate how different types of drawing features were particularly discriminative between the diagnostic groups, and how the combination of these features can facilitate the identification and differentiation of AD and DLB.

Automated Early Detection of Alzheimer's Disease by Capturing Impairments in Multiple Cognitive Domains with Multiple Drawing Tasks

BACKGROUND

Automatic analysis of the drawing process using a digital tablet and pen has been applied to successfully detect Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, most studies focused on analyzing individual drawing tasks separately, and the question of how a combination of drawing tasks could improve the detection performance thus remains unexplored.

OBJECTIVE

We aimed to investigate whether analysis of the drawing process in multiple drawing tasks could capture different, complementary aspects of cognitive impairments, with a view toward combining multiple tasks to effectively improve the detection capability.

METHODS

We collected drawing data from 144 community-dwelling older adults (27 AD, 65 MCI, and 52 cognitively normal, or CN) who performed five drawing tasks. We then extracted motion- and pause-related drawing features for each task and investigated the statistical associations of the features with the participants' diagnostic statuses and cognitive measures.

RESULTS

The drawing features showed gradual changes from CN to MCI and then to AD, and the changes in the features for each task were statistically associated with cognitive impairments in different domains. For classification into the three diagnostic categories, a machine learning model using the features from all five tasks achieved a classification accuracy of 75.2%, an improvement by 7.8% over that of the best single-task model.

CONCLUSION

Our results demonstrate that a common set of drawing features from multiple drawing tasks can capture different, complementary aspects of cognitive impairments, which may lead to a scalable way to improve the automated detection of AD and MCI.

Comparison of Behavior-Related Features in the MMSE Sentence in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease

Background: Despite the ubiquity of cognitive assessments using the MMSE, there has been little investigation of currently unscored features of the MMSE sentence item relevant to behavior and language in patients with behavioral variant Frontotemporal Dementia (bvFTD) and Alzheimer's disease (AD). Objective: To describe and compare the unscored content and grammar elements of the MMSE sentence item in patients with bvFTD and AD. Methods: Categorization of predefined content and grammar elements of the MMSE sentence was performed by two blinded raters in patients with bvFTD (n = 74) and AD (n = 84). Chi-square and ANCOVAs were conducted to identify differences between the diagnostic groups. A multinomial logistic regression analysis was conducted to determine whether these features aid in the prediction of diagnosis of bvFTD or AD. Results: A higher proportion of patients with bvFTD wrote sentences addressed to the examiner (22.7% vs. 4.7%, X 2 = 11.272, p = 0.001) and about interpersonal relationships (35.3% vs. 16.0%, X 2 = 10.139, p = 0.017) in comparison to those with AD. The number of words written was lower in patients with AD and was positively correlated with lower total MMSE scores in AD but not in bvFTD (AD: r = 0.370, p < 0.001; FTD: r = 0.209, p = 0.07). Assessment of the MMSE sentence content and grammar variables did not add to the prediction bvFTD or AD diagnosis beyond the variance explained by age and total MoCA score. Conclusions: Patients with bvFTD and AD showed differences in aspects of the content of the written MMSE sentence item, though these differences did not aid in the diagnosis prediction.

[Polarity of the freely formulated MMST sentence and state of health of people with dementia : Results of a cross-sectional study]

BACKGROUND

The mini-mental status examination (MMSE) includes a task in which participants are asked to write a sentence of their own choice. The emotional tone of the sentence may be related to the emotions of the writer; therefore, it was investigated whether the emotional tone of the sentence in the MMSE written by people with dementia was associated with health-related quality of life and depressive symptoms.

MATERIAL AND METHODS

A secondary analysis was carried out based on the cross-sectional data of 107 people with dementia included in the "7th framework EU project RightTimePlaceCare". Two raters assessed the emotional tone of the sentence based on a standardized procedure as positive, neutral or negative. The association between the emotional tone of the sentence, health-related quality of life and depressive symptoms was investigated. Health-related quality of life was assessed by the quality of life in Alzheimer's disease questionnaire and depressive symptoms by the Cornell scale for depression in dementia questionnaire.

RESULTS

The sentences were rated as either positive or neutral in both cases with 42 % and 16 % were judged to have a negative emotional tone. The variance analysis by ANOVA indicated significant differences between the three groups of sentences regarding health-related quality of life of the writer (p = 0.04). The results of the Scheffé test confirmed a significant difference between sentences with a positive and negative tone and the health-related quality of life where people who wrote a sentence with a negative tone showed a lower health-related quality of life (p = 0.043). No significant association was revealed regarding depressive symptoms (p = 0.97).

CONCLUSION

It remains to be investigated in future studies whether the emotional tone is a reliable indicator of health-related quality of life and depressive symptoms of people with dementia, so that the written MMSE sentence can be used for diagnostic purposes.

Loneliness is associated with an increased risk of sedentary life in older Israelis

OBJECTIVES

Both loneliness and insufficient physical activity are common in old age. This study investigated the association between loneliness and adherence to recommended guidelines of physical activity in a national sample of Israelis, and examined whether loneliness was a risk factor for insufficient physical activity independent of other variables.

METHODS

A random sample of 1663 (799 men) older adults aged 65+ reported their physical activity routine, and based on official guidelines were categorized as sufficiently active, insufficiently active, and inactive. In addition, they were divided into lonely or not lonely based on a single question from the Center for Epidemiologic Studies Depression Scale.

RESULTS

Chi-square analyses indicated that loneliness, but not living alone, were inversely related to level of physical activity in both genders. Based on multinomial stepwise logistic regressions body mass index, being religious versus secular, self-rated health, and education were associated with engaging in physical activity in men (Cox & Snell R(2) = 0.202). Loneliness contributed significantly to explaining the level of participation in physical activity beyond these variables in women, but not in men (Cox & Snell R(2) = 0.197).

CONCLUSIONS

Loneliness is associated with an increasing risk of inactivity in advanced age in women. Further research inquiring into whether loneliness is the cause of reduced physical activity or whether physical activity acts as a protective factor against loneliness is needed. Developing and implementing tailored intervention programs that encourage social interaction in combination with a physical activity program are recommended.