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Didcote L, Vitoratou S, Al-Chalabi A, Goldstein LH. Comparison of in-person vs. remote administration of cognitive screening tools for people with ALS. Neurol Sci 2024; 45:5309-5317. [PMID: 38951432 PMCID: PMC11470852 DOI: 10.1007/s10072-024-07661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE This study investigated whether cognitive screening tools used for people with amyotrophic lateral sclerosis (pwALS) are affected by the screen being administered face-to-face or remotely online. It also investigated whether demographic variables predicted total cognitive screen scores. METHODS The cognitive component of the Edinburgh Cognitive and Behavioural ALS Screen (ECASc), the cognitive component of the ALS Cognitive Behavioural Screen (ALS-CBSc), and the Mini Addenbrooke's Cognitive Examination (Mini-ACE) were administered to 41 pwALS and 41 controls face-to-face. Versions of the cognitive screens designed to be administered remotely were administered to 57 pwALS and 44 controls via videoconferencing methods. Backwards stepwise linear regressions were conducted to assess whether total scores on the ECASc, ALS-CBSc, and Mini-ACE scores were predicted by administration mode (face-to-face or remote) or demographic variables. RESULTS Mode of administration significantly affected scores on the ECASc and ALS-CBSc; remote administration was associated with better total scores. Administration mode did not significantly affect Mini-ACE scores. All cognitive screens were significantly affected by IQ scores; higher IQ scores predicted better screening tool scores. Only ECASc scores were significantly affected by age, with older age predicting poorer scores. Being female was associated with better Mini-ACE scores; sex did not predict ECASc and ALS-CBSc scores. CONCLUSIONS Our results suggest that videoconferencing versions of the ECASc and ALS-CBSc may function differently to the original, face-to-face versions. There are advantages to using remote versions of cognitive screening tools but clinicians and researchers who use them should consider that they may not yield equivalent scores.
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Affiliation(s)
- Lyndsay Didcote
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Silia Vitoratou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Bhargava Y, Kottapalli A, Baths V. Validation and comparison of virtual reality and 3D mobile games for cognitive assessment against ACE-III in 82 young participants. Sci Rep 2024; 14:23918. [PMID: 39397120 PMCID: PMC11471807 DOI: 10.1038/s41598-024-75065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 10/01/2024] [Indexed: 10/15/2024] Open
Abstract
Current medical and clinical ecosystem for dementia detection is inadequate for its early detection. Traditional cognitive assessments are introduced after cognitive impairment has begun to disrupt the real-world functioning of the person. Moreover, these tools are paper-pen based and fail to replicate the real-world situations wherein the person ultimately lives, acts and grows. The lack of tools for early detection of dementia, combined with absence of reliable pharmacological cure compound the problems associated with dementia diagnosis and care. Advancement of technology has facilitated early prediction of disease like cancer, diabetes, heart disease, but hardly any such translation has been observed for dementia or cognitive impairment. Given this background, we examine the potential of Virtual Reality (VR) and 3D Mobile-based goal-oriented games for cognitive assessment. We evaluate three games (2 in VR, one in mobile) among 82 young participants (aged 18-28 years) and compare and contrast the game-based results with their Addenbrooke Cognitive Examination (ACE-III) scores. Three main analysis methods are used: Correlative, Z-score and Regression analysis. Positive correlation was observed for ACE-III and game-based scores. Z-scores analysis revealed no difference between the two scores, and stronger statistical significance was found between game scores and cognitive health factors like age, smoking compared to ACE-III. Specific game performances also revealed about real-world traits of participants, like hand-use confusion and direction confusion. Results establish the plausibility of using goal-oriented games for more granular, time-based, and functional cognitive assessment.
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Affiliation(s)
- Yesoda Bhargava
- Cognitive Neuroscience Lab, Department of Biological Sciences, BITS Pilani K. K. Birla Goa Campus, Goa, 403726, India
| | - Ashwani Kottapalli
- Cognitive Neuroscience Lab, Department of Biological Sciences, BITS Pilani K. K. Birla Goa Campus, Goa, 403726, India
| | - Veeky Baths
- Cognitive Neuroscience Lab, Department of Biological Sciences, BITS Pilani K. K. Birla Goa Campus, Goa, 403726, India.
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Charoenporn V, Tungsukruthai P, Teacharushatakit P, Hanvivattanakul S, Sriyakul K, Sukprasert S, Kamalashiran C, Tungsukruthai S, Charernboon T. Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: A randomized controlled trial. Psychiatry Clin Neurosci 2024; 78:595-604. [PMID: 39072958 DOI: 10.1111/pcn.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
AIM This study evaluated the effectiveness of high-dose vitamin D supplementation in alleviating fatigue and neuropsychiatric symptoms in post-COVID syndrome. METHODS In an 8-week, double-blind, randomized, placebo-controlled trial, 80 patients with post-COVID fatigue or neuropsychiatric symptoms were enrolled. Participants were randomly assigned to receive either 60,000 IU of vitamin D weekly (n = 40) or a placebo (n = 40) for 8 weeks. Clinical outcomes were assessed using the 11-item Chalder Fatigue Scale (CFQ-11); 21-item Depression, Anxiety, and Stress Scale (DASS-21); Pittsburgh Sleep Quality Index (PSQI); Addenbrooke's Cognitive Examination III (ACE); and Trail Making Test A and B (TMT-A and TMT-B). Baseline and 8-week measurements of inflammatory markers, including interleukin 6 (IL-6) and C-reactive protein (CRP), were also collected. RESULTS Significant improvements were found in the vitamin D group for CFQ (coefficient -3.5, P = 0.024), DASS-anxiety (-2.0, P = 0.011), and ACE (2.1, P = 0.012). No significant differences were observed in PSQI, DASS-depression, TMT, IL-6, or CRP levels. The incidence of adverse events was comparable between groups, with no serious adverse events reported. CONCLUSION High-dose vitamin D supplementation may benefit patients with post-COVID syndrome by reducing fatigue, alleviating anxiety, and improving cognitive symptoms, with minimal side effects.
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Affiliation(s)
- Veevarin Charoenporn
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Department of Psychiatry, Thammasat University Hospital, Pathumthani, Thailand
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Parunkul Tungsukruthai
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Kusuma Sriyakul
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sophida Sukprasert
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chuntida Kamalashiran
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sucharat Tungsukruthai
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Thammanard Charernboon
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
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Menesgere A, Singh S, Stezin A, Sundarakumar J, Issac T. The impact of social isolation on cognitive performance and brain volumes among the urban older Indian cohort. Asian J Psychiatr 2024; 102:104258. [PMID: 39369644 DOI: 10.1016/j.ajp.2024.104258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/24/2024] [Accepted: 09/26/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Abhishek Menesgere
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Sadhana Singh
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Albert Stezin
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Jonas Sundarakumar
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Thomas Issac
- Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka 560012, India.
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Su Z, Garvert MM, Zhang L, Manohar SG, Vogel TA, Thomas L, Balsters JH, Husain M, Apps MAJ, Lockwood PL. Older adults are relatively more susceptible to impulsive social influence than young adults. COMMUNICATIONS PSYCHOLOGY 2024; 2:87. [PMID: 39313518 PMCID: PMC11420232 DOI: 10.1038/s44271-024-00134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024]
Abstract
People differ in their levels of impulsivity and patience, and these preferences are heavily influenced by others. Previous research suggests that susceptibility to social influence may vary with age, but the mechanisms and whether people are more influenced by patience or impulsivity remain unknown. Here, using a delegated inter-temporal choice task and Bayesian computational models, we tested susceptibility to social influence in young (aged 18-36, N = 76) and older (aged 60-80, N = 78) adults. Participants completed a temporal discounting task and then learnt the preferences of two other people (one more impulsive and one more patient) before making their choices again. We used the signed Kullback-Leibler divergence to quantify the magnitude and direction of social influence. We found that, compared to young adults, older adults were relatively more susceptible to impulsive social influence. Factor analyses showed that older adults with higher self-reported levels of affective empathy and emotional motivation were particularly susceptible to impulsive influence. Importantly, older and young adults showed similar learning accuracy about others' preferences, and their baseline impulsivity did not differ. Together, these findings suggest highly affectively empathetic and emotionally motivated older adults may be at higher risk for impulsive decisions, due to their susceptibility to social influence.
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Affiliation(s)
- Zhilin Su
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Mona M Garvert
- Faculty of Human Sciences, Junior professorship of Neuroscience, University of Würzburg, 97070, Würzburg, Germany
| | - Lei Zhang
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Developmental Sciences, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sanjay G Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
| | - Todd A Vogel
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Developmental Sciences, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Louisa Thomas
- Department of Psychology, Royal Holloway, University of London, Surrey, TW20 0EX, UK
| | - Joshua H Balsters
- Department of Psychology, Royal Holloway, University of London, Surrey, TW20 0EX, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
| | - Matthew A J Apps
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Developmental Sciences, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
| | - Patricia L Lockwood
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
- Centre for Developmental Sciences, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK.
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK.
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Cerajewska TL, Davies M, Allen-Birt SJ, Swirski M, Coulthard EJ, West NX. A feasibility study to recruit, retain and treat periodontitis in volunteers with mild dementia, whilst monitoring their cognition. J Dent 2024; 150:105355. [PMID: 39293537 DOI: 10.1016/j.jdent.2024.105355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVES Dementia patients are challenging to manage dentally. This study determined whether individuals with mild dementia and periodontitis, could be recruited, retained and demonstrate sustained oral health improvements over 2 years following personalised professional periodontitis treatment. The feasibility of same visit cognition measurements was assessed. METHODS A non-randomised study in individuals with mild dementia, capacity to consent, periodontitis and ≥6 teeth. Following enrolment and dental/cognitive assessments, personalised periodontal treatment, followed by 3-monthly supportive periodontal care was performed. Cognitive and periodontal assessments were undertaken at 6, 12, 24-months. Participants and project-partners fed back on homecare regimens. RESULTS 18 participants were recruited, 15 completed 12- & 8 completed 24-months, 1 participant failed to attend one appointment, and early study termination due to COVID19. From baseline to 12-months mean percentage bleeding sites, Turesky plaque score ≥2 and periodontal pockets ≥4 mm decreased significantly (34.4 vs 14.75, p < 0.01; 78.49 vs 57.5, p < 0.01; 18.38 vs 5.14, p < 0.001). Significant change from baseline was retained at 24-months for mean percentage periodontal pockets ≥4 mm (14.47 vs 4.29, p < 0.05; n = 8). Cognition declined significantly to 12-months (mean ACEIII 71.47 vs 65.40, p < 0.05), but not between 12- and 24-months (67.5 vs 65.38, n = 8). Most reported home-care regimen as easy/OK to follow. CONCLUSIONS Mild dementia participants with periodontitis can be recruited, retained in a 24-month study and periodontally treated with personalised professional and at-home care regimens. Cognitive assessments can be performed at the same treatment visit. This demonstrates sustained engagement and supports oral health compliance can be successful in challenging cohorts.
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Affiliation(s)
- Tanya L Cerajewska
- Periodontology, Clinical Trials Unit, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - Maria Davies
- Periodontology, Clinical Trials Unit, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK
| | | | - Marta Swirski
- Clinical Neurosciences, Bristol Medical School, Bristol, UK
| | | | - Nicola X West
- Periodontology, Clinical Trials Unit, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK.
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Deng F, Dounavi ME, Plini ERG, Ritchie K, Muniz-Terrera G, Hutchinson S, Malhotra P, Ritchie CW, Lawlor B, Naci L. Cardiovascular risk of dementia is associated with brain-behaviour changes in cognitively healthy, middle-aged individuals. Neurobiol Aging 2024; 144:78-92. [PMID: 39293163 DOI: 10.1016/j.neurobiolaging.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/20/2024]
Abstract
Alzheimer's Disease (AD) neuropathology start decades before clinical manifestations, but whether risk factors are associated with early cognitive and brain changes in midlife remains poorly understood. We examined whether AD risk factors were associated with cognition and functional connectivity (FC) between the Locus Coeruleus (LC) and hippocampus - two key brain structures in AD neuropathology - cross-sectionally and longitudinally in cognitively healthy midlife individuals. Neuropsychological assessments and functional Magnetic Resonance Imaging were obtained at baseline (N=210), and two-years follow-up (N=188). Associations of cognition and FC with apolipoprotein ε4 (APOE ε4) genotype, family history of dementia, and the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score were investigated. Cross-sectionally, higher CAIDE scores were associated with worse cognition. Menopausal status interacted with the CAIDE risk on cognition. Furthermore, the CAIDE score significantly moderated the relationship between cognition and LC-Hippocampus FC. Longitudinally, the LC-Hippocampus FC decreased significantly over 2 years. These results suggest that cardiovascular risk of dementia is associated with brain-behaviour changes in cognitively healthy, middle-aged individuals.
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Affiliation(s)
- Feng Deng
- School of Psychology, Shenzhen University, Shenzhen 518060, China
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - Emanuele R G Plini
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Karen Ritchie
- U1061 Neuropsychiatry, INSERM, University of Montpellier, Montpellier, France
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK; Department of Social medicine, Ohio University, USA
| | | | - Paresh Malhotra
- Department of Brain Science, Imperial College Healthcare NHS Trust, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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Rizko JM, Beishon LC, Panerai RB, Marmarelis VZ. Cognitive activity significantly affects the dynamic cerebral autoregulation, but not the dynamic vasoreactivity, in healthy adults. Front Physiol 2024; 15:1350832. [PMID: 39314625 PMCID: PMC11417032 DOI: 10.3389/fphys.2024.1350832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Neurovascular coupling (NVC) is an important mechanism for the regulation of cerebral perfusion during intensive cognitive activity. Thus, it should be examined in terms of its effects on the regulation dynamics of cerebral perfusion and its possible alterations during cognitive impairment. The dynamic dependence of continuous changes in cerebral blood velocity (CBv), which can be measured noninvasively using transcranial Doppler upon fluctuations in arterial blood pressure (ABP) and CO2 tension, using end-tidal CO2 (EtCO2) as a proxy, can be quantified via data-based dynamic modeling to yield insights into two key regulatory mechanisms: the dynamic cerebral autoregulation (dCA) and dynamic vasomotor reactivity (DVR), respectively. Methods Using the Laguerre Expansion Technique (LET), this study extracted such models from data in supine resting vs cognitively active conditions (during attention, fluency, and memory tasks from the Addenbrooke's Cognitive Examination III, ACE-III) to elucidate possible changes in dCA and DVR due to cognitive stimulation of NVC. Healthy volunteers (n = 39) were recruited at the University of Leicester and continuous measurements of CBv, ABP, and EtCO2 were recorded. Results Modeling analysis of the dynamic ABP-to-CBv and CO2-to-CBv relationships showed significant changes in dCA, but not DVR, under cognitively active conditions compared to resting state. Discussion Interpretation of these changes through Principal Dynamic Mode (PDM) analysis is discussed in terms of possible associations between stronger NVC stimulation during cognitive tasks and enhanced sympathetic activation.
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Affiliation(s)
- Jasmin M. Rizko
- A. E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Lucy C. Beishon
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Biomedical Research Centre, National Institute for Health Research, Leicester, United Kingdom
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Biomedical Research Centre, National Institute for Health Research, Leicester, United Kingdom
| | - Vasilis Z. Marmarelis
- A. E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
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Say MJ, O'Driscoll C. Inter-rater variability in scoring of Addenbrooke's Cognitive Examination-Third Edition (ACE-III) protocols. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:874-878. [PMID: 35705310 DOI: 10.1080/23279095.2022.2083964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite its wide use in dementia diagnosis on the basis of cut-off points, the inter-rater variability of the Addenbrooke's Cognitive Examination-Third Edition (ACE-III) has been poorly studied. METHODS Thirty-one healthcare professionals from an older adults' mental health team scored two ACE-III protocols based on mock patients in a computerised form. Scoring accuracy, as well as total and domain-specific scoring variability, were calculated; factors relevant to participants were obtained, including their level of experience and self-rated confidence administering the ACE-III. RESULTS There was considerable inter-rater variability (up to 18 points for one of the cases), and one case's mean score was significantly higher (by nearly four points) than the true score. The Fluency, Visuospatial and Attention domains had greater levels of variability than Language and Memory. Higher scoring accuracy was not associated with either greater levels of experience or higher self-confidence in administering the ACE-III. CONCLUSIONS The results suggest that the ACE-III is susceptible to scoring error and considerable inter-rater variability, which highlights the critical importance of initial, and continued, administration and scoring training.
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Affiliation(s)
- Miranda J Say
- Barts Health NHS Trust, London, UK
- Psychology Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Ciarán O'Driscoll
- Research Department of Clinical, Educational, and Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK
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Ball JD, Davies A, Gurung D, Mankoo A, Panerai R, Minhas JS, Robinson T, Beishon L. The effect of posture on the age dependence of neurovascular coupling. Physiol Rep 2024; 12:e70031. [PMID: 39218618 PMCID: PMC11366444 DOI: 10.14814/phy2.70031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Previous studies report contradicting age-related neurovascular coupling (NVC). Few studies assess postural effects, but less investigate relationships between age and NVC within different postures. Therefore, this study investigated the effect of age on NVC in different postures with varying cognitive stimuli. Beat-to-beat blood pressure, heart rate and end-tidal carbon dioxide were assessed alongside middle and posterior cerebral artery velocities (MCAv and PCAv, respectively) using transcranial Doppler ultrasonography in 78 participants (31 young-, 23 middle- and 24 older-aged) with visuospatial (VST) and attention tasks (AT) in various postures at two timepoints (T2 and T3). Between-group significance testing utilized one-way analysis-of-variance (ANOVA) (Tukey post-hoc). Mixed three-way/one-way ANOVAs explored task, posture, and age interactions. Significant effects of posture on NVC were driven by a 3.8% increase from seated to supine. For AT, mean supine %MCAv increase was greatest in younger (5.44%) versus middle (0.12%) and older-age (0.09%) at T3 (p = 0.005). For VST, mean supine %PCAv increase was greatest at T2 and T3 in middle (10.99%/10.12%) and older-age (17.36%/17.26%) versus younger (9.44%/8.89%) (p = 0.004/p = 0.002). We identified significant age-related NVC effects with VST-induced hyperactivation. This may reflect age-related compensatory processes in supine. Further work is required, using complex stimuli while standing/walking, examining NVC, aging and falls.
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Affiliation(s)
- James D. Ball
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Aaron Davies
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Dewakar Gurung
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Alex Mankoo
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Ronney Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research CentreGlenfield HospitalLeicesterUK
| | - Jatinder S. Minhas
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research CentreGlenfield HospitalLeicesterUK
| | - Thompson Robinson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research CentreGlenfield HospitalLeicesterUK
| | - Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
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Rojas-Pescio H, Beishon L, Panerai R, Chacón M. Statistical Complexity Analysis of Neurovascular Coupling with Cognitive Stimulation in Healthy Participants. J Cogn Neurosci 2024; 36:1995-2010. [PMID: 38820561 DOI: 10.1162/jocn_a_02200] [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] [Indexed: 06/02/2024]
Abstract
Neurovascular coupling (NVC) is the tight relationship between changes in cerebral blood flow and neural activation. NVC can be evaluated non-invasively using transcranial Doppler ultrasound (TCD)-measured changes in brain activation (cerebral blood velocity [CBv]) using different cognitive tasks and stimuli. This study used a novel approach to analyzing CBv changes occurring in response to 20 tasks from the Addenbrooke's Cognitive Examination III in 40 healthy individuals. The novel approach compared various information entropy families (permutation, Tsallis, and Rényi entropy) and statistical complexity measures based on disequilibrium. Using this approach, we found the majority of the attention, visuospatial, and memory tasks from the Addenbrooke's Cognitive Examination III that showed lower statistical complexity values when compared with the resting state. On the entropy-complexity (HC) plane, a receiver operating characteristic curve was used to distinguish between baseline and cognitive tasks using the area under the curve. Best area under the curve values were 0.91 ± 0.04, p = .001, to distinguish between resting and cognitively active states. Our findings show that brain hemodynamic signals captured with TCD can be used to distinguish between resting state (baseline) and cognitive effort (stimulation paradigms) using entropy and statistical complexity as an alternative method to traditional techniques such as coherent averaging of CBv signals. Further work should directly compare these analysis methods to identify the optimal method for analyzing TCD-measured changes in NVC.
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Chander RJ, Numbers K, Grainger SA, Cleary R, Mather KA, Kochan NA, Brodaty H, Henry JD, Sachdev PS. Differential Social Cognitive Performance in Older Adults With Mild Cognitive Impairment and Dementia. Am J Geriatr Psychiatry 2024:S1064-7481(24)00435-4. [PMID: 39266407 DOI: 10.1016/j.jagp.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/30/2024] [Accepted: 08/15/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE To study general and subdomain performance in measures of social cognition in individuals with mild cognitive impairment (MCI), and dementia, and to explore associations between social cognitive and neuropsychological subdomains. DESIGN Cross-sectional study of participants from the Sydney Memory and Ageing Study (MAS). SETTING Current data was collected in 2016-2018. PARTICIPANTS Community-dwelling older adults (n=321) aged 80 years and above, with no history of neurological or psychiatric conditions. Participants had dementia, MCI, or no cognitive impairment (NCI). MEASURES Social cognition was indexed using the Reading the Mind in the Eyes Test (RMET), the Interpersonal Reactivity Index - Perspective Taking (IRI-PT) and Empathic Concern (IRI-EC) subscales, and the Emotion Recognition Task (ERT). These subdomain scores were used to make a composite social cognition score. Apathy was measured via the Apathy Evaluation Scale (AES). Neurocognitive function was indexed using the Addenbrooke Cognitive Examination v3 (ACE-3). RESULTS Dementia was associated with poorer overall social cognitive composite performance. MCI and dementia participants performed poorer on RMET and recognition of anger, disgust and happiness on ERT. RMET and ERT disgust remained significant after controlling for relevant covariates. Dementia participants performed poorer than MCI and NCI on the IRI-PT, IRI-EC, and AES. AES remained significant after regression. RMET was correlated with ACE-3 Fluency and/or Language in all study groups. CONCLUSIONS MCI is associated with poorer scores in specific social cognitive assessments. Dementia is somewhat associated with poorer scores in informant-rated social cognition scales, though this is no longer significant after accounting for apathy.
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Affiliation(s)
- Russell J Chander
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Katya Numbers
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah A Grainger
- School of Psychology (SAG, JDH), University of Queensland, St Lucia Queensland, Australia
| | - Rhiagh Cleary
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia; Dementia Collaborative Research Centre (HB), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Academic Department for Old Age Psychiatry (HB), Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julie D Henry
- School of Psychology (SAG, JDH), University of Queensland, St Lucia Queensland, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (RJC, KN, RC, KAM, NAK, HB, PSS), Discipline of Psychiatry & Mental Health, School of Clinical Medicine , Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia; Neuropsychiatric Institute (PSS), Prince of Wales Hospital, Randwick, New South Wales, Australia
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Andresen K, Cutting E, Apostolopoulos D, Evans AH, Oakley L, Dayimu A, Demiris N, Bongaerts K, Staples R, Gooding W, Rubinsztein D, Barker RA. Trial to assess the tolerability of using felodipine to upregulate autophagy as a treatment of Huntington's disease (FELL-HD): a phase II, single-centre, open-label, dose-finding trial protocol. BMJ Open 2024; 14:e087983. [PMID: 39174070 PMCID: PMC11340714 DOI: 10.1136/bmjopen-2024-087983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder that presents with a progressive movement disorder along with cognitive and psychiatric problems. It is caused by a Cytosine-adenin-guanine (CAG) expansion in exon 1 of the huntingtin gene which codes for mutant huntingtin (mHTT) that over time accumulates in cells, causing dysfunction and then death through new toxic gain-of-function mechanisms. Autophagy has been shown to be critical for the degradation of diverse intracytoplasmic aggregate-prone proteins that cause neurodegenerative disease, including mHTT. From a screen of a library enriched in approved drugs, felodipine was selected as the most suitable candidate showing strong autophagy-inducing effects in preclinical models of HD. We are, therefore, conducting a trial to assess the safety and tolerability of felodipine in people with early HD. METHODS AND ANALYSIS FELL-HD is a phase II, single-centre, open-label, dose-finding trial in people with early HD. 18 participants with early clinical features of the disease will be treated with felodipine for 58 weeks, with a further 4-week follow-up. The primary outcome measure is the number of adverse events attributable to felodipine. Exploratory outcomes include additional measures of motor and cognitive function, non-motor symptoms and quality of life scales, as well as peripheral and central disease biomarkers assessed through brain MRI. Analysis of blood and cerebrospinal fluid will also be performed through an associated sample study, FELL HD-s. ETHICS AND DISSEMINATION The study was approved by the London-Brent Research Ethics Committee (reference 22/LO/0387) and has been accepted by the Medicines and Healthcare products Regulatory Agency for clinical trials authorisation (reference CTA 12854/0256/001-0001). A lay summary of the results of the trial will be uploaded to our research group website which is publicly accessible. A webinar or in-person open day, to present results of the trial to participants and our wider cohort of patients who attend our centre, will be held once the trial is completed. The results of the trial will also be published in scientific journals and presented at national and international conferences. TRIAL REGISTRATION NUMBERS EudraCT-2021-000897-27, ISRCTN56240656.
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Affiliation(s)
- Katie Andresen
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Emma Cutting
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | | | - Amy H Evans
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Laura Oakley
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | | | | | - Katherine Bongaerts
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Robyn Staples
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Wendy Gooding
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Bundil I, Baltruschat S, Zhang J. Characterising and differentiating cognitive and motor speed in older adults: structural equation modelling on a UK longitudinal birth cohort. BMJ Open 2024; 14:e083968. [PMID: 39160108 PMCID: PMC11337668 DOI: 10.1136/bmjopen-2024-083968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Information processing speed (IPS) has been proposed to be a key component in healthy ageing and cognitive functioning. Yet, current studies lack a consistent definition and specific influential characteristics. This study aimed to investigate IPS as a multifaceted concept by differentiating cognitive and motor IPS. DESIGN, SETTING AND PARTICIPANTS A retrospective data analysis using data from the Medical Research Council National Survey of Health and Development (a population-based cohort of UK adults born in 1946) at childhood (ages 8, 11 and 15) and adulthood (ages 60-64 and 68-70). Using structural equation modelling, we constructed two models of IPS with 2124 and 1776 participants, respectively. OUTCOME MEASURES Measures of interest included IPS (ie, letter cancellation, simple and choice reaction time), intelligence (ie, childhood intelligence and National Adult Reading Test), verbal memory, socioeconomic status (SES) and cognitive functions measured by the Addenbrooke's Cognitive Examination III, as well as a variety of health indexes. RESULTS We found distinct predictors for cognitive and motor IPS and how they relate to other cognitive functions in old age. In our first model, SES and antipsychotic medication usage emerged as significant predictors for cognitive IPS, intelligence and smoking as predictors for motor IPS while both share sex, memory and antiepileptic medication usage as common predictors. Notably, all differences between both IPS types ran in the same direction except for sex differences, with women performing better than men in cognitive IPS and vice versa in motor IPS. The second model showed that both IPS measures, as well as intelligence, memory, antipsychotic and sedative medication usage, explain cognitive functions later in life. CONCLUSION Taken together, these results shed further light on IPS as a whole by showing there are distinct types and that these measures directly relate to other cognitive functions.
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Affiliation(s)
- Indra Bundil
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Jiaxiang Zhang
- School of Psychology, Cardiff University, Cardiff, UK
- Department of Computer Science, Swansea University, Swansea, UK
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Foxe D, Ainkaran G, Carrick J, Cheung SC, Ahmed RM, Narasimhan M, Burrell JR, Hwang YT, Irish M, Piguet O. Everyday Memory Disturbance in Primary Progressive Aphasia. Eur Neurol 2024; 87:177-187. [PMID: 39154633 DOI: 10.1159/000540340] [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] [Received: 03/01/2024] [Accepted: 07/05/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Mounting evidence indicates distinct memory profiles among the primary progressive aphasia (PPA) variants. Neuropsychological tests reveal disproportionate memory impairments in the logopenic variant PPA (lv-PPA) relative to the non-fluent variant PPA (nfv-PPA) and semantic variant PPA (sv-PPA). The real-world experience of day-to-day memory disturbances in PPA, however, remains poorly understood. METHODS Everyday expressions of memory in 26 lv-PPA, 24 nfv-PPA, and 40 sv-PPA patients, and 70 healthy controls were examined using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Kruskal-Wallis tests compared CBI-R Memory items (1-8) across groups. Receiver operating characteristic curves evaluated the most discriminative items to distinguish lv-PPA from nfv-PPA. RESULTS Compared to controls, lv-PPA and sv-PPA patients were reported to experience more day-to-day memory issues (item 1), increased repetition of questions (2), forgetting the names of familiar people and objects (4, 5), and poor concentration (6). lv-PPA patients were also reported to exhibit more occurrences of losing or misplacing items (3) and forgetting the day (7). All PPA groups experienced more confusion in unfamiliar environments (8) than controls. Direct comparisons among PPA groups revealed distinct profiles, with lv-PPA and sv-PPA patients exhibiting more frequent forgetting of names and objects (3, 4) than nfv-PPA, and sv-PPA demonstrating greater day-to-day memory impairment (1), repeated questions (2), and poor concentration (6) compared to nfv-PPA. Forgetting the names of familiar objects (5) was the most sensitive and specific item to distinguish lv-PPA from nfv-PPA. CONCLUSIONS Our findings demonstrate distinct day-to-day memory profiles in PPA. Future research should explore the influence of language impairments on these profiles.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Gyan Ainkaran
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - James Carrick
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sau Chi Cheung
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Neuropsychology Unit, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Manisha Narasimhan
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Yun Tae Hwang
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Gosford Hospital, Gosford, New South Wales, Australia
- Central Coast Clinical School, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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16
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Valles-Salgado M, Matias-Guiu JA, Delgado-Álvarez A, Delgado-Alonso C, Gil-Moreno MJ, Valiente-Gordillo E, López-Carbonero JI, Fernández-Romero L, Peña-DeDiego L, Oliver-Mas S, Matías-Guiu J, Diez-Cirarda M. Comparison of the Diagnostic Accuracy of Five Cognitive Screening Tests for Diagnosing Mild Cognitive Impairment in Patients Consulting for Memory Loss. J Clin Med 2024; 13:4695. [PMID: 39200837 PMCID: PMC11354893 DOI: 10.3390/jcm13164695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: We aimed to evaluate and compare the diagnostic capacity of five cognitive screening tests for the diagnosis of mild cognitive impairment (MCI) in patients consulting by memory loss. Methods: A cross-sectional study involving 140 participants with a mean age of 74.42 ± 7.60 years, 87 (62.14%) women. Patients were classified as MCI or cognitively unimpaired according to a comprehensive neuropsychological battery. The diagnostic properties of the following screening tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III) and Mini-Addenbrooke (M-ACE), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS). Results: The area under the curve (AUC) was 0.861 for the ACE-III, 0.867 for M-ACE, 0.791 for MoCA, 0.795 for MMSE, 0.731 for RUDAS, and 0.672 for MIS. For the memory components, the AUC was 0.869 for ACE-III, 0.717 for MMSE, 0.755 for MoCA, and 0.720 for RUDAS. Cronbach's alpha was 0.827 for ACE-III, 0.505 for MMSE, 0.896 for MoCA, and 0.721 for RUDAS. Correlations with Free and Cued Selective Reminding Test were moderate with M-ACE, ACE-III, and MoCA, and moderate for the other tests. The M-ACE showed the best balance between diagnostic capacity and time of administration. Conclusions: ACE-III and its brief version M-ACE showed better diagnostic properties for the diagnosis of MCI than the other screening tests. MoCA and MMSE showed adequate properties, while the diagnostic capacity of MIS and RUDAS was limited.
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Affiliation(s)
- María Valles-Salgado
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Jordi A. Matias-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Alfonso Delgado-Álvarez
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
- Department of Psychobiology & Behavioral Sciences Methods, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - María José Gil-Moreno
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Esther Valiente-Gordillo
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Juan Ignacio López-Carbonero
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Lucía Fernández-Romero
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Lidia Peña-DeDiego
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Silvia Oliver-Mas
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Jorge Matías-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Maria Diez-Cirarda
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
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Sabatini S, Martyr A, Gamble LD, Matthews FE, Thom JM, Henderson C, Allan L, Pentecost C, Quinn C, Hunt A, Clare L. Identifying predictors of transition to a care home for people with dementia: findings from the IDEAL programme. Aging Ment Health 2024:1-9. [PMID: 39113585 DOI: 10.1080/13607863.2024.2383367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/10/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVES This study investigates factors associated with the person with dementia and the caregiver to identify those associated with an increased risk of transition to a care home. METHOD IDEAL data were collected at baseline and at 12- and 24-month follow-up for 1545 people with dementia and 1305 caregivers. Modified Poisson regressions with an offset for 'person years at risk' were used. Person with dementia factors explored were personal characteristics, cognition, health, self- and informant-rated functional ability, and neuropsychiatric symptoms. Caregiver factors explored were personal characteristics, stress, health, and quality of the dyadic relationship. RESULTS A 5% people moved into care. Risk of moving into a care home was higher among people with dementia who were ≥80 years, among people with Parkinson's disease dementia or dementia with Lewy bodies, and among those without a spousal caregiver. Poorer cognition and more self-rated or informant-rated functional difficulties increased the risk of moving into care. CONCLUSION Factors related to increased dementia severity and greater disability are the primary influences that place people with dementia at greater risk of moving into a care home. Strategies that help to maintain everyday functional ability for people with dementia could help delay people with dementia moving into care.
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Affiliation(s)
- Serena Sabatini
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, United Kingdom
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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Shaw SR, Horne KS, Piguet O, Ahmed RM, Whitton AE, Irish M. Profiles of motivational impairment and their relationship to functional decline in frontotemporal dementia. J Neurol 2024; 271:4963-4971. [PMID: 38758282 PMCID: PMC11319612 DOI: 10.1007/s00415-024-12430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Motivational disturbances are pervasive in frontotemporal dementia (FTD) and impact negatively on everyday functioning. Despite mounting evidence of anhedonia in FTD, it remains unclear how such changes fit within the broader motivational symptom profile of FTD, or how anhedonia relates to functional outcomes. Here we sought to comprehensively characterize motivational disturbances in FTD and their respective relationships with functional impairment. A cross-sectional study design was used including 211 participants-68 behavioral-variant FTD (bvFTD), 32 semantic dementia (SD), 43 Alzheimer's disease (AD), and 68 healthy older control participants. Anhedonia severity was measured using the Snaith-Hamilton Pleasure Scale while severity of apathy was assessed across Emotional, Executive, and Initiation dimensions using the Dimensional Apathy Scale. Functional impairment was established using the FTD Functional Rating Scale (FRS). Distinct motivational profiles emerged in each dementia syndrome: a domain-general motivational impairment in bvFTD; a predominantly anhedonic profile in SD; and more pronounced initiation and executive apathy in AD. Correlation analyses revealed differential associations between motivational symptoms and severity of functional impairment in each group. Executive apathy was associated with functional impairment in bvFTD, while anhedonia was strongly correlated with functional decline in SD. Finally, executive and emotional apathy were associated with functional decline in AD. Our study indicates distinct profiles of apathy and anhedonia in FTD syndromes, which in turn are differentially associated with functional decline. This detailed characterization of motivational phenotypes can inform patient stratification for targeted interventions to improve functional outcomes.
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Affiliation(s)
- Siobhán R Shaw
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Kristina S Horne
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Muireann Irish
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.
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Didcote L, Vitoratou S, Al-Chalabi A, Goldstein LH. What is the extent of reliability and validity evidence for screening tools for cognitive and behavioral change in people with ALS? A systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:437-451. [PMID: 38415696 PMCID: PMC10972547 DOI: 10.1080/21678421.2024.2314063] [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] [Received: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This systematic review provides an updated summary of the existing literature on the validity of screening tools for cognitive and behavioral impairment in people with Amyotrophic Lateral Sclerosis (pwALS), and also focuses on their reliability. METHOD The following cognitive and behavioral screening tools were assessed in this review: the Edinburgh Cognitive and Behavioral ALS Screen (ECAS); the ALS Cognitive Behavioral Screen (ALS-CBS), the Mini Addenbrooke's Cognitive Examination (Mini-ACE), the Beaumont Behavioral Interview (BBI); the MND Behavior Scale (MiND-B); and the ALS-FTD Questionnaire (ALS-FTD-Q). A search, using Medline, PsychINFO and Embase (21/09/2023), generated 37 results after exclusion criteria were applied. Evidence of internal consistency, item-total correlations, inter-rater reliability, clinical validity, convergent validity, and structural validity were extracted and assessed and risk of bias was evaluated. RESULTS The cognitive component of the ECAS was the tool with most evidence of reliability and validity for the assessment of cognitive impairment in ALS. It is well-suited to accommodate physical symptoms of ALS. For behavioral assessment, the BBI or ALS-FTD-Q had the most evidence of reliability and validity. The BBI is more thorough, but the ALS-FTD-Q is briefer. CONCLUSIONS There is good but limited evidence for the reliability and validity of cognitive and behavioral screens. Further evidence of clinical and convergent validity would increase confidence in their clinical and research use.
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Affiliation(s)
- Lyndsay Didcote
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Silia Vitoratou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London, UK, and
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Laura H. Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Foxe D, Irish M, Carrick J, Cheung SC, Teng H, Burrell JR, Kessels RPC, Piguet O. Visuospatial working memory in behavioural variant frontotemporal dementia: a comparative analysis with Alzheimer's disease using the box task. J Neurol 2024; 271:4852-4863. [PMID: 38713393 PMCID: PMC11319587 DOI: 10.1007/s00415-024-12406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study investigated the visuospatial working memory profiles of behavioural variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) using a novel computerised test of visuospatial working memory: the Box Task. METHODS Twenty-eight bvFTD and 28 AD patients, as well as 32 age-matched control participants were recruited. All participants completed the Box Task and conventional neuropsychological tests of working memory, episodic memory, and visuospatial function. RESULTS Both the bvFTD and AD groups exhibited significantly more Box Task between-search errors than the control group across all set sizes. Notably, the AD group demonstrated a significantly higher error rate compared to the bvFTD group. Regression analysis revealed that whilst episodic memory impairment significantly predicted Box Task error performance in AD, this was not the case for bvFTD. Additionally, a noticeable trend was observed for attention in predicting Box Task errors in both bvFTD and AD groups. The Box Task demonstrated high utility in differentiating between bvFTD and AD, with a decision tree correctly classifying 82.1% of bvFTD patients and 75% of AD patients. CONCLUSIONS Our findings reveal significant visuospatial working memory impairments in bvFTD, albeit of lesser severity compared to disease-matched AD patients. The Box Task, a novel measure of visuospatial working memory, proved effective in differentiating between bvFTD and AD, outperforming many traditional neuropsychological measures. Overall, our findings highlight the utility of assessing visuospatial memory when differentiating between bvFTD and AD in the clinical setting.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, Australia.
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia.
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - James Carrick
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - Sau Chi Cheung
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
- Neuropsychology Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Her Teng
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
- Concord Medical School, The University of Sydney, Sydney, Australia
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Sydney, NSW, 2006, Australia
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Connors MH, Gibbs J, Large MM, Halligan PW. Delusions in postpartum psychosis: Implications for cognitive theories. Cortex 2024; 177:194-208. [PMID: 38875734 DOI: 10.1016/j.cortex.2024.04.018] [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] [Received: 12/16/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 06/16/2024]
Abstract
Postpartum psychosis is a rare but serious condition that can affect women after childbirth. We present a case study of an individual with no comorbidities or psychiatric history who developed postpartum psychosis characterised by prominent misidentification delusions whilst admitted to hospital. The woman recovered quickly with medication and showed no evidence of relapse over the following three years. Whilst still symptomatic and after recovery, the patient was able to provide a detailed description of her experiences. Contemporaneous interviews and observations during her hospital admission and a subsequent detailed retrospective account provide a unique, comprehensive window into her experience of these time-limited delusions. Her case reveals important insights including the triggers for her misidentification delusions, the role of social and contextual influences on delusional beliefs, and her recall of active involvement in evaluating and discarding delusional hypotheses. These insights highlight the complexity of delusional beliefs, challenge existing theories of delusions, and help inform broader theories of belief formation.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia; Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Jessica Gibbs
- Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matthew M Large
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Peter W Halligan
- School of Psychology, Cardiff University, Cardiff, Wales, United Kingdom
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Okada-Oliveira M, Carthery-Goulart MT, César-Freitas KG, Nitrini R, Brucki SMD. Development of the Brazilian version of the Mini-Addenbrooke Cognitive Examination (M-ACE BR) to screen for cognitive impairment in older adults. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 39117348 DOI: 10.1055/s-0044-1788585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
BACKGROUND Age is the most important risk factor for develop dementia, and the recommendation is that older adults are cognitively tested to detect impairment in the initial stage for adequate treatment. The demand for the care of these older adults is great, drawing attention to the need for rapid tests, with good accuracy and simple application to identify cognitive impairment. OBJECTIVE To develop and validate the Brazilian Mini-Addenbrooke Cognitive Examination (M-ACE BR) as a short screening test for cognitive impairment in older adults. METHODS The M-ACE BR was developed using the Mokken scaling analysis in 352 participants (cognitively unimpaired [CU] = 232, cognitive impairment no dementia [CIND] = 82; and dementia = 38) and validated in an independent sample of 117 participants (CU = 25; CIND = 88; and dementia = 4). RESULTS The Mokken scaling analysis derived 9 items (spatial orientation, anterograde memory, retrograde memory, delayed recall, recognition [name and address], letter verbal fluency, repetition of 4 words, naming of 10 items, and comprehension) with a maximum score of 51 points and an average duration time of 7 minutes. The cut-off score ≤ 43/51 for CIND had a sensitivity of 59.09% and a specificity of 80%. For a screening test in which sensitivity is prioritized for further investigation, we suggest using a cutoff of ≤ 47 (sensitivity 85.23% and specificity 24%), maintaining a good positive predictive value (79.8%). CONCLUSION The M-ACE BR is a brief and adequate instrument to detect cognitive impairment in older Brazilian adults. However, screening for CIND and for different educational levels should be further explored.
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Affiliation(s)
- Maira Okada-Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Maria Teresa Carthery-Goulart
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
- Universidade Federal do ABC, Centro de Matemática, Computação e Cognição, Santo André SP, Brazil
| | | | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brazil
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Mensegere A, Singh S, Stezin A, Sundarakumar JS, Issac TG. Effect of early menopause on cognition and brain morphology in an Urban Indian Cohort. Alzheimers Dement 2024; 20:5607-5616. [PMID: 38946683 PMCID: PMC11350013 DOI: 10.1002/alz.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Evidence for the effect of early menopause on cognition among older women is not consistent and is scant among the Indian population. METHODS We aimed to examine the effect of early menopause (≤45 years) on cognitive performance and brain morphology among older dementia-free females of the TLSA cohort using a multiple linear regression analysis. RESULTS In a sample of 528 women, 144 (27%) had early menopause. The linear regression analysis showed that women with early menopause performed poorly in cognition and had lesser total gray matter volume [β = -11973.94, p = 0.033], left middle frontal [β = -353.14, p = 0.033], and left superior frontal [β = -460.97, p < 0.026] volume. CONCLUSION Dementia-free women with early menopause had poorer cognition, lower total gray matter, and frontal lobe. More research is needed to explore the link between earlier menopause and cognitive decline and develop ways to address it. HIGHLIGHTS Evidence on the effect of early menopause on brain morphology is inconsistent and scant in low and middle-income countries, such as India. In a cohort of dementia-free individuals in urban Bangalore, we observed that participants with early menopause had significantly lower cognitive performance and lower total gray matter and frontal lobe volume. We recommend increasing awareness of this fact among the medical community and the general public. There is an urgent need to explore the underlying biological mechanism and to discover effective interventions to mitigate the effect.
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Affiliation(s)
| | - Sadhana Singh
- Centre for Brain ResearchIIScBangaloreKarnatakaIndia
| | - Albert Stezin
- Centre for Brain ResearchIIScBangaloreKarnatakaIndia
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24
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Porrselvi AP, Gopalan R, C R S. Role of Tamil diglossia in the language preference for cognitive test administration. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-6. [PMID: 39036989 DOI: 10.1080/23279095.2024.2380481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- A P Porrselvi
- Neuropsychology, Unified Brain Health Care, Chennai, Tamil Nadu, India
| | | | - Sneha C R
- Neuropsychology, Unified Brain Health Care, Chennai, Tamil Nadu, India
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Dreo J, Jug J, Pavlovčič T, Ogrin A, Demšar A, Aljaž B, Agatić F, Marusic U. Comparative Performance of Five Cognitive Screening Tests in a Large Sample of Seniors. Dement Geriatr Cogn Disord 2024:1-10. [PMID: 39008953 DOI: 10.1159/000540225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Recent introductions of disease-modifying treatments for Alzheimer's disease have re-invigorated the cause of early dementia detection. Cognitive "paper and pencil" tests represent the bedrock of clinical assessment, because they are cheap, easy to perform, and do not require brain imaging or biological testing. Cognitive tests vary greatly in duration, complexity, sociolinguistic biases, probed cognitive domains, and their specificity and sensitivity of detecting cognitive impairment (CI). Consequently, an ecologically valid head-to-head comparison seems essential for evidence-based dementia screening. METHOD We compared five tests: Montreal cognitive assessment (MoCA), Alzheimer's disease assessment scale-cognitive subscale (ADAS), Addenbrooke's cognitive examination (ACE-III), euro-coin handling test (Eurotest), and image identification test (Phototest) on a large sample of seniors (N = 456, 77.9 ± 8 years, 71% females). Their specificity and sensitivity were estimated in a novel way by contrasting each test's outcome to the majority outcome across the remaining tests (comparative specificity and sensitivity calculation [CSSC]). This obviates the need for an a priori gold standard such as a clinically clear-cut sample of dementia/MCI/controls. We posit that the CSSC results in a more ecologically valid estimation of clinical performance while precluding biases resulting from different dementia/MCI diagnostic criteria and the proficiency in detecting these conditions. RESULTS There exists a stark trade-off between behavioral test specificity and sensitivity. The test with the highest specificity had the lowest sensitivity, and vice versa. The comparative specificities and sensitivities were, respectively: Phototest (97%, 47%), Eurotest (94%, 55%), ADAS (90%, 68%), ACE-III (72%, 77%), MoCA (55%, 95%). CONCLUSION Assuming a CI prevalence of 10%, the shortest (∼3 min) and the simplest instrument, the Phototest, was shown to have the best overall performance (accuracy 92%, PPV 66%, NPV 94%).
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Affiliation(s)
| | - Jan Jug
- BrainTrip, Ljubljana, Slovenia
| | | | | | | | - Barbara Aljaž
- BrainTrip, Ljubljana, Slovenia
- Faculty of Computer Science, University of Ljubljana, Ljubljana, Slovenia
| | | | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea University, Maribor, Slovenia
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Liu Q, Zhang Y. A Comparative Study on Cognitive Assessment in Cerebellar and Supratentorial Stroke. Brain Sci 2024; 14:676. [PMID: 39061417 PMCID: PMC11274804 DOI: 10.3390/brainsci14070676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
This study aims to understand the cognitive profiles of cerebellar infarction patients and compare them to those with supratentorial infarctions, particularly frontal infarctions. This current study also aims to find reliable assessment tools for detecting cognitive impairment in cerebellar infarction patients. A total of fifty cerebellar infarction patients, sixty supratentorial infarction patients, and thirty-nine healthy controls were recruited. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Addenbrooke's Cognitive Examination III (ACE-III), and Cerebellar Cognitive Affective Syndrome scale (CCAS-s) were used to assess global cognitive function. An extensive neuropsychological assessment battery was also tested to evaluate the characteristics of each cognitive domain. To assess the features of cognitive function, a comprehensive neuropsychological evaluation tool was also utilized. The cerebral infarction patients demonstrated cognitive impairment comparable to those with frontal infarcts, notably characterized by disturbance in attention and executive function. However, the degree of cognitive impairment was comparatively milder in cerebellar infarction patients. Furthermore, the patients in the cerebellar group had worse scores in the ACE-III and CCAS-s compared to healthy controls. The two assessments also demonstrated a significant area under the curve values, indicating their effectiveness in distinguishing cognitive impairment in cerebellar infarctions. In conclusion, cognitive impairment in a cerebellar infarction resembles frontal lobe dysfunction but is generally mild. It can be accurately assessed using the ACE-III and CCAS-s scales.
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Affiliation(s)
- Qi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yumei Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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27
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Attaallah B, Petitet P, Zambellas R, Toniolo S, Maio MR, Ganse-Dumrath A, Irani SR, Manohar SG, Husain M. The role of the human hippocampus in decision-making under uncertainty. Nat Hum Behav 2024; 8:1366-1382. [PMID: 38684870 PMCID: PMC11272595 DOI: 10.1038/s41562-024-01855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024]
Abstract
The role of the hippocampus in decision-making is beginning to be more understood. Because of its prospective and inferential functions, we hypothesized that it might be required specifically when decisions involve the evaluation of uncertain values. A group of individuals with autoimmune limbic encephalitis-a condition known to focally affect the hippocampus-were tested on how they evaluate reward against uncertainty compared to reward against another key attribute: physical effort. Across four experiments requiring participants to make trade-offs between reward, uncertainty and effort, patients with acute limbic encephalitis demonstrated blunted sensitivity to reward and effort whenever uncertainty was considered, despite demonstrating intact uncertainty sensitivity. By contrast, the valuation of these two attributes (reward and effort) was intact on uncertainty-free tasks. Reduced sensitivity to changes in reward under uncertainty correlated with the severity of hippocampal damage. Together, these findings provide evidence for a context-sensitive role of the hippocampus in value-based decision-making, apparent specifically under conditions of uncertainty.
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Affiliation(s)
- Bahaaeddin Attaallah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Pierre Petitet
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rhea Zambellas
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sofia Toniolo
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria Raquel Maio
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Akke Ganse-Dumrath
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sanjay G Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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28
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Pinto JO, Pontes D, Dores AR, Peixoto B, Barbosa F. Activities of Daily Living Inventory (ADLI): Proposal of a new instrument and preliminary data. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-18. [PMID: 38913789 DOI: 10.1080/23279095.2024.2367741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The evaluation of Activities of Daily Living (ADL) has become a critical issue in neuropsychology, but existing instruments for evaluating ADL have some limitations. This work aims to propose a new instrument to evaluate ADL, the ADL Inventory (ADLI), for which we present preliminary data. The ADLI was developed based on a comprehensive model of the stages of test development and following a combined framework of the World Health Organization's International Classification of Functioning, Disability, and Health and the American Occupational Therapy Association models. Besides sociodemographic information, ADLI includes 144 items, organized into four sections: (a) basic ADL; (b) IADL; (c) advanced ADL; and (d) factors influencing functionality. The main characteristics of ADLI are: having self- and informant-report forms; including items focused on different sensory and neurocognitive functions; individualizing the progression along items considering the person's functionality; considering the impact of several factors on functionality; and using a large response scale. Preliminary data of predictive and convergent validity for ADLI are presented. The preliminary study comprised 15 older adults. The Addenbrooke's Cognitive Examination - III, the Barthel Index, and the Instrumental Activities of Daily Living (IADL) Scale were applied to determine the predictive and convergent validity of ADLI.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Department of Social, Behavioral Sciences of University Institute of Health Sciences- CESPU, Gandra, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
- Lusófona University, Porto, Portugal
| | - Diogo Pontes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Bruno Peixoto
- Department of Social, Behavioral Sciences of University Institute of Health Sciences- CESPU, Gandra, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Porto, Portugal
- UCIBIO - Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Stanmore E, Eost-Telling C, Meekes W, Banham K, Chillala J, Roy B, Firth J. Exergames for falls prevention in sheltered homes: a feasibility study. Front Public Health 2024; 12:1344019. [PMID: 38975352 PMCID: PMC11227257 DOI: 10.3389/fpubh.2024.1344019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Falls prevention is a global priority given its substantial impact on older adults and cost to healthcare systems. Advances in telerehabilitation technology such as `exergaming' show potential for delivering accessible, engaging exercise programs for older adults. This study aimed to establish the feasibility, acceptability and usability of exergaming in sheltered housing. Methods A mixed-methods study with participants randomised in 2 sheltered housing facilities to intervention (n = 1 home, 12 participants) and control (n = 1 home 2, 12 participants) provided usual care for all, (physiotherapy prescribed strength and balance exercises and falls prevention advice) and a 6-week supervised exergaming programme (MIRA) offered 3 times per week to the intervention group only. At 6 weeks, feasibility, usability and acceptability outcomes were collected and analysed using descriptive statistics; qualitative focus groups with participants and interviews with staff were also completed and thematically analysed to elicit barriers and facilitators to usability and acceptability. Results Mean exercise per week increased from 10.6 to 14.1 minutes in the control group and 9.6 to 36.8 minutes in the intervention group. All study processes and measures appeared feasible; 72% of those invited consented to taking part and 92% completed 6-week follow-up. Individual domains for the System Usability Scores (SUS) showed participants felt `very confident' using the system with support (70%), would `like to use exergames frequently' (50%) and found the system `easy to use' (90%). However, they also felt they `needed to learn a lot at the beginning' (40%) and would `need technical support' (70%) for independent use of the exergames. Mean overall SUS was 63 reflecting moderate usability for independent use. Qualitative data indicated exergames were well received and highlighted motivational and social aspects; costs and set up. Staff also felt exergaming complemented traditional care. Discussion Our study contributes to the evidence guiding the use of exergames to deliver suitable falls prevention interventions for older adults within sheltered housing in community settings.
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Affiliation(s)
- Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Eost-Telling
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Wytske Meekes
- Academic Collaborative Center Older Adults, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Kelly Banham
- Community Therapy, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Jay Chillala
- Acute Medicine and Elderly Care Department, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Bibhas Roy
- Trauma and Orthopaedics Department, Trafford Hospital, Moorside Road, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Joseph Firth
- Division of Psychology and Mental Health, Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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McLaren J, Fradera A, Cullen B. The reliability and validity of brief cognitive screening tools used in traumatic brain injury: A systematic review. Neuropsychol Rehabil 2024:1-26. [PMID: 38848502 DOI: 10.1080/09602011.2024.2357850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/27/2024] [Indexed: 06/09/2024]
Abstract
Reliable and valid cognitive screening tools are essential in the assessment of those with traumatic brain injury (TBI). Yet, there is no consensus about which tool should be used in clinical practice. This systematic review assessed psychometric properties of cognitive screening tools for detecting cognitive impairment in TBI. Inclusion criteria were: peer-reviewed validation studies of a cognitive screening tool(s); with a sample of adults aged 18-80 diagnosed with TBI (mild-severe); and with psychometrics consistent with COSMIN guidelines. Published literature was retrieved from MEDLINE, Web of Science Core Collection, EMBASE, CINAHL, and PsycINFO on 27 January 2022. A narrative synthesis was performed. Thirty-four studies evaluated the psychometric properties of a total of 22 cognitive screening tools, in a variety of languages. Properties assessed included structural validity, internal consistency, reliability, criterion validity (or diagnostic test accuracy), convergent/divergent validity, and discriminant validity. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were the most widely validated cognitive screening tools for use in TBI. The MoCA had the most promising evidence of its psychometric properties, which has implications for clinical practice. Future research should aim to follow standard criteria for psychometric studies to allow meaningful comparisons across the literature.
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Affiliation(s)
- Jessica McLaren
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- NHS Ayrshire and Arran, Ayr, UK
| | - Alexander Fradera
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- NHS Lanarkshire, Motherwell, UK
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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31
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Barker MS, Ceslis A, Argall R, McCombe P, Henderson RD, Robinson GA. Verbal and nonverbal fluency in amyotrophic lateral sclerosis. J Neuropsychol 2024; 18:265-285. [PMID: 37997256 DOI: 10.1111/jnp.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty-two ALS patients and 21 demographically-matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.
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Affiliation(s)
- Megan S Barker
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rosemary Argall
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Pamela McCombe
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert D Henderson
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Wesley Medical Research, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Gail A Robinson
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Powell A, Sumnall H, Kullu C, Owens L, Montgomery C. Changes in processing speed during early abstinence from alcohol dependence. J Psychopharmacol 2024; 38:551-561. [PMID: 38804547 PMCID: PMC11179317 DOI: 10.1177/02698811241254830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Processing speed is a task-independent construct underpinning more complex goal-related abilities. Processing speed is impaired in alcohol dependence (AD) and is linked to relapse, as are the functions it underpins. Reliable measurement of processing speed may allow tracking of AD recovery trajectories and identify patients requiring additional support. AIMS To assess changes in reaction time (RT) from baseline (at the start of a detoxification programme) across early abstinence. METHODS Vibrotactile RT was assessed in early recovery between days 3 and 7 of treatment in 66 individuals with AD (25 females; aged 19-74, 44.60 ± 10.60 years) and against 35 controls tested on one occasion (19 females; 41.00 ± 13.60), using two multivariate multiple regressions. A mixed multivariate analysis of covariance (MANCOVA) of available AD data (n = 45) assessed change in RT between timepoints and between treatment settings (outpatient vs inpatient). RESULTS The group (AD vs control) significantly predicted choice RT at baseline and follow-up but did not significantly predict simple RT or RT variability, which is inconsistent with previous findings. At follow-up, mental fatigue was also predicted by the group, and MANCOVA indicated that this had worsened in inpatients but improved in outpatients. CONCLUSIONS Recovery of RT measures so early in the treatment journey was not in line with previous research which indicates persisting deficits. The interaction between setting and timepoint indicates that despite being typically less medically complex, outpatients require ongoing support and monitoring during their recovery.
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Affiliation(s)
- Anna Powell
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Harry Sumnall
- Liverpool Centre for Alcohol Research, Liverpool, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Cecil Kullu
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Lynn Owens
- Liverpool Centre for Alcohol Research, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Catharine Montgomery
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Alcohol Research, Liverpool, UK
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Flavell J, Nestor PJ. A systematic review of cognitive and behavioral tools to differentiate behavioral variant frontotemporal dementia from other conditions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e210. [PMID: 38887313 PMCID: PMC11180949 DOI: 10.1002/pcn5.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
The behavioral variant of frontotemporal dementia (bvFTD) is thought to be the commonest clinical presentation of frontotemporal lobar degeneration and is predominantly characterized by changes in behavior. In patients lacking unequivocal biomarker evidence of frontotemporal neurodegeneration, the clinical diagnosis of bvFTD is often unstable. In response, we conducted a systematic review and critical appraisal of cognitive and behavioral tools that have sought to differentiate bvFTD from other conditions. A systematic literature review of PubMed, Scopus, and Web of Science was conducted on December 31, 2023 for cognitive and behavioral tools that differentiated bvFTD from other cohorts. Ninety-six studies were included. The quality appraisal of almost all studies was low and introduced a high risk of bias. The few studies that were of high quality had a prospective study design and recruited patients suspected (but not yet confirmed) to have bvFTD. These studies reported that behavioral tools (e.g., the Frontal Behavioral Inventory) and social cognition tests (e.g., the Ekman's Faces Test) had good test performance in differentiating bvFTD from a broad range of psychiatric and neurological conditions. Importantly, the review highlighted the extreme paucity of studies that have evaluated methods where, in Bayesian terms, there is genuine clinical uncertainty regarding a diagnosis of bvFTD. Most studies used healthy controls of typical Alzheimer's disease as comparators-groups that often have negligible pretest probability of bvFTD. In response, we propose a study design checklist for studies seeking to develop diagnostic algorithms in bvFTD research.
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Affiliation(s)
- Joshua Flavell
- The Queensland Brain InstituteThe University of QueenslandBrisbaneAustralia
- The Mater HospitalBrisbaneAustralia
- Metro North Hospital and Health ServiceBrisbaneAustralia
| | - Peter John Nestor
- The Queensland Brain InstituteThe University of QueenslandBrisbaneAustralia
- The Mater HospitalBrisbaneAustralia
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Laurell AAS, Venkataraman AV, Schmidt T, Montagnese M, Mueller C, Stewart R, Lewis J, Mundell C, Isaacs JD, Krishnan MS, Barber R, Rittman T, Underwood BR. Estimating demand for potential disease-modifying therapies for Alzheimer's disease in the UK. Br J Psychiatry 2024; 224:198-204. [PMID: 38235531 DOI: 10.1192/bjp.2023.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Phase three trials of the monoclonal antibodies lecanemab and donanemab, which target brain amyloid, have reported statistically significant differences in clinical end-points in early Alzheimer's disease. These drugs are already in use in some countries and are going through the regulatory approval process for use in the UK. Concerns have been raised about the ability of healthcare systems, including those in the UK, to deliver these treatments, considering the resources required for their administration and monitoring. AIMS To estimate the scale of real-world demand for monoclonal antibodies for Alzheimer's disease in the UK. METHOD We used anonymised patient record databases from two National Health Service trusts for the year 2019 to collect clinical, demographic, cognitive and neuroimaging data for these cohorts. Eligibility for treatment was assessed using the inclusion criteria from the clinical trials of donanemab and lecanemab, with consideration given to diagnosis, cognitive performance, cerebrovascular disease and willingness to receive treatment. RESULTS We examined the records of 82 386 people referred to services covering around 2.2 million people. After applying the trial criteria, we estimate that a maximum of 906 people per year would start treatment with monoclonal antibodies in the two services, equating to 30 200 people if extrapolated nationally. CONCLUSIONS Monoclonal antibody treatments for Alzheimer's disease are likely to present a significant challenge for healthcare services to deliver in terms of the neuroimaging and treatment delivery. The data provided here allows health services to understand the potential demand and plan accordingly.
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Affiliation(s)
- Axel A S Laurell
- Department of Psychiatry, University of Cambridge, UK; and Older People and Adult Community Directorate, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ashwin V Venkataraman
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Tatjana Schmidt
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Christoph Mueller
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan Lewis
- Informatics Department, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Clare Mundell
- Pharmacy Department, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jeremy D Isaacs
- Department of Neurology, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK; and Molecular and Clinical Sciences Research Institute, St George's, University of London, UK
| | - Mani S Krishnan
- Department of Old Age Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, UK; and Older People and Adult Community Directorate, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Ritchie CW, Bridgeman K, Gregory S, O’Brien JT, Danso SO, Dounavi ME, Carriere I, Driscoll D, Hillary R, Koychev I, Lawlor B, Naci L, Su L, Low A, Mak E, Malhotra P, Manson J, Marioni R, Murphy L, Ntailianis G, Stewart W, Muniz-Terrera G, Ritchie K. The PREVENT dementia programme: baseline demographic, lifestyle, imaging and cognitive data from a midlife cohort study investigating risk factors for dementia. Brain Commun 2024; 6:fcae189. [PMID: 38863576 PMCID: PMC11166176 DOI: 10.1093/braincomms/fcae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/27/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
PREVENT is a multi-centre prospective cohort study in the UK and Ireland that aims to examine midlife risk factors for dementia and identify and describe the earliest indices of disease development. The PREVENT dementia programme is one of the original epidemiological initiatives targeting midlife as a critical window for intervention in neurodegenerative conditions. This paper provides an overview of the study protocol and presents the first summary results from the initial baseline data to describe the cohort. Participants in the PREVENT cohort provide demographic data, biological samples (blood, saliva, urine and optional cerebrospinal fluid), lifestyle and psychological questionnaires, undergo a comprehensive cognitive test battery and are imaged using multi-modal 3-T MRI scanning, with both structural and functional sequences. The PREVENT cohort governance structure is described, which includes a steering committee, a scientific advisory board and core patient and public involvement groups. A number of sub-studies that supplement the main PREVENT cohort are also described. The PREVENT cohort baseline data include 700 participants recruited between 2014 and 2020 across five sites in the UK and Ireland (Cambridge, Dublin, Edinburgh, London and Oxford). At baseline, participants had a mean age of 51.2 years (range 40-59, SD ± 5.47), with the majority female (n = 433, 61.9%). There was a near equal distribution of participants with and without a parental history of dementia (51.4% versus 48.6%) and a relatively high prevalence of APOEɛ4 carriers (n = 264, 38.0%). Participants were highly educated (16.7 ± 3.44 years of education), were mainly of European Ancestry (n = 672, 95.9%) and were cognitively healthy as measured by the Addenbrookes Cognitive Examination-III (total score 95.6 ± 4.06). Mean white matter hyperintensity volume at recruitment was 2.26 ± 2.77 ml (median = 1.39 ml), with hippocampal volume being 8.15 ± 0.79 ml. There was good representation of known dementia risk factors in the cohort. The PREVENT cohort offers a novel data set to explore midlife risk factors and early signs of neurodegenerative disease. Data are available open access at no cost via the Alzheimer's Disease Data Initiative platform and Dementia Platforms UK platform pending approval of the data access request from the PREVENT steering group committee.
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Affiliation(s)
- Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Scottish Brain Sciences, Edinburgh, EH12 9DQ, UK
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Katie Bridgeman
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Scottish Brain Sciences, Edinburgh, EH12 9DQ, UK
| | - John T O’Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Samuel O Danso
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | | | | | - Robert Hillary
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Lorina Naci
- Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, D02 PX31, Ireland
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
- Department of Neuroscience, University of Sheffield, Sheffield, S10 2HQ, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Paresh Malhotra
- Imperial College London, UK Dementia Research Institute Care Research and Technology Centre, London, W12 0BZ, UK
- Brain Sciences, Imperial College London, London, W12 0NN, UK
- Clinical Neurosciences, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - Jean Manson
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
| | - Riccardo Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Lee Murphy
- Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Georgios Ntailianis
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QB, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Ohio, OH 45701, USA
| | - Karen Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
- INM, Université de Montpellier, INSERM, Montpellier, 34091, France
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Boucher E, Jell A, Singh S, Davies J, Smith T, Pill A, Varnai K, Woods K, Walliker D, McColl A, Shepperd S, Pendlebury S. Protocol for the Development and Analysis of the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Records (ORCHARD-EPR). BMJ Open 2024; 14:e085126. [PMID: 38816052 PMCID: PMC11141189 DOI: 10.1136/bmjopen-2024-085126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Hospital electronic patient records (EPRs) offer the opportunity to exploit large-scale routinely acquired data at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, than retrospective administrative data sets in which clinical complexity is often poorly captured. With population ageing, a wide range of hospital specialties now manage older people with multimorbidity, frailty and associated poor outcomes. We, therefore, set-up the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Records (ORCHARD-EPR) to facilitate clinically meaningful research in older hospital patients, including algorithm development, and to aid medical decision-making, implementation of guidelines, and inform policy. METHODS AND ANALYSIS ORCHARD-EPR uses routinely acquired individual patient data on all patients aged ≥65 years with unplanned admission or Same Day Emergency Care unit attendance at four acute general hospitals serving a population of >800 000 (Oxfordshire, UK) with planned extension to the neighbouring Berkshire regional hospitals (>1 000 000). Data fields include diagnosis, comorbidities, nursing risk assessments, frailty, observations, illness acuity, laboratory tests and brain scan images. Importantly, ORCHARD-EPR contains the results from mandatory hospital-wide cognitive screening (≥70 years) comprising the 10-point Abbreviated-Mental-Test and dementia and delirium diagnosis (Confusion Assessment Method-CAM). Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions and death. The rich multimodal data are further enhanced by linkage to secondary care electronic mental health records. Selection of appropriate subgroups or linkage to existing cohorts allows disease-specific studies. Over 200 000 patient episodes are included to date with data collection ongoing of which 129 248 are admissions with a length of stay ≥1 day in 64 641 unique patients. ETHICS AND DISSEMINATION ORCHARD-EPR is approved by the South Central Oxford C Research Ethics Committee (ref: 23/SC/0258). Results will be widely disseminated through peer-reviewed publications and presentations at conferences, and regional meetings to improve hospital data quality and clinical services.
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Affiliation(s)
- Emily Boucher
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Aimee Jell
- Informatics Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sudhir Singh
- Department of Acute General (Internal) Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Tanya Smith
- Research Informatics Team, Research and Development Department, Oxford Health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Adam Pill
- Research Informatics Team, Research and Development Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Kinga Varnai
- Research and Development Clinical Informatics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kerrie Woods
- Research and Development Clinical Informatics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Walliker
- Research and Development Clinical Informatics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Aubretia McColl
- Department of Acute Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
- Department of Elderly Care Medicine, Royal Berkshire NHS Hospital Foundation Trust, Reading, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Acute General (Internal) Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Huang M, Landin-Romero R, Matis S, Dalton MA, Piguet O. Longitudinal volumetric changes in amygdala subregions in frontotemporal dementia. J Neurol 2024; 271:2509-2520. [PMID: 38265470 PMCID: PMC11055736 DOI: 10.1007/s00415-023-12172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
Amygdala atrophy has been found in frontotemporal dementia (FTD), yet the specific changes of its subregions across different FTD phenotypes remain unclear. The aim of this study was to investigate the volumetric alterations of the amygdala subregions in FTD phenotypes and how they evolve with disease progression. Patients clinically diagnosed with behavioral variant FTD (bvFTD) (n = 20), semantic dementia (SD) (n = 20), primary nonfluent aphasia (PNFA) (n = 20), Alzheimer's disease (AD) (n = 20), and 20 matched healthy controls underwent whole brain structural MRI. The patient groups were followed up annually for up to 3.5 years. Amygdala nuclei were segmented using FreeSurfer, corrected by total intracranial volumes, and grouped into the basolateral, superficial, and centromedial subregions. Linear mixed effects models were applied to identify changes in amygdala subregional volumes over time. At baseline, bvFTD, SD, and AD displayed global amygdala volume reduction, whereas amygdala volume appeared to be preserved in PNFA. Asymmetrical amygdala atrophy (left > right) was most pronounced in SD. Longitudinally, SD and PNFA showed greater rates of annual decline in the right basolateral and superficial subregions compared to bvFTD and AD. The findings provide comprehensive insights into the differential impact of FTD pathology on amygdala subregions, revealing distinct atrophy patterns that evolve over disease progression. The characterization of amygdala subregional involvement in FTD and their potential role as biomarkers carry substantial clinical implications.
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Affiliation(s)
- Mengjie Huang
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Ramon Landin-Romero
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- School of Health Sciences, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Sophie Matis
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- School of Health Sciences, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Marshall A Dalton
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Camperdown, NSW, 2050, Australia.
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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Gaastra B, Whyte S, Hankin B, Bulters D, Galea I, Campbell N. An assistive listening device improves hearing following aneurysmal subarachnoid haemorrhage. Eur J Neurol 2024; 31:e16240. [PMID: 38332663 PMCID: PMC11235765 DOI: 10.1111/ene.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND PURPOSE Hearing impairment is common following aneurysmal subarachnoid haemorrhage (aSAH). Previous studies have demonstrated that auditory processing disorder (APD) is the primary underlying pathology. Assistive listening devices (ALDs) can be used to manage APD but have not been explored in aSAH. The aim of this study was to assess the benefit of an ALD for patients reporting hearing difficulty after aSAH. METHODS This was a prospective pilot single-arm intervention study of an ALD for APD following aSAH. Patients who reported subjective hearing difficulty following aSAH were identified from the Wessex Neurological Centre aSAH database. Speech-in-noise was evaluated using the Bamford-Kowal-Bench (BKB) test under 60 and 65 dB noise conditions. BKB performance was compared with and without an ALD. Cognition was assessed using the Addenbrooke's Cognitive Examination-III. RESULTS Fourteen aSAH patients with self-reported hearing loss were included in the analysis. Under both noise conditions the ALD significantly improved BKB performance (60 dB, Z = -3.30, p < 0.001; 65 dB, Z = -3.33, p < 0.001). There was no relationship between cognition and response to the ALD. CONCLUSIONS This study demonstrates the marked benefit of ALDs to manage APD following aSAH, regardless of cognitive status. This finding has implications for the management of this common yet disabling deficit which impacts quality of life and employment. A further trial of ALDs in this patient group is needed to test whether these large, short-term benefits can be practically translated to the community for long-term benefit when used at home.
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Affiliation(s)
- Ben Gaastra
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Department of Neurosurgery, Wessex Neurological CentreUniversity Hospital SouthamptonSouthamptonUK
| | - Stuart Whyte
- Faculty of Engineering and Physical Sciences, Auditory Implant ServiceUniversity of SouthamptonSouthamptonUK
| | - Bethan Hankin
- Faculty of Engineering and Physical SciencesUniversity of SouthamptonSouthamptonUK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological CentreUniversity Hospital SouthamptonSouthamptonUK
| | - Ian Galea
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Nicole Campbell
- Faculty of Engineering and Physical Sciences, Auditory Implant ServiceUniversity of SouthamptonSouthamptonUK
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Conti F, Carnemolla S, Piguet O, Irish M. Scene construction in healthy aging - Exploring the interplay between task complexity and oculomotor behaviour. Brain Cogn 2024; 177:106163. [PMID: 38685168 DOI: 10.1016/j.bandc.2024.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Mounting evidence indicates a close correspondence between episodic memory, mental imagery, and oculomotor behaviour. It remains unclear, however, how oculomotor variables support endogenously driven forms of mental imagery and how this relationship changes across the adult lifespan. In this study we investigated age-related changes in oculomotor signatures during scene construction and explored how task complexity impacts these processes. Younger and cognitively healthy older participants completed a guided scene construction paradigm where scene complexity was manipulated according to the number of elements to be sequentially integrated. We recorded participants' eye movements and collected subjective ratings regarding their phenomenological experience. Overall, older adults rated their constructions as more vivid and more spatially integrated, while also generating more fixations and saccades relative to the younger group, specifically on control trials. Analyses of participants' total scan paths revealed that, in the early stages of scene construction, oculomotor behaviour changed as a function of task complexity within each group. Following the introduction of a second stimulus, older but not younger adults showed a significant decrease in the production of eye movements. Whether this shift in oculomotor behaviour serves a compensatory function to bolster task performance represents an important question for future research.
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Affiliation(s)
- Federica Conti
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Sarah Carnemolla
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.
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40
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Devenney EM, Tse NY, O’Callaghan C, Kumfor F, Ahmed RM, Caga J, Hazelton JL, Carrick J, Halliday GM, Piguet O, Kiernan MC, Hodges JR. An attentional and working memory theory of hallucination vulnerability in frontotemporal dementia. Brain Commun 2024; 6:fcae123. [PMID: 38725706 PMCID: PMC11081077 DOI: 10.1093/braincomms/fcae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/30/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
The rate and prevalence of hallucinations in behavioural variant frontotemporal dementia is well established. The mechanisms for underlying vulnerability however are the least well described in FTD compared with other neuropsychiatric conditions, despite the presence of these features significantly complicating the diagnostic process. As such, this present study aimed to provide a detailed characterization of the neural, cognitive and behavioural profile associated with a predisposition to hallucinatory experiences in behavioural variant frontotemporal dementia. In total, 153 patients with behavioural variant frontotemporal dementia were recruited sequentially for this study. A group of patients with well characterized hallucinations and good-quality volumetric MRI scans (n = 23) were genetically and demographically matched to a group without hallucinations (n = 23) and a healthy control cohort (n = 23). All patients were assessed at their initial visit by means of a detailed clinical interview, a comprehensive battery of neuropsychological tests and MRI. Data were analysed according to three levels: (i) the relationship between neural structures, cognition, behaviour and hallucinations in behavioural variant frontotemporal dementia; (ii) the impact of the C9orf72 expansion; and (iii) hallucination subtype on expression of hallucinations. Basic and complex attentional (including divided attention and working memory) and visual function measures differed between groups (all P < 0.001) with hallucinators demonstrating poorer performance, along with evidence of structural changes centred on the prefrontal cortex, caudate and cerebellum (corrected for False Discovery Rate at P < 0.05 with a cluster threshold of 100 contiguous voxels). Attentional processes were also implicated in C9orf72 carriers with hallucinations with structural changes selectively involving the thalamus. Patients with visual hallucinations in isolation showed a similar pattern with emphasis on cerebellar atrophy. Our findings provided novel insights that attentional and visual function subsystems and related distributed brain structures are implicated in the generation of hallucinations in behavioural variant frontotemporal dementia, that dissociate across C9orf72, sporadic behavioural variant frontotemporal dementia and for the visual subtype of hallucinations. This loading on attentional and working memory measures is in line with current mechanistic models of hallucinations that frequently suggest a failure of integration of cognitive and perceptual processes. We therefore propose a novel cognitive and neural model for hallucination predisposition in behavioural variant frontotemporal dementia that aligns with a transdiagnostic model for hallucinations across neurodegeneration and psychiatry.
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Affiliation(s)
- Emma M Devenney
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- Neurology Department, Western Sydney Local Health District, Sydney 2145, Australia
| | - Nga Yan Tse
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- Systems Lab, Department of Psychiatry, The University of Melbourne, Parkville 3052, Australia
| | - Claire O’Callaghan
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, Australia
| | - Fiona Kumfor
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- School of Psychology, The University of Sydney, Sydney 2050, Australia
| | - Rebekah M Ahmed
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Jashelle Caga
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
| | - Jessica L Hazelton
- School of Psychology, The University of Sydney, Sydney 2050, Australia
- Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2050, Australia
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires B1644BID, Argentina
- Latin American Brain Health Institute (Brain Lat), Universidad Adolfo Ibáñez, Santiago 7941169, Chile
| | - James Carrick
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
| | - Glenda M Halliday
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2050, Australia
| | - Olivier Piguet
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
- School of Psychology, The University of Sydney, Sydney 2050, Australia
| | - Matthew C Kiernan
- Neuroscience Research Australia, Randwick 2031, Australia
- Faculty of Medicine and Health, University of New South Wales 2031, Australia
- Neurology Department, South Eastern Sydney Local Health District, NSW 2031, Australia
| | - John R Hodges
- Brain & Mind Centre, The University of Sydney, Sydney 2050, Australia
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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [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] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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Dutta M, Mello TMD, Cheng Y, Dash NS, Nandi R, Dutt A, Bose A. Universal and Language-Specific Connected Speech Characteristics of Bilingual Speakers With Alzheimer's Disease: Insights From Case Studies of Structurally Distinct Languages. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1143-1164. [PMID: 38568053 DOI: 10.1044/2024_jslhr-23-00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
PURPOSE Connected speech analysis has been effectively utilized for the diagnosis and disease monitoring of individuals with Alzheimer's disease (AD). Existing research has been conducted mostly in monolingual English speakers with a noticeable lack of evidence from bilinguals and non-English speakers, particularly in non-European languages. Using a case study approach, we characterized connected speech profiles of two Bengali-English bilingual speakers with AD to determine the universal features of language impairments in both languages, identify language-specific differences between the languages, and explore language impairment characteristics of the participants with AD in relation to their bilingual language experience. METHOD Participants included two Bengali-English bilingual speakers with AD and a group of age-, gender-, education-, and language-matched neurologically healthy controls. Connected speech samples were collected in first language (L1; Bengali) and second language (L2; English) using a novel storytelling task (i.e., Frog, Where Are You?). These samples were analyzed using an augmented quantitative production analysis and correct information unit analyses for productivity, fluency, syntactic and morphosyntactic features, and lexical and semantic characteristics. RESULTS Irrespective of the language, AD impacted speech productivity (speech rate and fluency) and semantic characteristics in both languages. Unique language-specific differences were noted on syntactic measures (reduced sentence length in Bengali), lexical distribution (fewer pronouns and absence of reduplication in Bengali), and inflectional properties (no difficulties with noun or verb inflections in Bengali). Among the two participants with AD, the individual who showed lower proficiency and usage in L2 (English) demonstrated reduced syntactic complexity and morphosyntactic richness in English. CONCLUSIONS Evidence from these case studies suggests that language impairment features in AD are not universal across languages, particularly in comparison to impairments typically associated with language breakdowns in English. This study underscores the importance of establishing connected speech profiles in AD for non-English-speaking populations, especially for structurally different languages. This would in turn lead to the development of language-specific markers that can facilitate early detection of language deterioration and aid in improving diagnosis of AD in individuals belonging to underserved linguistically diverse populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25412458.
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Affiliation(s)
- Manaswita Dutta
- Department of Speech & Hearing Sciences, Portland State University, OR
| | - Tina M D Mello
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Yesi Cheng
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ranita Nandi
- Neuropsychology & Clinical Psychology Unit, Duttanagar Mental Health Center, Kolkata, India
| | - Aparna Dutt
- Neuropsychology & Clinical Psychology Unit, Duttanagar Mental Health Center, Kolkata, India
| | - Arpita Bose
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Newton C, Pope M, Rua C, Henson R, Ji Z, Burgess N, Rodgers CT, Stangl M, Dounavi M, Castegnaro A, Koychev I, Malhotra P, Wolbers T, Ritchie K, Ritchie CW, O'Brien J, Su L, Chan D. Entorhinal-based path integration selectively predicts midlife risk of Alzheimer's disease. Alzheimers Dement 2024; 20:2779-2793. [PMID: 38421123 PMCID: PMC11032581 DOI: 10.1002/alz.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Entorhinal cortex (EC) is the first cortical region to exhibit neurodegeneration in Alzheimer's disease (AD), associated with EC grid cell dysfunction. Given the role of grid cells in path integration (PI)-based spatial behaviors, we predicted that PI impairment would represent the first behavioral change in adults at risk of AD. METHODS We compared immersive virtual reality (VR) PI ability to other cognitive domains in 100 asymptomatic midlife adults stratified by hereditary and physiological AD risk factors. In some participants, behavioral data were compared to 7T magnetic resonance imaging (MRI) measures of brain structure and function. RESULTS Midlife PI impairments predicted both hereditary and physiological AD risk, with no corresponding multi-risk impairment in episodic memory or other spatial behaviors. Impairments associated with altered functional MRI signal in the posterior-medial EC. DISCUSSION Altered PI may represent the transition point from at-risk state to disease manifestation in AD, prior to impairment in other cognitive domains.
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Affiliation(s)
- Coco Newton
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Marianna Pope
- Department of PsychiatryUniversity of CambridgeCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Catarina Rua
- Wolfson Brain Imaging CentreUniversity of CambridgeCambridgeUK
| | - Richard Henson
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Zilong Ji
- Institute of Cognitive NeuroscienceUCLLondonUK
| | | | | | - Matthias Stangl
- Jane and Terry Semel Institute for Neuroscience and Human BehaviorUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical EngineeringBoston UniversityBostonMassachusettsUSA
| | | | | | - Ivan Koychev
- Department of PsychiatryWarneford HospitalOxford UniversityOxfordUK
| | | | - Thomas Wolbers
- German Centre for Neurodegenerative Diseases (DZNE)MagdeburgGermany
| | | | - Craig W. Ritchie
- Centre for Dementia PreventionWestern General HospitalUniversity of EdinburghEdinburghUK
| | - John O'Brien
- Department of PsychiatryUniversity of CambridgeCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Li Su
- Department of PsychiatryUniversity of CambridgeCambridgeUK
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Dennis Chan
- Department of PsychiatryUniversity of CambridgeCambridgeUK
- Institute of Cognitive NeuroscienceUCLLondonUK
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Kumfor F, Wei G, Ries N, Bennett H, D'Mello M, Kaizik C, Piguet O, Hodges JR. Examining the propensity and nature of criminal risk behaviours in frontotemporal dementia syndromes and Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12577. [PMID: 38605995 PMCID: PMC11007792 DOI: 10.1002/dad2.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Some people with dementia develop changes in behaviour and cognition that may lead to interactions with police or the legal system. However, large, prospective case-control studies examining these behaviours are lacking. METHODS One hundred and forty-four people with dementia and 53 controls completed the Misdemeanours and Transgressions Screener. RESULTS Criminal risk behaviours were reported in: 65.6% of behavioural-variant frontotemporal dementia, 46.2% of right-lateralised semantic dementia, and 27.0% of Alzheimer's disease patients. In 19.1% of patients these behaviours led to contact with police or authority figures. Compared to controls, people with dementia showed higher rates of physical assault (p = 0.024), financial/professional recklessness (p = 0.009), and inappropriate behaviours (p = 0.052). DISCUSSION Criminal risk behaviours are common across dementia subtypes and may be one of the first clinical signs of frontotemporal dementia. Further research to understand how to balance risk minimisation with an individual's liberties as well as the inappropriate criminalisation of people with dementia is needed. Highlights The Misdemeanours and Transgressions Screener is a new tool to assess criminal risk behaviours.Forty-seven percent of patients with dementia show criminal risk behaviour after dementia onset.Behaviours included verbal abuse, traffic violations, physical assault.New onset of criminal risk behaviours >50 years is a clinical sign for frontotemporal dementia.
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Affiliation(s)
- Fiona Kumfor
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Grace Wei
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Nola Ries
- Law Health Justice Research CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Hayley Bennett
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
| | - Mirelle D'Mello
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Cassandra Kaizik
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Olivier Piguet
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - John R. Hodges
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
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45
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Dimitriou NK, Nousia A, Georgopoulou EN, Martzoukou M, Liampas I, Dardiotis E, Nasios G. Language and Communication Interventions in People with Alzheimer's Disease: A Systematic Review. Healthcare (Basel) 2024; 12:741. [PMID: 38610163 PMCID: PMC11011709 DOI: 10.3390/healthcare12070741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Although language impairment is frequently observed in patients with Alzheimer's disease (pwAD), targeted language rehabilitation is often overlooked. The present study reviews published evidence on the impact of language training, either alone or in combination with cognitive training, on cognitive outcomes in pwAD. A systematic search of PubMed, Google Scholar, and Cochrane was carried out, including studies published from inception to November 2023. A total of eight research articles (four randomized controlled trials and four observational studies) met the inclusion criteria: six assessed language training combined with cognitive training and two evaluated language rehabilitation alone. Regarding language and non-language (mainly memory, attention, and executive functions) outcomes, there was a consensus among studies that language rehabilitation (alone or in combination with cognitive training) yields positive results. Some of the articles also explored the impact on patients' and their caregivers' quality of life, with all but one showing improvement. Consequently, the combination of language and cognitive training leads to improvements across various cognitive domains. However, limited evidence supports the value of sole language rehabilitation. This conclusion is influenced by heterogeneity among studies (different types and duration of interventions, small participant sets, various assessment tools), and, thus, further research is warranted.
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Affiliation(s)
- Nefeli K. Dimitriou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece; (N.K.D.); (E.-N.G.); (G.N.)
| | - Anastasia Nousia
- Department of Speech and Language Therapy, University of Peloponnese, 24100 Kalamata, Greece;
| | - Eleni-Nefeli Georgopoulou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece; (N.K.D.); (E.-N.G.); (G.N.)
| | - Maria Martzoukou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece;
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece; (N.K.D.); (E.-N.G.); (G.N.)
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Ahmed S, Caswell J, Butler CR, Bose A. Secondary language impairment in posterior cortical atrophy: insights from sentence repetition. Front Neurosci 2024; 18:1359186. [PMID: 38576871 PMCID: PMC10993779 DOI: 10.3389/fnins.2024.1359186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive impairment in visuospatial and perceptual function linked to atrophy of the occipito-parietal cortex. Besides the salient visual impairment, several studies have documented subtle changes in language may also be present. Sentence repetition is a highly constrained linguistic task involving multiple linguistic and cognitive processes and have been shown to be impaired in other AD spectrum disorders, with little consensus on its relevance in PCA. This aim of this study was to further delineate the linguistic and cognitive features of impaired language in PCA using a sentence repetition task. Method Seven PCA patients and 16 healthy controls verbally repeated 16 sentences from the Boston Diagnostic Aphasia Examination. Responses were transcribed orthographically and coded for accuracy (percentage accuracy; percentage Correct Information Units; Levenshtein Distance) and for temporal characteristics (preparation duration (ms); utterance duration (ms); silent pause duration (ms); speech duration (ms); dysfluency duration (ms)). The potential modulating effects of attentional control and working memory capacity were explored. Results PCA patients showed lower overall accuracy with retained semantic content of the sentences, and lower phonological accuracy. Temporal measures revealed longer preparation and utterance duration for PCA patients compared to controls, alongside longer speech duration but comparable dysfluency duration. PCA patients also showed comparable silent pause duration to controls. Attentional control, measured using the Hayling sentence completion task, predicted accuracy of sentence repetition. Discussion The findings suggest that sentence repetition is impaired in PCA and is characterized by phonological, response planning and execution difficulties, underpinned in part by attentional control mechanisms. The emerging profile of language impairment in PCA suggests vulnerability of similar cognitive systems to other Alzheimer's syndromes, with subtle differences in clinical presentation.
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Affiliation(s)
- Samrah Ahmed
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Josie Caswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Christopher R. Butler
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Arpita Bose
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Wilson NA, Ahmed R, Piguet O, Irish M. Disrupted social perception in frontotemporal dementia and Alzheimer's disease - Associated cognitive processes and clinical implications. J Neurol Sci 2024; 458:122902. [PMID: 38325063 DOI: 10.1016/j.jns.2024.122902] [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] [Received: 09/28/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Social perception refers to the ability to adapt and update one's behaviour in accordance with the current context and provides the foundation for many complex social and emotional interactions. Alterations in social cognition are a hallmark of the behavioural variant of frontotemporal dementia (bvFTD), yet the capacity for social perception in this syndrome remains unclear. METHODS We examined social perception in 18 bvFTD and 13 Alzheimer's disease (AD) patients, in comparison with 17 healthy older controls, using a social perception task derived from the Dewey Story Test. Participants also completed a comprehensive neuropsychological battery and carers provided ratings of behavioural and neuropsychiatric changes. RESULTS Overall, bvFTD and AD performance diverged significantly from control ratings on the social perception task, however, no significant difference was found between patient groups. Standardised values relative to the mean control rating revealed considerable variability within the patient groups in terms of the direction of deviation, i.e., over- or under-rating the vignettes relative to healthy controls (range z-scores = -1.79 to +1.63). Greater deviation from control ratings was associated with more pronounced memory (p = .007) and behavioural (p = .009) disturbances in bvFTD; whilst social perception performance correlated exclusively with verbal fluency in AD (p = .003). CONCLUSIONS Social perception is comparably disrupted in bvFTD and AD, yet likely reflects the differential breakdown of distinct cognitive processes in each dementia syndrome. Our findings have important clinical implications for the development of targeted interventions to manage disease-specific changes in social perception in dementia.
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Affiliation(s)
- Nikki-Anne Wilson
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia; The University of New South Wales, School of Psychology, Sydney, NSW 2052, Australia; Neuroscience Research Australia, Sydney, NSW 2031, Australia.
| | - Rebekah Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, NSW 2050, Australia; The University of Sydney, School of Psychology, Sydney, NSW 2006, Australia
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Lan F, Roquet D, Dalton MA, El-Omar H, Ahmed RM, Piguet O, Irish M. Exploring graded profiles of hippocampal atrophy along the anterior-posterior axis in semantic dementia and Alzheimer's disease. Neurobiol Aging 2024; 135:70-78. [PMID: 38232501 DOI: 10.1016/j.neurobiolaging.2024.01.004] [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] [Received: 07/13/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
Mounting evidence indicates marked hippocampal degeneration in semantic dementia (SD) however, the spatial distribution of hippocampal atrophy profiles in this syndrome remains unclear. Using a recently developed parcellation approach, we extracted hippocampal volumes from four distinct subregions running from anterior to posterior along the longitudinal axis (anterior, intermediate rostral, intermediate caudal, and posterior). Volumetric differences in hippocampal subregions were compared between 21 SD, 24 matched Alzheimer's disease (AD), and 27 healthy older Control participants. Despite comparable overall hippocampal volume loss, SD and AD groups diverged in terms of the magnitude of atrophy along the anterior-posterior axis of the hippocampus. Global hippocampal atrophy was observed in AD, with no discernible gradation or lateralisation. In contrast, SD patients displayed graded bilateral hippocampal atrophy, most pronounced on the left-hand side, and concentrated in anterior relative to posterior subregions. Finally, we found preliminary evidence that disease-specific vulnerability along the anterior-posterior axis of the hippocampus was associated with canonical clinical features of these syndromes.
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Affiliation(s)
- Fang Lan
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Marshall A Dalton
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia.
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Rogers F, Metzler-Baddeley C. The effects of musical instrument training on fluid intelligence and executive functions in healthy older adults: A systematic review and meta-analysis. Brain Cogn 2024; 175:106137. [PMID: 38340535 DOI: 10.1016/j.bandc.2024.106137] [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] [Received: 09/19/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Intervention studiescombiningcognitive and motor demands have reported far-transfer cognitive benefits in healthy ageing. This systematic review and meta-analysis evaluated the effects of music and rhythm intervention on cognition in older adulthood. Inclusion criteria specified: 1) musical instrument training; 2) healthy, musically-naïve adults (≥60 years); 3) control group; 4) measure of executive function. Ovid, PubMed, Scopus and the Cochrane Library online databases were searched in August 2023. Data from thirteen studies were analysed (N = 502 participants). Study quality was assessed using the Cochrane Risk of Bias tool (RoB 2; Sterne et al., 2019). Random effects models revealed: a low effect on inhibition (d = 0.27,p = .0335); a low-moderate effect on switching (d = -0.39, p = .0021); a low-moderate effect on verbal category switching (d =0.39,p = .0166); and a moderate effect on processing speed (d = 0.47,p < .0001). No effect was found for selective visual attention, working memory, or verbal memory. With regards to overall bias, three studies were rated as "high", nine studies were rated as having "some concerns" and one was rated "low". The meta-analysis suggests that learning to play a musical instrument enhances attention inhibition, switching and processing speed in ageing.
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Affiliation(s)
- Fionnuala Rogers
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Maindy Road, Cardiff University, Cardiff, United Kingdom.
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Maindy Road, Cardiff University, Cardiff, United Kingdom
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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