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García MJ, Introzzi IM, Aydmune YS, Comesaña A. [Coin tossing: Development of a computerized test to assess cognitive flexibility in older adults]. Rev Esp Geriatr Gerontol 2024; 59:101514. [PMID: 38964264 DOI: 10.1016/j.regg.2024.101514] [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: 03/08/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The aging population is increasing. Aging has been associated with some degree of cognitive decline, especially in functions such as cognitive flexibility. The voluntary task-switching paradigm is a novel model for studying this function. The aim of this work was to design and test a computerized instrument to assess cognitive flexibility with this paradigm. METHODS A non-probabilistic and intentional sample of individuals aged 60 and above (N=57; M=70; SD=7.5), 72% of whom were women, was utilized. A general cognitive screening test (ACE III) and the "Coin Tossing" task, a computerized program consisting of four levels of complexity, were administered. RESULTS A Wilcoxon test was used to contrast parity versus size responses (z(56)=-1.16, P=.24). To assess repetition bias, a Wilcoxon test was conducted between new and repeated responses (TR: z(56)=-1.81, P=.07 // Accuracy: z(56)=-6.33, P=.00). A repeated measures ANOVA was performed between reaction times before, during, and after a response change, F(1.02)=59.6, P<.01, η2=.937, B-1=1. And a repeated measures ANOVA between mean RTs per level, F(3)=7.92, P<.001, η2=.128, B-1=.98. CONCLUSIONS The test was designed with a progressive structure across levels. The theoretical assumptions of the paradigm were partially demonstrated, showing its utility for the assessment and training of cognitive flexibility.
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Affiliation(s)
- Matías Jonás García
- Instituto de Psicología Básica, Aplicada y Tecnología IPSIBAT (UNMdP-CONICET), Mar del Plata, Argentina; Facultad de Ciencias de la Salud y Trabajo Social FCSyTS - Universidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Isabel María Introzzi
- Instituto de Psicología Básica, Aplicada y Tecnología IPSIBAT (UNMdP-CONICET), Mar del Plata, Argentina; Facultad de Psicología, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Yesica Sabina Aydmune
- Instituto de Psicología Básica, Aplicada y Tecnología IPSIBAT (UNMdP-CONICET), Mar del Plata, Argentina; Facultad de Ciencias de la Salud y Trabajo Social FCSyTS - Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Ana Comesaña
- Instituto de Psicología Básica, Aplicada y Tecnología IPSIBAT (UNMdP-CONICET), Mar del Plata, Argentina; Facultad de Ciencias de la Salud y Trabajo Social FCSyTS - Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
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Corbo I, Troisi G, Marselli G, Casagrande M. The role of cognitive flexibility on higher level executive functions in mild cognitive impairment and healthy older adults. BMC Psychol 2024; 12:317. [PMID: 38816884 PMCID: PMC11140914 DOI: 10.1186/s40359-024-01807-5] [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] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Mild Cognitive Impairment (MCI) is a preclinical condition between healthy and pathological aging, which is characterized by impairments in executive functions (EFs), including cognitive flexibility. According to Diamond's model, cognitive flexibility is a core executive function, along with working memory and inhibition, but it requires the development of these last EFs to reach its full potential. In this model, planning and fluid intelligence are considered higher-level EFs. Given their central role in enabling individuals to adapt their daily life behavior efficiently, the goal is to gain valuable insight into the functionality of cognitive flexibility in a preclinical form of cognitive decline. This study aims to investigate the role of cognitive flexibility and its components, set-shifting and switching, in MCI. The hypotheses are as follows: (I) healthy participants are expected to perform better than those with MCI on cognitive flexibility and higher-level EFs tasks, taking into account the mediating role of global cognitive functioning; (II) cognitive flexibility can predict performance on higher-level EFs (i.e., planning and fluid intelligence) tasks differently in healthy individuals and those diagnosed with MCI. METHODS Ninety participants were selected and divided into a healthy control group (N = 45; mean age 64.1 ± 6.80; 66.6% female) and an MCI group (N = 45; mean age 65.2 ± 8.14; 40% female). Cognitive flexibility, fluid intelligence, planning, and global cognitive functioning of all participants were assessed using standardized tasks. RESULTS Results indicated that individuals with MCI showed greater impairment in global cognitive functioning and EFs performance. Furthermore, the study confirms the predictive role of cognitive flexibility for higher EFs in individuals with MCI and only partially in healthy older adults.
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Affiliation(s)
- Ilaria Corbo
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Via degli Apuli 1 - 00185, Rome, Italy.
| | - Giovanna Troisi
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Marselli
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Via degli Apuli 1 - 00185, Rome, Italy
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Zhang X, Lv L, Shen J, Chen J, Zhang H, Li Y. A tablet-based multi-dimensional drawing system can effectively distinguish patients with amnestic MCI from healthy individuals. Sci Rep 2024; 14:982. [PMID: 38200020 PMCID: PMC10781783 DOI: 10.1038/s41598-023-46710-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: 02/17/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024] Open
Abstract
The population with dementia is expected to rise to 152 million in 2050 due to the aging population worldwide. Therefore, it is significant to identify and intervene in the early stage of dementia. The Rey-Osterreth complex figure (ROCF) test is a visuospatial test scale. Its scoring methods are numerous, time-consuming, and inconsistent, which is unsuitable for wide application as required by the high number of people at risk. Therefore, there is an urgent need for a rapid, objective, and sensitive digital scoring method to detect cognitive dysfunction in the early stage accurately. This study aims to clarify the organizational strategy of aMCI patients to draw complex figures through a multi-dimensional digital evaluation system. At the same time, a rapid, objective, and sensitive digital scoring method is established to replace traditional scoring. The data of 64 subjects (38 aMCI patients and 26 NC individuals) were analyzed in this study. All subjects completed the tablet's Geriatric Complex Figure (GCF) test, including copying, 3-min recall, and 20-min delayed recall, and also underwent a standardized neuropsychological test battery and classic ROCF test. Digital GCF (dGCF) variables and conventional GCF (cGCF) scores were input into the forward stepwise logistic regression model to construct classification models. Finally, ROC curves were made to visualize the difference in the diagnostic value of dGCF variables vs. cGCF scores in categorizing the diagnostic groups. In 20-min delayed recall, aMCI patients' time in air and pause time were longer than NC individuals. Patients with aMCI had more short strokes and poorer ability of detail integration (all p < 0.05). The diagnostic sensitivity of dGCF variables for aMCI patients was 89.47%, slightly higher than cGCF scores (sensitivity: 84.21%). The diagnostic accuracy of both was comparable (dGCF: 70.3%; cGCF: 73.4%). Moreover, combining dGCF variables and cGCF scores could significantly improve the diagnostic accuracy and specificity (accuracy: 78.1%, specificity: 84.62%). At the same time, we construct the regression equations of the two models. Our study shows that dGCF equipment can quantitatively evaluate drawing performance, and its performance is comparable to the time-consuming cGCF score. The regression equation of the model we constructed can well identify patients with aMCI in clinical application. We believe this new technique can be a highly effective screening tool for patients with MCI.
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Affiliation(s)
- Xiaonan Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | | | - Jiani Shen
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, China
| | - Jinyu Chen
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, China
| | - Hui Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China.
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China.
- Shanxi Key Laboratory of Intelligent Imaging and Nanomedicine, First Hospital of Shanxi Medical University, Taiyuan, China.
| | - Yang Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
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Ceresetti R, Celle S, Roche F, Barthélémy JC, Michael GA, Borg C. Normative Data for a Neuropsychological Test Battery in the French Aging Population: 20-Year Follow-Up From the "PROgnostic OF Cardiovascular and Cerebrovascular Events" Study. Arch Clin Neuropsychol 2023:acad074. [PMID: 37769183 DOI: 10.1093/arclin/acad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE The study aimed to present relevant norms for the evaluation of pathological aging in the French population over a 20-year period, utilizing the "PROgnostic OF cardiovascular and cerebrovascular events" test and questionnaire. METHODS Three neuropsychological evaluations were administered over 20 years with 929 participants at the first cognitive evaluation (62-69 years old), 631 at the second (71-78 years old), and 293 at the third (81-88 years old). The tests and questionnaires were administered in the following order: McNair's Cognitive Complaints Questionnaire, Depression Questionnaire of Pichot, Mini Mental State Examination, Free and Cued Selective Reminding test, Benton Visual Retention Test, Digit-Symbol Substitution Test of the WAIS-III, Trail Making Test, Stroop Test, Verbal Fluency, and the Similarities subtest of the WAIS-III. RESULTS Normative data were presented at three time points of the repeated evaluation over 20 years (62-69 years, 71-78 years, and 81-88 years) and four educational levels (no diploma, primary school certificate, certificate of professional aptitude, and baccalaureate and above). The data showed a significant effect of educational level in all neuropsychological tests regardless of age. Gender primarily affected memory, Stroop scores, and Similarities scores. CONCLUSION This study highlights the importance of educational level and gender in the evaluation of the memory and executive function of elderly persons. Furthermore, the presented norms consider the self-report cognitive complaints and depression symptoms over a long period of life.
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Affiliation(s)
- Romain Ceresetti
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Étienne, France
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
| | - Sébastien Celle
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Étienne, France
- INSERM, U 1059 Sainbiose, Univ Jean Monnet, Mines Saint-Étienne, Saint-Étienne, France
| | - Frédéric Roche
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Étienne, France
- INSERM, U 1059 Sainbiose, Univ Jean Monnet, Mines Saint-Étienne, Saint-Étienne, France
| | - Jean-Claude Barthélémy
- Department of Clinical Physiology, VISAS Center, University Hospital, Saint-Étienne, France
- INSERM, U 1059 Sainbiose, Univ Jean Monnet, Mines Saint-Étienne, Saint-Étienne, France
| | - George A Michael
- Unité de Recherche Etude des Mécanismes Cognitifs (EMC), University of Lyon, University Lyon 2, Lyon, France
| | - Céline Borg
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
- Psychology faculty, University of Lyon, Lyon, France
- Laboratoire de Psychologie et Neurocognition (LPNC), University of Grenoble Alpes, University of Savoie Mont Blanc, CNRS UMR 5105, Grenoble, France
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Michalko D, Marko M, Riečanský I. Executive functioning moderates the decline of retrieval fluency in time. PSYCHOLOGICAL RESEARCH 2023; 87:397-409. [PMID: 35467164 PMCID: PMC11189984 DOI: 10.1007/s00426-022-01680-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/28/2022] [Indexed: 12/21/2022]
Abstract
Prevailing theoretical accounts consider that automatic and controlled processes are uniformly engaged in memory retrieval across performance of the semantic verbal fluency (SVF) task. We tested this proposal against the alternative, namely that a rapid automatic retrieval, exploiting stable associative structure in the early stages of the performance, is followed by a slower, more executively demanding, retrieval in later stages. Eighty-five healthy adults completed low- and high-demand SVF tasks that were assessed for retrieval rate, response typicality, and inter-response similarity across the performance. Additional measures of executive functioning were collected to estimate individual differences in executive control. We found that decrease in fluency in time was associated with lower typicality and weaker semantic similarity of the responses. Critically, the time-dependent retrieval slowing was steeper in individuals with less efficient interference control, particularly in high-demand SVF tasks. Steeper retrieval slowing was also associated with poorer working-memory capacity. Our findings show that the relative contribution of automatic and controlled processes to semantic retrieval changes with associative sparsity over time and across task demands, and provide implications for the use of SVF tasks in clinical assessment.
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Affiliation(s)
- Drahomír Michalko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovakia
| | - Martin Marko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovakia
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Mlynská Dolina F1, 842 48, Bratislava, Slovakia
| | - Igor Riečanský
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Sienkiewiczova 1, 813 71, Bratislava, Slovakia.
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria.
- Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Limbová 12, 833 03, Bratislava, Slovakia.
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Leite J, Gonçalves ÓF, Carvalho S. Speed of Processing (SoP) Training Plus α-tACS in People With Mild Cognitive Impairment: A Double Blind, Parallel, Placebo Controlled Trial Study Protocol. Front Aging Neurosci 2022; 14:880510. [PMID: 35928993 PMCID: PMC9344129 DOI: 10.3389/fnagi.2022.880510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Several cognitive training programs, alone or in combination with non-invasive brain stimulation have been tested in order to ameliorate age-related cognitive impairments, such as the ones found in Mild Cognitive Impairment (MCI). However, the effects of Cognitive Training (CT)—combined or not—with several forms of non-invasive brain stimulation have been modest at most. We aim to assess if Speed of Processing (SoP) training combined with alpha transcranial alternating current stimulation (α-tACS) is able to increase speed of processing as assessed by the Useful Field of View (UFOV), when comparing to SoP training or active α-tACS alone. Moreover, we want to assess if those changes in speed of processing transfer to other cognitive domains, such as memory, language and executive functioning by using the NIH EXAMINER. We also want to test the mechanisms underlying these interventions, namely brain connectivity and coherence as assessed by electroencephalography (EEG). To that purpose, our proposal is to enroll 327 elders diagnosed with MCI in a double-blinded, parallel randomized clinical trial assessing the effects of combining SoP with alpha endogenous tACS (either active or sham) in people with MCI. Participants will perform an intervention that will last for 15 sessions. For the first 3 weeks, participants will receive nine sessions of the intervention, and then will receive two sessions per week (i.e., booster) for the following 3 weeks. They will then be assessed at 1, 3, and 6 months after the intervention has ended. This will allow us to detect the immediate, and long-term effects of the interventions, as well as to probe the mechanisms underlying its effects.Clinical Trial Registration:Clinicaltrials.gov, Identifier: NCT05198726.
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Affiliation(s)
- Jorge Leite
- Portucalense Institute for Human Development—INPP, Portucalense University, Porto, Portugal
- Portuguese Network for the Psychological Neuroscience, Portugal
- *Correspondence: Jorge Leite
| | - Óscar F. Gonçalves
- Portuguese Network for the Psychological Neuroscience, Portugal
- Proaction Laboratory, CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sandra Carvalho
- Portuguese Network for the Psychological Neuroscience, Portugal
- Department of Education and Psychology and William James Center for Research, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- The Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Silva PCD, de Oliveira LLV, Teixeira RLP, Brito MLDA, Filippe ARTM. Executive Functions in Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis Rep 2022. [DOI: 10.3233/adr-210059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In Alzheimer’s disease, in addition to memory, attention has been given to cognitive testing due to its interface and connection with memory. Objective: The aim of this study is to take a global view of executive functions and place the concept within the theoretical framework of Alzheimer’s disease dementia, verifying their role in the cognitive functioning of the human mind, as well as how they are compromised in this pathology. Methods: An initial search was carried out in databases such as PubMed, ScienceDirect, and Web of Science. The guiding question presented at the end of the introduction was elaborated from the PICO/PIO/PEO strategy. The selected articles, therefore, answered the guiding question, were made available in full, and published in the period from 2000 to 2020. Studies without specific methodology and which correlated with other diseases or other types of dementia were excluded. To meet the objective, an integrative literature review was adopted. Results: The results indicate that, although the tests to verify the performance of cognitive functions have their limitations, they bring some evidence that they have been compromised, especially when analyzed periodically during the development of dementia. Conclusion: It is concluded that there is an interference of executive functions in function of Alzheimer’s and that memory and attention are the most evident in this type of dementia.
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Affiliation(s)
| | | | | | - Max Leandro de Araújo Brito
- Faculdade de Engenharia, Letras e Ciências Sociais do Seridó da Universidade Federal do Rio Grande do Norte, State of Rio Grande do Norte, Brazil
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Cherkasov NS, Kolykhalov IV. [Non-cognitive psychopathological symptoms in mild cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-51. [PMID: 34870913 DOI: 10.17116/jnevro202112110241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Noncognitive psychopathological symptoms (NPS) in elderly patients are increasingly attracting the attention of researchers in the field of neurodegenerative diseases. The question is raised whether these symptoms are risk factors or initial manifestations of the neurodegeneration process. This article provides information on the prevalence of late-onset NPS together with mild cognitive impairment (MCI), combination of which reflects the risk of developing dementia. The characteristic of mild behavioral impairment syndrome, which is currently used along with the concept of MCI, is given. The authors summarized data of the studies published over the past 10 years on the effect of NPS on the progression of cognitive impairment. Topics related to the differential diagnosis of these disorders, as well as existing approaches to treatment, are considered.
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Duarte-Abritta B, Sánchez SM, Abulafia C, Gustafson DR, Vázquez S, Sevlever G, Castro MN, Fiorentini L, Villarreal MF, Guinjoan SM. Amyloid and anatomical correlates of executive functioning in middle-aged offspring of patients with late-onset Alzheimer's disease. Psychiatry Res Neuroimaging 2021; 316:111342. [PMID: 34365076 DOI: 10.1016/j.pscychresns.2021.111342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/02/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
A traditional hallmark of cognitive impairment associated with late-onset Alzheimer´s disease (LOAD) is episodic memory impairment. However, early alterations have been identified in brain regions associated with executive function in asymptomatic, middle-age offspring of patients with LOAD (O-LOAD) compared to those with no family history. We hypothesized that executive function among O-LOAD would correlate with structural and amyloid brain imaging differently from those without a family history of LOAD (control subjects, CS). Executive function, cortical thickness, and in-vivo Aβ deposits were quantified in 30 O-LOAD and 25 CS. Associations were observed among O-LOAD only. Cortical thickness in the left lateral orbitofrontal cortex was positively associated with Design Fluency. The Stroop Color and Word Test, correlated positively with right rostral mid-frontal cortex thickness. Trails Making Test-B was inversely related to left medial orbitofrontal thickness. Tower of London total time was positively associated with β-amyloid deposition in the right precuneus. These results support previous evidence that early executive dysfunction might reflect subtle, early changes in persons at risk of LOAD and suggests that executive function alterations deserve further exploration in the LOAD literature.
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Affiliation(s)
- Bárbara Duarte-Abritta
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Stella-Maris Sánchez
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Carolina Abulafia
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Institute for Biomedical Research (BIOMED), Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Deborah R Gustafson
- Department of Neurology, State University of New York University Downstate Health Sciences University, United States
| | - Silvia Vázquez
- Centro de imágenes moleculares (CIM), Fundación FLENI, Argentina
| | - Gustavo Sevlever
- Departamento de Neuropatología y Biología Molecular, Fundación FLENI, Buenos Aires, Argentina
| | - Mariana N Castro
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Servicio de Psiquiatría, Fundación FLENI, Buenos Aires, Argentina
| | - Leticia Fiorentini
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Servicio de Psiquiatría, Fundación FLENI, Buenos Aires, Argentina
| | - Mirta F Villarreal
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Salvador M Guinjoan
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Argentina; Laureate Institute for Brain Research, OK, United States.
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10
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Junquera A, García-Zamora E, Olazarán J, Parra MA, Fernández-Guinea S. Role of Executive Functions in the Conversion from Mild Cognitive Impairment to Dementia. J Alzheimers Dis 2020; 77:641-653. [DOI: 10.3233/jad-200586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Recent research pointed to executive dysfunction as a potential early predictor of the progression of mild cognitive impairment (MCI) to dementia in Alzheimer’s clinical syndrome (ACS). Such cognitive impairments account for functional impairments in instrumental activities of daily living (IADL). Objective: The present study analyzes the contributions of executive functions to predict MCI–dementia progression in ACS. Methods: We assessed 145 participants, 51 cognitively unimpaired and 94 MCI. The latter were divided using the traditional, memory-based MCI classification (single domain amnestic, multidomain amnestic, and non-amnestic). Eight tests assessing executive functions were administered at baseline and at 1-year follow-up, together with cognitive screening tools and IADL measures. MCI patients were reclassified based on the outcomes from a K-mean cluster analysis which identified three groups. A simple lineal regression model was used to examine whether the classification based on executive functioning could more accurately predict progression to dementia a year later. Results: Clusters based on executive function deficits explained a significant proportion of the variance linked to MCI–dementia conversion, even after controlling for the severity of MCI at baseline (F(1, 68) = 116.25, p = 0.000, R2 = 0.63). Classical memory-based MCI classification failed to predict such a conversion (F(1, 68) = 5.09, p = 0.955, R2 = 0.07). Switching, categories generation, and planning were the executive functions that best distinguished between MCI converters and stable. Conclusion: MCI with a dysexecutive phenotype significantly predicts conversion to dementia in ACS a year later. Switching abilities and verbal fluency (categories) must be evaluated in MCI patients to assess risk of future dementia.
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Affiliation(s)
- Almudena Junquera
- Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, Facultad de Psicología, Universidad Complutense de Madrid, España
| | - Estefanía García-Zamora
- Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, Facultad de Psicología, Universidad Complutense de Madrid, España
| | - Javier Olazarán
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Mario A. Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Neuroprogressive and Dementia Network, NHS Scotland, UK
- Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Sara Fernández-Guinea
- Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, Facultad de Psicología, Universidad Complutense de Madrid, España
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11
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Guarino A, Forte G, Giovannoli J, Casagrande M. Executive functions in the elderly with mild cognitive impairment: a systematic review on motor and cognitive inhibition, conflict control and cognitive flexibility. Aging Ment Health 2020; 24:1028-1045. [PMID: 30938193 DOI: 10.1080/13607863.2019.1584785] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Mild Cognitive Impairment (MCI) is a syndrome characterised by mild cognitive decline, on one or more domains, but which does not compromise daily functions. Several studies have investigated the relationship between MCI and deficit in executive functions (EFs) but, unlike robust evidence in the mnestic domain, the nature of executive deficits in the MCI population remains uncertain.Objectives: This systematic review aims to evaluate EFs in patients with MCI, considering inhibition (motor and cognitive), conflict control and cognitive flexibility.Method: The databases used for the search were PUBMED, PsycINFO, PsycARTICLES and MEDLINE. Eligibility criteria: use of specific paradigms for EFs assessment ('Wisconsin Card Sorting Test', 'Stroop Task', 'Go/No-Go Task', 'Flanker Task'); age over 65, studies published in English. Exclusion criteria: presence of dementia; psychiatric disorders; stroke; cranial trauma; inclusion of participants with MCI in groups with healthy elderly or those with dementia.Results: Fifty-five studies were selected, namely: Stroop Task (N = 30), WCST (N = 14), Go/No-Go (N = 9), Flanker Task (N = 2). Results have shown in people with MCI deficits in all the EFs considered.Conclusions: The results of this review support the applicability of the four experimental tasks examined for the study of EFs in people with MCI. These paradigms are useful in research, diagnosis and therapeutic purposes, allowing obtaining an articulated EFs profile that can compromise the daily life in elderly. These EFs are not generally evaluated by standard assessment of MCI, but their evaluation can lead to a better knowledge of MCI and help in the diagnosis and treatment.
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Affiliation(s)
- Angela Guarino
- Dipartimento di Psicologia, Università di Roma Sapienza, Rome, Italy
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma Sapienza, Rome, Italy
| | | | - Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma Sapienza, Rome, Italy
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Inhibitory Control Deficits in Individuals with Amnestic Mild Cognitive Impairment: a Meta-Analysis. Neuropsychol Rev 2020; 30:97-125. [DOI: 10.1007/s11065-020-09428-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/05/2020] [Indexed: 01/07/2023]
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13
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Chehrehnegar N, Nejati V, Shati M, Rashedi V, Lotfi M, Adelirad F, Foroughan M. Early detection of cognitive disturbances in mild cognitive impairment: a systematic review of observational studies. Psychogeriatrics 2020; 20:212-228. [PMID: 31808989 DOI: 10.1111/psyg.12484] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/28/2022]
Abstract
Mild cognitive impairment (MCI) is an intermediate state between normal cognition and early dementia and is not considered as a typical outcome of brain aging. It has been estimated that 10% to 20% of individuals above 65 years of age will be diagnosed as having MCI. The increased rate of dementia and the importance of early detection of its forerunners have encouraged researchers to focus on detecting MCI and modifiable risk factors with the hope of developing better ways of managing dementia and its consequences. The main aim of this study was to systematically review the related literature concerning the cognitive changes in the spectrum of cognitive aging to cognitive impairment. Articles included in this review were identified through searching the databases of PubMed, Psych Info, Embase, ProQuest, and Scopus. Many domains like verbal memory, language, executive function, visual memory, attentional skills, and working memory showed acceptable predictive power. Testing subdomains such as executive function, speed of processing, working memory and semantic language are critical and others may indicate some suggestions for further clinical deteriorations in normal individuals. Although various cognitive instruments have been used for evaluation of impaired cognitive domains, it remains challenging to select the most appropriate ones having high-level accuracy and their related cognitive subdomains. It also revealed that none of the identified cognitive domains solely fulfilled the criteria for MCI screening; in clinical settings, multiple neuropsychological batteries may be used for one single cognitive domain, while longitudinal studies prefer the use of at least two cognitive measures for each domain to improve accuracy and research settings might focus on only a single neuropsychological test. However, along with episodic memory, testing for amnestic MCI, executive function could increase the chance of early detection of MCI. Executive control has been found to deteriorate the earliest in MCI patients.
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Affiliation(s)
- Negin Chehrehnegar
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Occupational Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Nejati
- Department of Psychology and Educational Sciences, Shahid Behehsti University Tehran, Tehran, Iran.,Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Centre, School of Behavioural Science and Mental health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadsajad Lotfi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Adelirad
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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14
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Mallo SC, Patten SB, Ismail Z, Pereiro AX, Facal D, Otero C, Juncos-Rabadán O. Does the neuropsychiatric inventory predict progression from mild cognitive impairment to dementia? A systematic review and meta-analysis. Ageing Res Rev 2020; 58:101004. [PMID: 31881368 DOI: 10.1016/j.arr.2019.101004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/22/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuropsychiatric Symptoms (NPS) are common in Mild Cognitive Impairment (MCI). The Neuropsychiatric Inventory (NPI) and its shorter version, the Neuropsychiatric Inventory Questionnaire (NPI-Q), are the most common measures to assess NPS. Our objective was to determine if NPI/NPI-Q ratings predict conversion from MCI to dementia. METHODS Empirical longitudinal studies published in English or Spanish, concerned with the role of NPS as a risk factor for conversion from MCI to dementia, with a diagnosis of MCI following clinical criteria, that reported NPI/NPI-Q total score in converters versus non-converters, were included. Random effects models were used, and heterogeneity was explored with stratification and a random-effects meta-regression. The overall conversion rate and the standardized mean difference (SMD) for evolution, as a function of NPI/NPI-Q scores, were calculated. RESULTS The overall conversion rate was 35 %. Mean NPI/NPI-Q ratings were higher in converters versus in non-converters, with the overall SMD approaching significance. Heterogeneity was observed in studies of more than two years of follow-up and in a study with a mean age of more than 80 years. This heterogeneity concerned the size, not the direction of the difference. CONCLUSIONS Our results suggest that NPI/NPI-Q ratings are associated with conversion from MCI to dementia.
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15
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Quaranta D, Piccininni C, Caprara A, Malandrino A, Gainotti G, Marra C. Semantic Relations in a Categorical Verbal Fluency Test: An Exploratory Investigation in Mild Cognitive Impairment. Front Psychol 2019; 10:2797. [PMID: 31920840 PMCID: PMC6927990 DOI: 10.3389/fpsyg.2019.02797] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/27/2019] [Indexed: 01/23/2023] Open
Abstract
Categorical verbal fluency tests (CFT) are commonly used to assess the integrity of semantic memory in individuals with brain damage. Persons with Dementia of the Alzheimer's Type display a reduced output on CFT, and a similar pattern has been reported in persons with amnesic Mild Cognitive Impairment (aMCI). The aims of the present study were to assess whether the semantic relations between lexical entries produced on a categorical fluency test were different between healthy persons and those with aMCI, and whether this difference was more pronounced in individuals who converted to dementia during a 3-year follow-up period. Methods We recruited 34 individuals with aMCI and 29 matched healthy persons. During the follow-up period, 10 individuals converted to Dementia (aMCI-conv). Two measures assessing semantic relations between consecutively produced word pairs (Path length and Extended Gloss Overlap) were obtained from the Wordnet database. Results The number of word pairs analyzed among the healthy participants (HP) and persons with aMCI were 498 (birds: 262; pieces of furniture: 236) and 395 (birds: 174; pieces of furniture: 221), respectively. Path length was lower in aMCI-conv than in HP (p = 0.035), but no differences were found between stable aMCI and HP, and between aMCI-stable and aMCI-conv. The ANOVA for lexical entries belonging to the "birds" category showed a significant effect of group (F = 5.630; p = 0.004); the post hoc analysis showed a significant difference between HP and aMCI-conv (p = 0.003). The "pieces of furniture" category was significantly affected by group (F = 4.107; p = 0.017); the post hoc test showed significant differences between aMCI-conv and healthy individuals (p = 0.049), and between aMCI-conv and stable aMCI (p = 0.001). Discussion Individuals with aMCI who convert to dementia show a deterioration in the semantic relations between lexical entries, produced on a CFT. This phenomenon may be interpreted as a marker of a very early disruption of semantic memory.
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Affiliation(s)
- Davide Quaranta
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Piccininni
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessia Caprara
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Malandrino
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Gainotti
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy.,Department of Clinical and Behavioral Neurology, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Camillo Marra
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
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16
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Narme P, Maillet D, Palisson J, Le Clésiau H, Moroni C, Belin C. How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases? Am J Alzheimers Dis Other Demen 2019; 34:469-477. [PMID: 30827122 PMCID: PMC10653371 DOI: 10.1177/1533317519833844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.
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Affiliation(s)
- Pauline Narme
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Laboratoire Mémoire, Cerveau et Cognition (EA 7536), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
| | - Didier Maillet
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Juliette Palisson
- Unité Fonctionnelle Mémoire et Maladies Neurodégénératives, Service de Neurologie, CHU Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Hervé Le Clésiau
- Centre d’Examens de Santé de la Caisse primaire d’Assurance Maladie de la Seine-Saint-Denis, Bobigny, France
| | - Christine Moroni
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Catherine Belin
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
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Viklund H, Ausén B, Hagman G, Thorell LB. The Executive Checklist (EC-10) - a new rating instrument for clinicians assessing dysexecutive behavior. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:525-534. [PMID: 31526050 DOI: 10.1080/23279095.2019.1660881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Assessment of executive functions (EF) is often criticized for its lack of ecological validity. As a consequence, several self- and partner rating scales for EF have been developed, while rating scales designed for clinicians are lacking. We therefore developed the Executive Checklist (EC-10), a new rating scale for clinicians assessing dysexecutive behavior during neuropsychological assessment and examined its psychometric properties. Consecutive referrals from a memory clinic with subjective cognitive impairment (SCI; n = 27), mild cognitive impairment (MCI; n = 29), dementia (DEM; n = 16), as well as 11 healthy controls were assessed with the EC-10 while performing common neuropsychological tests. Results showed that the EC-10 had excellent inter-rater reliability, good internal consistency and modest relations to cognitive laboratory measures. The EC-10 increased the classification rate above and beyond the influence of neuropsychological tests when comparing patients with SCI and MCI or between cognitively impaired and non-impaired patients. Conclusively, the present study demonstrates that clinical observations can be quantified using the EC-10 and that this rating provides valuable information. As executive deficits are common in many neurological and neuropsychiatric disorders, validating the EC-10 in broader patient groups should be an important avenue for future research.
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Affiliation(s)
- Henrik Viklund
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Birgitta Ausén
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Göran Hagman
- Patient Area the Aging Brain, Functional Unit Neuro and Cognition, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa B Thorell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Abulafia C, Fiorentini L, Loewenstein DA, Curiel-Cid R, Sevlever G, Nemeroff CB, Villarreal MF, Vigo DE, Guinjoan SM. Executive functioning in cognitively normal middle-aged offspring of late-onset Alzheimer's disease patients. J Psychiatr Res 2019; 112:23-29. [PMID: 30836202 DOI: 10.1016/j.jpsychires.2019.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
Episodic memory deficits are traditionally seen as the hallmark cognitive impairment during the prodromal continuum of late-onset Alzheimer's disease (LOAD). Previous studies identified early brain alterations in regions subserving executive functions in asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD), suggesting that premature episodic memory deficits could be associated to executive dysfunction in this model. We hypothesized that O-LOAD would exhibit reduced executive performance evidenced by increased errors and decreased strategy use on an episodic memory task. We assessed 32 asymptomatic middle-aged O-LOAD and 28 age-equivalent control subjects (CS) with several tests that measure executive functions and the Rey Auditory Verbal Learning Test (RAVLT) to measure memory performance. All tests were scored using both traditional and process scores (quantification of errors and strategies underlying overall performance). T-tests were used to compare performance between both groups and Spearman correlations were implemented to measure associations between variables. O-LOAD participants exhibited decreased executive performance compared to CS as it relates to initiation time (Tower of London), mental switching (Trail Making Test B), and interference effects (Stroop Word-Color condition). Traditional RAVLT measures showed a poorer performance by O-LOAD and RAVLT process scores revealed increased interference effects on this group. Positive correlations (rs) were found between the executive measures and several RAVLT measures for O-LOAD but not for CS. In conclusion, O-LOAD participants exhibited early subtle cognitive changes in executive processing. Observed memory difficulties may be associated in part to executive deficits suggesting an interplay between memory and executive functions. Process score impairments were observed earlier than clinical decline on neuropsychological scores in this at-risk cohort and might be useful cognitive markers of preclinical LOAD.
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Affiliation(s)
- Carolina Abulafia
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta. FLENI, Buenos Aires, Argentina; Servicio de Psiquiatría. FLENI, Buenos Aires, Argentina
| | - Leticia Fiorentini
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta. FLENI, Buenos Aires, Argentina; National Council for Scientific and Technological Research (CONICET), Argentina; Servicio de Psiquiatría. FLENI, Buenos Aires, Argentina
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences and Center on Aging, Miller School of Medicine, University of Miami, USA
| | - Rosie Curiel-Cid
- Department of Psychiatry and Behavioral Sciences and Center on Aging, Miller School of Medicine, University of Miami, USA
| | - Gustavo Sevlever
- Departamento de Neuropatología y Biología Molecular. FLENI, Buenos Aires, Argentina; Departamento de Docencia e Investigación. FLENI, Buenos Aires, Argentina
| | - Charles B Nemeroff
- Institute of Early Life Adversity Research, Dell Medical School, The University of Texas, Austin, USA
| | - Mirta F Villarreal
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta. FLENI, Buenos Aires, Argentina; National Council for Scientific and Technological Research (CONICET), Argentina; Department of Physics (FCEyN), University of Buenos Aires, Argentina
| | - Daniel E Vigo
- National Council for Scientific and Technological Research (CONICET), Argentina; Institute for Biomedical Research (BIOMED), School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina; School of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Belgium
| | - Salvador M Guinjoan
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta. FLENI, Buenos Aires, Argentina; National Council for Scientific and Technological Research (CONICET), Argentina; Servicio de Psiquiatría. FLENI, Buenos Aires, Argentina; Departamento de Psiquiatría y Salud Mental, Unidad docente FLENI, Universidad de Buenos Aires, Facultad de Medicina, Argentina.
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19
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Müller S, Herde L, Preische O, Zeller A, Heymann P, Robens S, Elbing U, Laske C. Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer's disease from healthy individuals. Sci Rep 2019; 9:3543. [PMID: 30837580 PMCID: PMC6400894 DOI: 10.1038/s41598-019-40010-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
The early detection of cognitive impairment or dementia is in the focus of current research as the amount of cognitively impaired individuals will rise intensely in the next decades due to aging population worldwide. Currently available diagnostic tools to detect mild cognitive impairment (MCI) or dementia are time-consuming, invasive or expensive and not suitable for wide application as required by the high number of people at risk. Thus, a fast, simple and sensitive test is urgently needed to enable an accurate detection of people with cognitive dysfunction and dementia in the earlier stages to initiate specific diagnostic and therapeutic interventions. We examined digital Clock Drawing Test (dCDT) kinematics for their clinical utility in differentiating patients with amnestic MCI (aMCI) or mild Alzheimer’s dementia (mAD) from healthy controls (HCs) and compared it with the diagnostic value of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery total score. Data of 381 participants (138 patients with aMCI, 106 patients with mAD and 137 HCs) was analyzed in the present study. All participants performed the clock drawing test (CDT) on a tablet computer and underwent the CERAD test battery and depression screening. CERAD total scores were calculated by subtest summation, excluding MMSE scores. All tablet variables (i.e. time in air, time on surface, total time, velocity, pressure, pressure/velocity relation, strokes per minute, time not painting, pen-up stroke length, pen-up/pen-down relation, and CDT score) during dCDT performance were entered in a forward stepwise logistic regression model to assess, which parameters best discriminated between aMCI or mAD and HC. Receiver operating characteristics (ROC) curves were constructed to visualize the specificity in relation to the sensitivity of dCDT variables against CERAD total scores in categorizing the diagnostic groups. dCDT variables provided a slightly better diagnostic accuracy of 81.5% for discrimination of aMCI from HCs than using CERAD total score (accuracy 77.5%). In aMCI patients with normal CDT scores, both dCDT (accuracy 78.0%) and CERAD total scores (accuracy 76.0%) were equally accurate in discriminating against HCs. Finally, in differentiating patients with mAD from healthy individuals, accuracy of both dCDT (93.0%) and CERAD total scores (92.3%) was excellent. Our findings suggest that dCDT is a suitable screening tool to identify early cognitive dysfunction. Its performance is comparable with the time-consuming established psychometric measure (CERAD test battery).
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Affiliation(s)
- Stephan Müller
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany. .,Geriatric Center at the University Hospital, Eberhard Karls University, Tübingen, Germany.
| | - Laura Herde
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany.,Geriatric Center at the University Hospital, Eberhard Karls University, Tübingen, Germany
| | - Oliver Preische
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Anja Zeller
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany.,Geriatric Center at the University Hospital, Eberhard Karls University, Tübingen, Germany
| | - Petra Heymann
- Nuertingen-Geislingen University (HfWU), Institute of Research and Development in Art Therapies, Nuertingen, Germany
| | - Sibylle Robens
- University Witten/Herdecke, Department of Psychology and Psychotherapy, Witten, Germany
| | - Ulrich Elbing
- Nuertingen-Geislingen University (HfWU), Institute of Research and Development in Art Therapies, Nuertingen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
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20
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Liao W, Zhang X, Shu H, Wang Z, Liu D, Zhang Z. The characteristic of cognitive dysfunction in remitted late life depression and amnestic mild cognitive impairment. Psychiatry Res 2017; 251:168-175. [PMID: 28208078 DOI: 10.1016/j.psychres.2017.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
Remitted late life depression exhibits persistent cognitive impairments and enhances the risk of dementia. This study aimed to examine the characteristics of cognitive dysfunction in remitted late life depression and amnestic mild cognitive impairment (MCI). Remitted late life depression (n=61), amnestic MCI (n=61) and age-education-matched controls (n=65) were evaluated with a battery of neuropsychological tests grouped into executive function, memory, processing speed, attention and visuospatial domains. Compared with control subjects, amnestic MCI individuals showed more severe cognitive impairments in all domains, while remitted late life depression individuals performed worse in executive function and memory. The pattern of cognitive profiles significantly differed between remitted late life depression and amnestic MCI groups, which might be mainly attributed to worse impairments in memory and executive function in amnestic MCI individuals. Executive function was the core impaired cognitive domain mediating the influence of predictors on other cognitions in both remitted late life depression and amnestic MCI groups, which indicated a possible etiopathogenic mechanism underlying the conversion to dementia.
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Affiliation(s)
- Wenxiang Liao
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Xiangrong Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China; Department of Geriatric Psychiatry Affiliated Nanjing Brain Hospital Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Hao Shu
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Zan Wang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Duan Liu
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - ZhiJun Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
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21
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Müller S, Preische O, Heymann P, Elbing U, Laske C. Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals. Front Aging Neurosci 2017; 9:101. [PMID: 28443019 PMCID: PMC5386968 DOI: 10.3389/fnagi.2017.00101] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/29/2017] [Indexed: 11/13/2022] Open
Abstract
The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs). Parameters assessed by dCDT were time while transitioning the stylus from one stroke to the next above the surface (i.e., time-in-air), time the stylus produced a visible stroke (i.e., time-on-surface) and total-time during clock drawing. Receiver-operating characteristic (ROC) curves were calculated and logistic regression analyses have been conducted for statistical analysis. Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p < 0.001). In addition, time-in-air was significantly longer in patients with aMCI compared to HC (p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001). Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%. Most interestingly, time-in-air allowed even discrimination of aMCI patients with normal cCDT scores (80% from all aMCI patients) from HCs with a clinically relevant sensitivity of 80.8% and a specificity of 77.8%. A combination of dCDT variables and cCDT scores did not improve the discrimination of patients with aMCI from HC. In conclusion, assessment of time-in-air using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores. Modern digitizing devices offer the opportunity to measure subtle changes of visuo-constructive demands and executive functions that may be used as a fast and easy to perform screening instrument for the early detection of cognitive impairment in primary care.
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Affiliation(s)
- Stephan Müller
- Department of Psychiatry and Psychotherapy, Eberhard Karls UniversityTübingen, Germany.,Geriatric Center at the University Hospital, Eberhard Karls UniversityTübingen, Germany
| | - Oliver Preische
- German Center for Neurodegenerative Diseases (DZNE)Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Eberhard Karls UniversityTübingen, Germany
| | - Petra Heymann
- Art Therapy Research Institute, Nürtingen-Geislingen UniversityNürtingen, Germany
| | - Ulrich Elbing
- Art Therapy Research Institute, Nürtingen-Geislingen UniversityNürtingen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE)Tübingen, Germany.,Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Eberhard Karls UniversityTübingen, Germany
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