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Andruchow D, Cunningham D, Sharma MJ, Ismail Z, Callahan BL. Characterizing mild cognitive impairment to predict incident dementia in adults with bipolar disorder: What should the benchmark be? Clin Neuropsychol 2023; 37:1455-1478. [PMID: 36308307 PMCID: PMC11128134 DOI: 10.1080/13854046.2022.2135605] [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: 05/04/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Objective: Although mild cognitive impairment (MCI) is generally considered a risk state for dementia, its prevalence and association with dementia are impacted by the number of tests and cut-points used to assess cognition and define "impairment," and sources of norms. Here, we investigate how these methodological variations impact estimates of incident dementia in adults with bipolar disorder (BD), a vulnerable population with pre-existing cognitive deficits and increased dementia risk. Method: Neuropsychological data from 148 adults with BD and 13,610 healthy controls (HC) were drawn from the National Alzheimer's Coordinating Center. BD participants' scores were standardized against published norms and again using regression-based norms generated from HC within the same catchment area as individual BD patients ("site-specific norms"), varying the number of within-domain tests (one vs. two) and the cut-points (-1 vs. -1.5 SD) used to operationalize MCI. Results: Site-specific norms were more sensitive to incident dementia (88.6%-94.3%) than published norms (74.3%-88.6%), but only when using a "single test" definition of impairment. Specificity (22.1%-74.3%), accuracy (37.8%-68.9%), and positive predictive values (26.1%-38.3%) were overall poor. Applying a "single test" definition of impairment resulted in better negative predictive values using site-specific (92.3%-93.3%) than published norms (83.6%-86.2%), and a substantial increase in relative risk of incident dementia relative to published norms. Conclusions: Neuropsychologists should define "impairment" as scores below -1.0 or -1.5 SD on at least two within-domain measures when using published norms to interpret cognitive performance in adults with BD.
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Affiliation(s)
- Daniel Andruchow
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Daniel Cunningham
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Manu J. Sharma
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
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Tian J, Wang Y, Guo L, Li S. Association of Income with Post-Stroke Cognition and the Underlying Neuroanatomical Mechanism. Brain Sci 2023; 13:brainsci13020363. [PMID: 36831905 PMCID: PMC9954609 DOI: 10.3390/brainsci13020363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/01/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To investigate the association between income and post-stroke cognition at 3 months, and the underlying neuroanatomical mechanism. METHODS Patients with first-ever ischemic stroke were enrolled and analyzed. Baseline information on income and neuroimaging measurements with predictive values for post-stroke cognitive impairment (PSCI) were collected within 7 days of the admission. Three months after the index stroke, all participants underwent a detailed neuropsychological test battery. The associations between income and PSCI and between income and brain structural measurements were investigated. RESULTS A total of 294 patients were recruited for this study. Lower income was independently associated with poor cognitive performance on Stroop tests, Clinical Dementia Rating, Boston Naming Test, and Verbal Fluency Test. Regarding neuroimaging parameters, lower income was associated with a lower total brain volume (TBV)/total intracranial volume (TICV) ratio (p = 0.004). CONCLUSIONS Lower income is associated with an increased chance of post-stroke cognitive decline, particularly in executive function and language domains. Since global brain atrophy (measured by TBV/TICV ratio) is a strong predictor for PSCI, its correlation with income may help explain the neuroanatomical mechanism between income and post-stroke cognition.
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Affiliation(s)
- Jingyuan Tian
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Yue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- National Clinical Research Center for Neurological Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Correspondence: (L.G.); (S.L.); Tel.: +86-18531135618 (L.G.)
| | - Shiping Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- National Clinical Research Center for Neurological Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
- Correspondence: (L.G.); (S.L.); Tel.: +86-18531135618 (L.G.)
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L K, Ng TKS, Wee HN, Ching J. Gut-brain axis through the lens of gut microbiota and their relationships with Alzheimer's disease pathology: Review and recommendations. Mech Ageing Dev 2023; 211:111787. [PMID: 36736919 DOI: 10.1016/j.mad.2023.111787] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/05/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that affects millions of people worldwide. Growing evidence suggests that the gut microbiome (GM) plays a pivotal role in the pathogenesis of AD through the microbiota-gut-brain axis (MGB). Alterations in GM composition and diversity have been observed in both animal models and in human patients with AD. GM dysbiosis has been implicated in increased intestinal permeability, blood-brain barrier (BBB) impairment, neuroinflammation and the development of hallmarks of AD. Further elucidation of the role of GM in AD could pave way for the development of holistic predictive methods for determining AD risk and progression of disease. Furthermore, accumulating evidence suggests that GM modulation could alleviate adverse symptoms of AD or serve as a preventive measure. In addition, increasing evidence shows that Type 2 Diabetes Mellitus (T2DM) is often comorbid with AD, with common GM alterations and inflammatory response, which could chart the development of GM-related treatment interventions for both diseases. We conclude by exploring the therapeutic potential of GM in alleviating symptoms of AD and in reducing risk. Furthermore, we also propose future directions in AD research, namely fecal microbiota transplantation (FMT) and precision medicine.
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Affiliation(s)
- Krishaa L
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Ted Kheng Siang Ng
- Arizona State University, Edson College of Nursing and Health Innovation, USA.
| | - Hai Ning Wee
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore; KK Research Centre, KK Women's and Children's Hospital, Singapore.
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Sapkota S, Ramirez J, Yhap V, Masellis M, Black SE. Brain atrophy trajectories predict differential functional performance in Alzheimer's disease: Moderations with apolipoprotein E and sex. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12244. [PMID: 34692981 PMCID: PMC8515221 DOI: 10.1002/dad2.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION We examine whether distinct brain atrophy patterns (using brain parenchymal fraction [BPF]) differentially predict functional performance and decline in Alzheimer's disease (AD), and are independently moderated by (1) a key AD genetic risk marker (apolipoprotein E [APOE]), (2) sex, and (3) high-risk group (women APOE ɛ4 carriers). METHODS We used a 2-year longitudinal sample of AD patients (baseline N = 170; mean age = 71.3 [9.1] years) from the Sunnybrook Dementia Study. We applied latent class analysis, latent growth modeling, and path analysis. We aimed to replicate our findings (N = 184) in the Alzheimer's Disease Neuroimaging Initiative. RESULTS We observed that high brain atrophy class predicted lower functional performance and steeper decline. This association was moderated by APOE, sex, and high-risk group. Baseline findings as moderated by APOE and high-risk group were replicated. DISCUSSION Women APOE ɛ4 carriers may selectively be at a greater risk of functional impairment with higher brain atrophy.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Joel Ramirez
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Vanessa Yhap
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Mario Masellis
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
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Liu X, Chen X, Zhou X, Shang Y, Xu F, Zhang J, He J, Zhao F, Du B, Wang X, Zhang Q, Zhang W, Bergeron MF, Ding T, Ashford JW, Zhong L. Validity of the MemTrax Memory Test Compared to the Montreal Cognitive Assessment in the Detection of Mild Cognitive Impairment and Dementia due to Alzheimer's Disease in a Chinese Cohort. J Alzheimers Dis 2021; 80:1257-1267. [PMID: 33646151 DOI: 10.3233/jad-200936] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A valid, reliable, accessible, engaging, and affordable digital cognitive screen instrument for clinical use is in urgent demand. OBJECTIVE To assess the clinical utility of the MemTrax memory test for early detection of cognitive impairment in a Chinese cohort. METHODS The 2.5-minute MemTrax and the Montreal Cognitive Assessment (MoCA) were performed by 50 clinically diagnosed cognitively normal (CON), 50 mild cognitive impairment due to AD (MCI-AD), and 50 Alzheimer's disease (AD) volunteer participants. The percentage of correct responses (MTx-% C), the mean response time (MTx-RT), and the composite scores (MTx-Cp) of MemTrax and the MoCA scores were comparatively analyzed and receiver operating characteristic (ROC) curves generated. RESULTS Multivariate linear regression analyses indicated MTx-% C, MTx-Cp, and the MoCA score were significantly lower in MCI-AD versus CON and in AD versus MCI-AD groups (all with p≤0.001). For the differentiation of MCI-AD from CON, an optimized MTx-% C cutoff of 81% had 72% sensitivity and 84% specificity with an area under the curve (AUC) of 0.839, whereas the MoCA score of 23 had 54% sensitivity and 86% specificity with an AUC of 0.740. For the differentiation of AD from MCI-AD, MTx-Cp of 43.0 had 70% sensitivity and 82% specificity with an AUC of 0.799, whereas the MoCA score of 20 had 84% sensitivity and 62% specificity with an AUC of 0.767. CONCLUSION MemTrax can effectively detect both clinically diagnosed MCI and AD with better accuracy as compared to the MoCA based on AUCs in a Chinese cohort.
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Affiliation(s)
- Xiaolei Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Yunnan Provincial Clinical Research Center for Neurological Diseases, Yunnan, China
| | - Xinjie Chen
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Yunnan Provincial Clinical Research Center for Neurological Diseases, Yunnan, China
| | - Xianbo Zhou
- SJN Biomed Ltd., Kunming, Yunnan, China.,Center for Alzheimer's Research, Washington Institute of Clinical Research, Vienna, VA, USA
| | - Yajun Shang
- Yunnan Provincial Clinical Research Center for Neurological Diseases, Yunnan, China.,Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Sichuan, China
| | - Junyan Zhang
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Feng Zhao
- Department of Neurology, Dehong People's Hospital, Dehong, Yunnan, China
| | - Bo Du
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xuan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qi Zhang
- SJN Biomed Ltd., Kunming, Yunnan, China
| | | | | | - Tao Ding
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - J Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lianmei Zhong
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Yunnan Provincial Clinical Research Center for Neurological Diseases, Yunnan, China
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Sharma MJ, Callahan BL. Cerebrovascular and Neurodegenerative Pathologies in Long-Term Stable Mild Cognitive Impairment. J Alzheimers Dis 2021; 79:1269-1283. [PMID: 33427736 DOI: 10.3233/jad-200829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is considered by some to be a prodromal phase of a progressive disease (i.e., neurodegeneration) resulting in dementia; however, a substantial portion of individuals (ranging from 5-30%) remain cognitively stable over the long term (sMCI). The etiology of sMCI is unclear but may be linked to cerebrovascular disease (CVD), as evidence from longitudinal studies suggest a significant proportion of individuals with vasculopathy remain stable over time. OBJECTIVE To quantify the presence of neurodegenerative and vascular pathologies in individuals with long-term (>5-year) sMCI, in a preliminary test of the hypothesis that CVD may be a contributor to non-degenerative cognitive impairment. We expect frequent vasculopathy at autopsy in sMCI relative to neurodegenerative disease, and relative to individuals who convert to dementia. METHODS In this retrospective study, using data from the National Alzheimer's Coordinating Center, individuals with sMCI (n = 28) were compared to those with MCI who declined over a 5 to 9-year period (dMCI; n = 139) on measures of neurodegenerative pathology (i.e., Aβ plaques, neurofibrillary tangles, TDP-43, and cerebral amyloid angiopathy) and CVD (infarcts, lacunes, microinfarcts, hemorrhages, and microbleeds). RESULTS Alzheimer's disease pathology (Aβ plaques, neurofibrillary tangles, and cerebral amyloid angiopathy) was significantly higher in the dMCI group than the sMCI group. Microinfarcts were the only vasculopathy associated with group membership; these were more frequent in sMCI. CONCLUSION The most frequent neuropathology in this sample of long-term sMCI was microinfarcts, tentatively suggesting that silent small vessel disease may characterize non-worsening cognitive impairment.
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Affiliation(s)
- Manu J Sharma
- Department of Psychology, University of Calgary, Calgary (AB), Canada
- Hotchkiss Brain Institute, Calgary (AB), Canada
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary (AB), Canada
- Hotchkiss Brain Institute, Calgary (AB), Canada
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Weiss J, Puterman E, Prather AA, Ware EB, Rehkopf DH. A data-driven prospective study of dementia among older adults in the United States. PLoS One 2020; 15:e0239994. [PMID: 33027275 PMCID: PMC7540891 DOI: 10.1371/journal.pone.0239994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Studies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups. Methods and findings We conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women). Conclusions We identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.
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Affiliation(s)
- Jordan Weiss
- Population Studies Center and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (DHR); (JW)
| | - Eli Puterman
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aric A. Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, United States of America
| | - Erin B. Ware
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David H. Rehkopf
- School of Medicine, Stanford University, Palo Alto, California, United States of America
- * E-mail: (DHR); (JW)
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Operationalizing Impaired Performance in Neuropsychological Assessment: A Comparison of the Use of Published Versus Sample-Based Normative Data for the Prediction of Dementia. J Int Neuropsychol Soc 2020; 26:624-631. [PMID: 31822300 DOI: 10.1017/s1355617719001309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To compare the sensitivity, specificity, and predictive value of published versus sample-based norms to detect early dementia in the Uniform Data Set (UDS). METHODS The UDS was administered to 526 nondemented participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Baseline scores were standardized using published norms and healthy control data from ADNI corrected for age, education, and sex. Subjects obtaining two scores < -1 SD (determined separately using published and sample norms) were labeled "at risk for dementia." Both methods were compared on sensitivity, specificity, and positive/negative predictive value (PPV/NPV) for dementia at follow-up. RESULTS Risk scores derived from published data had 86.1% sensitivity, 62.0% specificity, 68.6% accuracy, 46.1% PPV, and 92.2% NPV. Those from sample norms were more sensitive (91.0%), less specific (52.9%), and less accurate (63.3%), with worse PPV (42.1%) and similar NPV (94.0%). Sample norms were better at identifying incident dementia cases with relatively lower education than those with higher education. Discrepancies between both methods were more common in women. CONCLUSIONS Sample norms are marginally more sensitive than published norms for predicting dementia, while published norms are slightly more accurate. Accuracy of risk estimates for women and those with lower education may be increased using locally generated norms.
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Lombardi G, Crescioli G, Cavedo E, Lucenteforte E, Casazza G, Bellatorre A, Lista C, Costantino G, Frisoni G, Virgili G, Filippini G. Structural magnetic resonance imaging for the early diagnosis of dementia due to Alzheimer's disease in people with mild cognitive impairment. Cochrane Database Syst Rev 2020; 3:CD009628. [PMID: 32119112 PMCID: PMC7059964 DOI: 10.1002/14651858.cd009628.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) due to Alzheimer's disease is the symptomatic predementia phase of Alzheimer's disease dementia, characterised by cognitive and functional impairment not severe enough to fulfil the criteria for dementia. In clinical samples, people with amnestic MCI are at high risk of developing Alzheimer's disease dementia, with annual rates of progression from MCI to Alzheimer's disease estimated at approximately 10% to 15% compared with the base incidence rates of Alzheimer's disease dementia of 1% to 2% per year. OBJECTIVES To assess the diagnostic accuracy of structural magnetic resonance imaging (MRI) for the early diagnosis of dementia due to Alzheimer's disease in people with MCI versus the clinical follow-up diagnosis of Alzheimer's disease dementia as a reference standard (delayed verification). To investigate sources of heterogeneity in accuracy, such as the use of qualitative visual assessment or quantitative volumetric measurements, including manual or automatic (MRI) techniques, or the length of follow-up, and age of participants. MRI was evaluated as an add-on test in addition to clinical diagnosis of MCI to improve early diagnosis of dementia due to Alzheimer's disease in people with MCI. SEARCH METHODS On 29 January 2019 we searched Cochrane Dementia and Cognitive Improvement's Specialised Register and the databases, MEDLINE, Embase, BIOSIS Previews, Science Citation Index, PsycINFO, and LILACS. We also searched the reference lists of all eligible studies identified by the electronic searches. SELECTION CRITERIA We considered cohort studies of any size that included prospectively recruited people of any age with a diagnosis of MCI. We included studies that compared the diagnostic test accuracy of baseline structural MRI versus the clinical follow-up diagnosis of Alzheimer's disease dementia (delayed verification). We did not exclude studies on the basis of length of follow-up. We included studies that used either qualitative visual assessment or quantitative volumetric measurements of MRI to detect atrophy in the whole brain or in specific brain regions, such as the hippocampus, medial temporal lobe, lateral ventricles, entorhinal cortex, medial temporal gyrus, lateral temporal lobe, amygdala, and cortical grey matter. DATA COLLECTION AND ANALYSIS Four teams of two review authors each independently reviewed titles and abstracts of articles identified by the search strategy. Two teams of two review authors each independently assessed the selected full-text articles for eligibility, extracted data and solved disagreements by consensus. Two review authors independently assessed the quality of studies using the QUADAS-2 tool. We used the hierarchical summary receiver operating characteristic (HSROC) model to fit summary ROC curves and to obtain overall measures of relative accuracy in subgroup analyses. We also used these models to obtain pooled estimates of sensitivity and specificity when sufficient data sets were available. MAIN RESULTS We included 33 studies, published from 1999 to 2019, with 3935 participants of whom 1341 (34%) progressed to Alzheimer's disease dementia and 2594 (66%) did not. Of the participants who did not progress to Alzheimer's disease dementia, 2561 (99%) remained stable MCI and 33 (1%) progressed to other types of dementia. The median proportion of women was 53% and the mean age of participants ranged from 63 to 87 years (median 73 years). The mean length of clinical follow-up ranged from 1 to 7.6 years (median 2 years). Most studies were of poor methodological quality due to risk of bias for participant selection or the index test, or both. Most of the included studies reported data on the volume of the total hippocampus (pooled mean sensitivity 0.73 (95% confidence interval (CI) 0.64 to 0.80); pooled mean specificity 0.71 (95% CI 0.65 to 0.77); 22 studies, 2209 participants). This evidence was of low certainty due to risk of bias and inconsistency. Seven studies reported data on the atrophy of the medial temporal lobe (mean sensitivity 0.64 (95% CI 0.53 to 0.73); mean specificity 0.65 (95% CI 0.51 to 0.76); 1077 participants) and five studies on the volume of the lateral ventricles (mean sensitivity 0.57 (95% CI 0.49 to 0.65); mean specificity 0.64 (95% CI 0.59 to 0.70); 1077 participants). This evidence was of moderate certainty due to risk of bias. Four studies with 529 participants analysed the volume of the total entorhinal cortex and four studies with 424 participants analysed the volume of the whole brain. We did not estimate pooled sensitivity and specificity for the volume of these two regions because available data were sparse and heterogeneous. We could not statistically evaluate the volumes of the lateral temporal lobe, amygdala, medial temporal gyrus, or cortical grey matter assessed in small individual studies. We found no evidence of a difference between studies in the accuracy of the total hippocampal volume with regards to duration of follow-up or age of participants, but the manual MRI technique was superior to automatic techniques in mixed (mostly indirect) comparisons. We did not assess the relative accuracy of the volumes of different brain regions measured by MRI because only indirect comparisons were available, studies were heterogeneous, and the overall accuracy of all regions was moderate. AUTHORS' CONCLUSIONS The volume of hippocampus or medial temporal lobe, the most studied brain regions, showed low sensitivity and specificity and did not qualify structural MRI as a stand-alone add-on test for an early diagnosis of dementia due to Alzheimer's disease in people with MCI. This is consistent with international guidelines, which recommend imaging to exclude non-degenerative or surgical causes of cognitive impairment and not to diagnose dementia due to Alzheimer's disease. In view of the low quality of most of the included studies, the findings of this review should be interpreted with caution. Future research should not focus on a single biomarker, but rather on combinations of biomarkers to improve an early diagnosis of Alzheimer's disease dementia.
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Affiliation(s)
- Gemma Lombardi
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Giada Crescioli
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Enrica Cavedo
- Pitie‐Salpetriere Hospital, Sorbonne UniversityAlzheimer Precision Medicine (APM), AP‐HP47 boulevard de l'HopitalParisFrance75013
| | - Ersilia Lucenteforte
- University of PisaDepartment of Clinical and Experimental MedicineVia Savi 10PisaItaly56126
| | - Giovanni Casazza
- Università degli Studi di MilanoDipartimento di Scienze Biomediche e Cliniche "L. Sacco"via GB Grassi 74MilanItaly20157
| | | | - Chiara Lista
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo BestaNeuroepidemiology UnitVia Celoria, 11MilanoItaly20133
| | - Giorgio Costantino
- Ospedale Maggiore Policlinico, Università degli Studi di MilanoUOC Pronto Soccorso e Medicina D'Urgenza, Fondazione IRCCS Ca' GrandaMilanItaly
| | | | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Brambilla, 3FlorenceItaly50134
| | - Graziella Filippini
- Carlo Besta Foundation and Neurological InstituteScientific Director’s Officevia Celoria, 11MilanItaly20133
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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: 26] [Impact Index Per Article: 6.5] [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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11
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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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12
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Andrés P, Vico H, Yáñez A, Siquier A, Ferrer GA. Quantifying memory deficits in amnestic mild cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:108-114. [PMID: 30723774 PMCID: PMC6351432 DOI: 10.1016/j.dadm.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the present study, we use the item-specific deficit approach (ISDA), a method for characterizing memory deficits in list-learning, to portray the memory deficits in amnestic mild cognitive impairment (aMCI). METHODS We applied the ISDA to compare memory performance of patients with aMCI and healthy controls in encoding, consolidation, and retrieval using the Free and Cued Selective Reminding Test. RESULTS The results revealed clear differences in recall performance between patients with aMCI and controls. When analyzing the ISDA deficit indices, the results revealed a prominent encoding deficit, followed by a consolidating deficit. A greater sensitivity for the encoding index confirmed that a difficulty with encoding information plays a major role in explaining the episodic memory deficits experienced by patients with aMCI. DISCUSSION The present study applying the ISDA reveals great sensitivity and specificity of the encoding deficit index when identifying aMCI. As aMCI constitutes a risk factor to develop Alzheimer's disease, the current findings also confirm the need to concentrate on encoding deficits as an early diagnostic sign of cognitive decline.
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Affiliation(s)
- Pilar Andrés
- Neuropsychology and Cognition Research Group, Research Institute on Health Sciences and Balearic Health Research Institute and IdISBa, Palma, Spain
- Department of Psychology, University of the Balearic Islands, Palma, Spain
| | - Helena Vico
- Neuropsychology and Cognition Research Group, Research Institute on Health Sciences and Balearic Health Research Institute and IdISBa, Palma, Spain
- Valencia University Clinic Hospital, Valencia, Spain
- Dr Peset University Hospital, Valencia, Spain
| | - Aina Yáñez
- Neuropsychology and Cognition Research Group, Research Institute on Health Sciences and Balearic Health Research Institute and IdISBa, Palma, Spain
- Department of Physiotherapy and Infirmary, University of the Balearic Islands, Palma, Spain
| | - Antònia Siquier
- Neuropsychology and Cognition Research Group, Research Institute on Health Sciences and Balearic Health Research Institute and IdISBa, Palma, Spain
- Department of Psychology, University of the Balearic Islands, Palma, Spain
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13
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Abstract
Objective: The purpose of this critical review was to evaluate the current state of research regarding the incremental value of neuropsychological assessment in clinical practice, above and beyond what can be accounted for on the basis of demographic, medical, and other diagnostic variables. The focus was on neurological and other medical conditions across the lifespan where there is known risk for presence or future development of cognitive impairment.Method: Eligible investigations were group studies that had been published after 01/01/2000 in English in peer-reviewed journals and that had used standardized neuropsychological measures and reported on objective outcome criterion variables. They were identified through PubMed and PsychInfo electronic databases on the basis of predefined specific selection criteria. Reference lists of identified articles were also reviewed to identify potential additional sources. The Grades of Recommendation, Assessment, Development and Evaluation Working Group's (GRADE) criteria were used to evaluate quality of studies.Results: Fifty-six studies met the final selection criteria, including 2 randomized-controlled trials, 9 prospective cohort studies, 12 retrospective cohort studies, 21 inception cohort studies, 2 case control studies, and 10 case series studies. The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.Conclusions: Neuropsychological assessment can improve both diagnostic classification and prediction of long-term daily-life outcomes in patients across the lifespan. Future high-quality prospective cohort studies and randomized-controlled trials are necessary to demonstrate more definitively the incremental value of neuropsychological assessment in the management of patients with various neurological and other medical conditions.
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Affiliation(s)
- Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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14
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Abstract
There are many instruments for screening cognitive impairment. The common tools for screening cognitive impairment are categorized into 4 groups (very brief, brief, self-administered, and test batteries) in geriatrics. There are some tests used for specific tests of 6 cognitive domains (learning and memory, language, executive function, complex attention, and social cognition) by following the DSM-V criteria. Different settings, stages, conditions, and specific people need some specific tools for screening cognitive impairment. It must be noted that there is some harm in screening for cognitive impairment in geriatrics.
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Affiliation(s)
- Ziqi Wang
- Department of Neurology, Chengdu Fifth People's Hospital, No. 33 Mashi Street, Chengdu, Sichuan, China 611130
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China 610041.
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15
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Ashford JW, Tarpin-Bernard F, Ashford CB, Ashford MT. A Computerized Continuous-Recognition Task for Measurement of Episodic Memory. J Alzheimers Dis 2019; 69:385-399. [PMID: 30958384 PMCID: PMC6597981 DOI: 10.3233/jad-190167] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Based on clinical observations of severe episodic memory (EM) impairment in dementia of Alzheimer’s disease (AD), a brief, computerized EM test was developed for AD patient evaluation. A continuous recognition task (CRT) was chosen because of its extensive use in EM research. Initial experience with this computerized CRT (CCRT) showed patients were very engaged in the test, but AD patients had marked failure in recognizing repeated images. Subsequently, the test was administered to audiences, and then a two-minute online version was implemented (http://www.memtrax.com). The online CCRT shows 50 images, 25 unique and 25 repeats, which subjects respectively either try to remember or indicate recognition as quickly as possible. The pictures contain 5 sets of 5 images of scenes or objects (e.g., mountains, clothing, vehicles, etc.). A French company (HAPPYneuron, SAS) provided the test for 2 years, with these results. Of 18,477 individuals, who indicated sex and age 21–99 years and took the test for the first time, 18,007 individuals performed better than chance. In this group, age explained 1.5% of the variance in incorrect responses and 3.5% of recognition time variance, indicating considerable population variability. However, when averaging for specific year of age, age explained 58% of percent incorrect variance and 78% of recognition time variance, showing substantial population variability but a major age effect. There were no apparent sex effects. Further studies are indicated to determine the value of this CCRT as an AD screening test and validity as a measure of EM impairment in other clinical conditions.
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Affiliation(s)
- J Wesson Ashford
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,War Related Illness & Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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16
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Early versus late MCI: Improved MCI staging using a neuropsychological approach. Alzheimers Dement 2019; 15:699-708. [PMID: 30737119 DOI: 10.1016/j.jalz.2018.12.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The Alzheimer's Disease Neuroimaging Initiative (ADNI) separates "early" and "late" mild cognitive impairment (MCI) based on a single memory test. We compared ADNI's MCI classifications to our neuropsychological approach, which more broadly assesses cognitive abilities. METHODS Three hundred thirty-six ADNI-2 participants were classified as "early" or "late" MCI. Cluster analysis was performed on neuropsychological test data, and participants were reclassified based on cluster results. These two staging approaches were compared on progression rates, cerebrospinal fluid biomarkers, and cortical thickness profiles. RESULTS There was little correspondence between the two staging methods. ADNI's early MCI group included a large proportion of false-positive diagnostic errors. The reclassified neuropsychological MCI groups showed steeper survival curves and more abnormal biomarkers. CONCLUSIONS Our novel neuropsychological approach improved the staging of MCI by (1) capturing individuals at an early symptomatic stage, (2) minimizing false-positive cases, and (3) identifying a late MCI group further along the disease trajectory.
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17
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Role of GTPases in the Regulation of Mitochondrial Dynamics in Alzheimer's Disease and CNS-Related Disorders. Mol Neurobiol 2018; 56:4530-4538. [PMID: 30338485 DOI: 10.1007/s12035-018-1397-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/14/2018] [Indexed: 12/22/2022]
Abstract
Data obtained from several studies have shown that mitochondria are involved and play a central role in the progression of several distinct pathological conditions. Morphological alterations and disruptions on the functionality of mitochondria may be related to metabolic and energy deficiency in neurons in a neurodegenerative disorder. Several recent studies demonstrate the linkage between neurodegeneration and mitochondrial dynamics in the spectrum of a promising era called precision mitochondrial medicine. In this review paper, an analysis of the correlation between mitochondria, Alzheimer's disease, and other central nervous system (CNS)-related disorders like the Parkinson's disease and the autism spectrum disorder is under discussion. The role of GTPases like the mfn1, mfn2, opa1, and dlp1 in mitochondrial fission and fusion is also under investigation, influencing mitochondrial population and leading to oxidative stress and neuronal damage.
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18
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Laubach M, Lammers F, Zacharias N, Feinkohl I, Pischon T, Borchers F, Slooter AJC, Kühn S, Spies C, Winterer G. Size matters: Grey matter brain reserve predicts executive functioning in the elderly. Neuropsychologia 2018; 119:172-181. [PMID: 30102906 DOI: 10.1016/j.neuropsychologia.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Abstract
Preserved executive functioning (EF) is crucial for daily functioning in the elderly and it appears to predict dementia development. We sought to clarify the role of atrophy-corrected cortical grey matter (GM) volume as a potential brain reserve (BR) marker for EF in the elderly. In total, 206 pre-surgical subjects (72.50 ± 4.95 years; mean MMSE score 28.50) were investigated. EF was primarily assessed using the Trail Making Test B (TMT B). Global/ lobar GM volumes were acquired with T1 MP-RAGE. Adjusting for key covariates including a brain atrophy index (i.e. brain parenchymal fraction), multiple linear regression analysis was used to study associations of GM volumes and TMT B. All GM volumes - most notably of global GM - were significantly associated with TMT B independently of GM atrophy (ß = -0.201 to -0.275, p = 0.001-0.012). Using atrophy-corrected GM volume as an estimate of maximal GM size in youth may serve as a BR predictor for cognitive decline in future studies investigating BR in the elderly.
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Affiliation(s)
- M Laubach
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany.
| | - F Lammers
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - N Zacharias
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - I Feinkohl
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - T Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - F Borchers
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - S Kühn
- Clinic and Polyclinic of Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - C Spies
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - G Winterer
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Dept. of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Biotech Park Berlin-Buch, Robert-Rössle-Str. 10, 13125 Berlin, Germany
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19
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Hane F, Augusta C, Bai O. A hierarchical Bayesian model to predict APOE4 genotype and the age of Alzheimer's disease onset. PLoS One 2018; 13:e0200263. [PMID: 30001420 PMCID: PMC6042730 DOI: 10.1371/journal.pone.0200263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/24/2018] [Indexed: 11/19/2022] Open
Abstract
In this work we use a hierarchical Bayesian paradigm to introduce a theoretical framework to determine an individual's Apolipoprotein ε4 (APOE4) genotype, which heavily influences both the age of onset and probability of acquiring Alzheimer's disease (AD). This calculation is based solely on an individual's family history. This APOE4 genotype estimation is then combined with a number of known factors that influence AD onset to produce a function that estimates the onset of AD as a function of age. We disseminated our Alzheimer's predictive tool online at http://www.alzheimerspredictor.com.
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Affiliation(s)
- Francis Hane
- Lakehead University, Thunder Bay, Ontario, CANADA
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, CANADA
| | | | - Owen Bai
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, CANADA
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20
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Venneri A, Jahn-Carta C, de Marco M, Quaranta D, Marra C. Diagnostic and prognostic role of semantic processing in preclinical Alzheimer's disease. Biomark Med 2018; 12:637-651. [PMID: 29896968 DOI: 10.2217/bmm-2017-0324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Relatively spared during most of the timeline of normal aging, semantic memory shows a subtle yet measurable decline even during the pre-clinical stage of Alzheimer's disease. This decline is thought to reflect early neurofibrillary changes and impairment is detectable using tests of language relying on lexical-semantic abilities. A promising approach is the characterization of semantic parameters such as typicality and age of acquisition of words, and propositional density from verbal output. Seminal research like the Nun Study or the analysis of the linguistic decline of famous writers and politicians later diagnosed with Alzheimer's disease supports the early diagnostic value of semantic processing and semantic memory. Moreover, measures of these skills may play an important role for the prognosis of patients with mild cognitive impairment.
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Affiliation(s)
- Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Matteo de Marco
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Davide Quaranta
- Neurology Unit, Fondazione Policlinico Universitario 'A Gemelli', Rome, Italy
| | - Camillo Marra
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome; Memory Clinic, Fondazione Policlinico Universitario 'A Gemelli', Rome, Italy
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21
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Kauppi K, Fan CC, McEvoy LK, Holland D, Tan CH, Chen CH, Andreassen OA, Desikan RS, Dale AM. Combining Polygenic Hazard Score With Volumetric MRI and Cognitive Measures Improves Prediction of Progression From Mild Cognitive Impairment to Alzheimer's Disease. Front Neurosci 2018; 12:260. [PMID: 29760643 PMCID: PMC5937163 DOI: 10.3389/fnins.2018.00260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023] Open
Abstract
Improved prediction of progression to Alzheimer's Disease (AD) among older individuals with mild cognitive impairment (MCI) is of high clinical and societal importance. We recently developed a polygenic hazard score (PHS) that predicted age of AD onset above and beyond APOE. Here, we used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to further explore the potential clinical utility of PHS for predicting AD development in older adults with MCI. We examined the predictive value of PHS alone and in combination with baseline structural magnetic resonance imaging (MRI) data on performance on the Mini-Mental State Exam (MMSE). In survival analyses, PHS significantly predicted time to progression from MCI to AD over 120 months (p = 1.07e-5), and PHS was significantly more predictive than APOE alone (p = 0.015). Combining PHS with baseline brain atrophy score and/or MMSE score significantly improved prediction compared to models without PHS (three-factor model p = 4.28e-17). Prediction model accuracies, sensitivities and area under the curve were also improved by including PHS in the model, compared to only using atrophy score and MMSE. Further, using linear mixed-effect modeling, PHS improved the prediction of change in the Clinical Dementia Rating-Sum of Boxes (CDR-SB) score and MMSE over 36 months in patients with MCI at baseline, beyond both APOE and baseline levels of brain atrophy. These results illustrate the potential clinical utility of PHS for assessment of risk for AD progression among individuals with MCI both alone, or in conjunction with clinical measures of prodromal disease including measures of cognitive function and regional brain atrophy.
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Affiliation(s)
- Karolina Kauppi
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Radiation Sciences, University of Umea, Umea, Sweden
| | - Chun Chieh Fan
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Cognitive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Linda K. McEvoy
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Dominic Holland
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Chin Hong Tan
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Chi-Hua Chen
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Ole A. Andreassen
- NORMENT, Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo University Hospital, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rahul S. Desikan
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Anders M. Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Cognitive Sciences, University of California, San Diego, La Jolla, CA, United States
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
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22
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Chung JK, Plitman E, Nakajima S, Caravaggio F, Iwata Y, Gerretsen P, Kim J, Takeuchi H, Shinagawa S, Patel R, Chakravarty MM, Graff-Guerrero A. Hippocampal and Clinical Trajectories of Mild Cognitive Impairment with Suspected Non-Alzheimer's Disease Pathology. J Alzheimers Dis 2018; 58:747-762. [PMID: 28505977 DOI: 10.3233/jad-170201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suspected non-Alzheimer's disease pathology (SNAP) characterizes individuals showing neurodegeneration (e.g., hypometabolism) without amyloid-β (Aβ). Findings from previous studies regarding clinical and structural trajectories of SNAP are inconsistent. Using data from the Alzheimer's Disease Neuroimaging Initiative, patients with amnestic mild cognitive impairment (MCI) were categorized into four groups: amyloid positive with hypometabolism (Aβ+ND+), amyloid only (Aβ+ND-), neither amyloid nor hypometabolism (Aβ-ND-), and SNAP (Aβ-ND+). Aβ+ND+(n = 33), Aβ+ND-(n = 32), and Aβ-ND-(n = 36) were matched to SNAP for age, gender, apolipoprotein E4 (apoE4) genotype, and scores on the Montreal Cognitive Assessment. Elderly controls (n = 40) were also matched to SNAP for age, gender, and apoE4 genotype. Longitudinal changes were compared across groups in terms of hippocampal volume, clinical symptoms, daily functioning, and cognitive functioning over a 2-year period. At baseline, no difference in cognition and functioning was observed between SNAP and Aβ+groups. SNAP showed worse clinical symptoms and impaired functioning at baseline compared to Aβ-ND-and controls. Two years of follow-up showed no differences in hippocampal volume changes between SNAP and any of the comparison groups. SNAP showed worse functional deterioration in comparison to Aβ-ND-and controls. However, Aβ+ND+ showed more severe changes in clinical symptoms in comparison to SNAP. Thus, patients with MCI and SNAP showed 1) more severe functional deterioration compared to Aβ-ND-and controls, 2) no differences with Aβ+ND-, and 3) less cognitive deterioration than Aβ+ND+. Future studies should investigate what causes SNAP, which is different from typical AD pathology and biomarker cascades.
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Affiliation(s)
- Jun Ku Chung
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Eric Plitman
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Philip Gerretsen
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Julia Kim
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | | | - Raihaan Patel
- Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, QC, Canada.,Department of Psychiatry and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada
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Aerts L, Heffernan M, Kochan NA, Crawford JD, Draper B, Trollor JN, Sachdev PS, Brodaty H. Effects of MCI subtype and reversion on progression to dementia in a community sample. Neurology 2017; 88:2225-2232. [PMID: 28490651 DOI: 10.1212/wnl.0000000000004015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/16/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to understand the trajectory of mild cognitive impairment (MCI) better by examining longitudinally different MCI subtypes and progression to dementia and reversion to normal cognition in a community sample. METHODS We evaluated the stability of MCI subtypes and risk of dementia over 4 biennial assessments as part of an ongoing prospective cohort study, the Sydney Memory and Ageing Study. RESULTS While prevalence of MCI and different MCI subtypes remains relatively stable across all assessments, reversion from MCI and transitions between different MCI subtypes were common. Up to 46.5% of participants classified with MCI at baseline reverted at some point during follow-up. The majority (83.8%) of participants with incident dementia were diagnosed with MCI 2 years prior to their dementia diagnosis. Both reverters and participants with stable MCI were at an increased risk of progression to dementia compared to those without MCI at baseline (HR 6.4, p = 0.02, and HR 24.7, p < 0.001, respectively); however, the risk of dementia in participants with MCI who did not revert was higher than in reverters (HR 2.5, p = 0.01). This effect was specific to amnestic subtypes (MCI reverters vs nonreverters: amnestic MCI HR 3.3, p = 0.006; nonamnestic MCI: HR 1.3, p = 0.67). CONCLUSION Our findings indicate that the relevance of reversion for progression risk depends on the MCI subtype. Subtype specificity and longitudinal characterization are required for the reliable identification of individuals at high risk of developing dementia.
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Affiliation(s)
- Liesbeth Aerts
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Megan Heffernan
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Nicole A Kochan
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - John D Crawford
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Brian Draper
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Julian N Trollor
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Perminder S Sachdev
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia
| | - Henry Brodaty
- From the Dementia Collaborative Research Centre Network (L.A., M.H., H.B.), Centre for Healthy Brain Ageing (J.D.C., N.A.K., B.D., J.N.T., P.S.S., H.B.), and Department of Developmental Disability Neuropsychiatry (J.N.T.), School of Psychiatry, University of New South Wales; and Neuropsychiatric Institute (N.A.K., P.S.S.) and Academic Department for Old Age Psychiatry (B.D., H.B.), Prince of Wales Hospital, Randwick, Australia.
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24
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Brodaty H, Aerts L, Crawford JD, Heffernan M, Kochan NA, Reppermund S, Kang K, Maston K, Draper B, Trollor JN, Sachdev PS. Operationalizing the Diagnostic Criteria for Mild Cognitive Impairment: The Salience of Objective Measures in Predicting Incident Dementia. Am J Geriatr Psychiatry 2017; 25:485-497. [PMID: 28110876 DOI: 10.1016/j.jagp.2016.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia. DESIGN Six-year longitudinal study, part of the Sydney Memory and Ageing Study. SETTING Community-based. PARTICIPANTS 873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded. MEASUREMENTS Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals. RESULTS Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy. CONCLUSIONS Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals.
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Affiliation(s)
- Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia.
| | - Liesbeth Aerts
- Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Megan Heffernan
- Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kate Maston
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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25
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Goerlich KS, Votinov M, Dicks E, Ellendt S, Csukly G, Habel U. Neuroanatomical and Neuropsychological Markers of Amnestic MCI: A Three-Year Longitudinal Study in Individuals Unaware of Cognitive Decline. Front Aging Neurosci 2017; 9:34. [PMID: 28275349 PMCID: PMC5320546 DOI: 10.3389/fnagi.2017.00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/08/2017] [Indexed: 11/15/2022] Open
Abstract
Structural brain changes underlying mild cognitive impairment (MCI) have been well-researched, but most previous studies required subjective cognitive complaints (SCC) as a diagnostic criterion, diagnosed MCI based on a single screening test or lacked analyses in relation to neuropsychological impairment. This longitudinal voxel-based morphometry study aimed to overcome these limitations: The relationship between regional gray matter (GM) atrophy and behavioral performance was investigated over the course of 3 years in individuals unaware of cognitive decline, identified as amnestic MCI based on an extensive neuropsychological test battery. Region of interest analyses revealed GM atrophy in the left amygdala, hippocampus, and parahippocampus in MCI individuals compared to normally aging participants, which was specifically related to verbal memory impairment and evident already at the first measurement point. These findings demonstrate that GM atrophy is detectable in individuals with amnestic MCI despite unawareness of beginning cognitive decline. Thus, individuals with GM atrophy in regions associated with verbal memory impairment do not necessarily need to experience SCC before meeting neuropsychological criteria for MCI. These results have important implications for future research and diagnostic procedures of MCI.
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Affiliation(s)
- Katharina S Goerlich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University Aachen, Germany
| | - Mikhail Votinov
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen UniversityAachen, Germany; Jülich Aachen Research Alliance (JARA) - Translational Brain MedicineAachen, Germany; Institute of Neuroscience and Medicine (INM-10), Research Centre JülichJülich, Germany
| | - Ellen Dicks
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen UniversityAachen, Germany; Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Sinika Ellendt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University Aachen, Germany
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University Budapest, Hungary
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen UniversityAachen, Germany; Jülich Aachen Research Alliance (JARA) - Translational Brain MedicineAachen, Germany
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26
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Alexopoulos P, Werle L, Roesler J, Thierjung N, Gleixner LS, Yakushev I, Laskaris N, Wagenpfeil S, Gourzis P, Kurz A, Perneczky R. Conflicting cerebrospinal fluid biomarkers and progression to dementia due to Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2016; 8:51. [PMID: 27931251 PMCID: PMC5146856 DOI: 10.1186/s13195-016-0220-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/28/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND According to new diagnostic guidelines for Alzheimer's disease (AD), biomarkers enable estimation of the individual likelihood of underlying AD pathophysiology and the associated risk of progression to AD dementia for patients with mild cognitive impairment (MCI). Nonetheless, how conflicting biomarker constellations affect the progression risk is still elusive. The present study explored the impact of different cerebrospinal fluid (CSF) biomarker constellations on the progression risk of MCI patients. METHODS A multicentre cohort of 469 patients with MCI and available CSF biomarker results and clinical follow-up data was considered. Biomarker values were categorized as positive for AD, negative or borderline. Progression risk differences between patients with different constellations of total Tau (t-Tau), phosphorylated Tau at threonine 181 (p-Tau) and amyloid-beta 1-42 (Aβ42) were studied. Group comparison analyses and Cox regression models were employed. RESULTS Patients with all biomarkers positive for AD (N = 145) had the highest hazard for progression to dementia due to AD, whilst patients with no positive biomarkers (N = 111) had the lowest. The risk of patients with only abnormal p-Tau and/or t-Tau (N = 49) or with positive Aβ42 in combination with positive t-Tau or p-Tau (N = 119) is significantly lower than that of patients with all biomarkers positive. CONCLUSIONS The risk of progression to dementia due to AD differs between patients with different CSF biomarker constellations.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, University Hospital of Rion, University of Patras, 26504, Rio, Patras, Greece. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany. .,Department of Psychiatry, University Hospital of Patras, University of Patras, 26504, Rion, Patras, Greece.
| | - Lukas Werle
- Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, München, Germany
| | - Jennifer Roesler
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Nathalie Thierjung
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Lena Sophie Gleixner
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Nikolaos Laskaris
- Department of Informatics, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Stefan Wagenpfeil
- Institute of Medical Biometrics, Epidemiology, and Medical Informatics (IMBEI), University of the Saarland, 66421, Homburg/Saar, Germany
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Rion, University of Patras, 26504, Rio, Patras, Greece
| | - Alexander Kurz
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, W6 8RP, UK.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilans-Universität München, Nußbaumstraße 7, München, 80336, Germany
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27
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Small GW. Detection and Prevention of Cognitive Decline. Am J Geriatr Psychiatry 2016; 24:1142-1150. [PMID: 27745823 DOI: 10.1016/j.jagp.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 02/05/2023]
Abstract
Current diagnostic and treatment strategies for cognitive decline can help patients maintain cognitive ability and higher levels of function longer. Despite advances in detection and early treatment strategies, many patients do not receive proper assessments and available therapies. A systematic assessment strategy will increase the likelihood of an accurate diagnosis, which can facilitate pharmacologic and non-pharmacologic treatment plans that can have a meaningful impact on prognosis. Available data support the integration of healthy lifestyle strategies in the treatment plan to help to stabilize symptoms and potentially delay future cognitive decline. While investigators continue to pursue more effective detection, treatment, and prevention strategies, the scientific data support the use of symptomatic drug treatments and recommendations for healthy lifestyle behaviors to improve quality of life and potentially stave off future cognitive decline. Success of such healthy lifestyle programs involves educating participants on the connection between lifestyle and disease prevention, offering enjoyable exercises that target the patient's skill level, and providing feedback that motivates participants to continue their healthy behaviors so they become habits.
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Affiliation(s)
- Gary W Small
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, The UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
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28
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Huang SF, Liu CK, Chang CC, Su CY. Sensitivity and specificity of executive function tests for Alzheimer's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:493-504. [PMID: 27420924 DOI: 10.1080/23279095.2016.1204301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Decline in executive function (EF) occurs early in Alzheimer's disease (AD) and can interfere with daily functioning. Unfortunately, little is known about the relative ability of traditional EF tests to detect these cognitive changes. Given that timely diagnosis and intervention are essential to improving functional outcome in this population, our aim was to identify the specific EF measures that best differentiated mild dementia from normal aging. Thirty-one patients with mild AD and 31 controls were administered 7 EF tests. Findings indicated significant between-group differences on all measures except Wisconsin Card Sorting Test. The remaining 6 tests displayed fair to good accuracy discriminating between AD cases and controls. Only category fluency and Tower of London test remained in the final regression model that yielded the highest AUC of 0.90, which was not statistically different from that of either test alone. Overall, most of the tests employed were valid for assessing mild EF disturbances. Specifically, the two measures can be used in isolation for quick screening or in combination to facilitate a more in-depth evaluation of EF performance. This study contributes to clinical field by testifying to the validity of various EF tests to identify AD-related compromises in this cognitive domain.
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Affiliation(s)
- Shu-Fen Huang
- a Department of Rehabilitation Medicine, Ministry of Health and Welfare Pingtung Hospital , Pingtung , Taiwan
| | - Ching-Kuan Liu
- b Department of Neurology, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chiung-Chih Chang
- c Department of Neurology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chwen-Yng Su
- d Occupational Therapy, Kaohsiung Medical University , Kaohsiung , Taiwan
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29
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Mini Mental State Examination and Logical Memory scores for entry into Alzheimer's disease trials. ALZHEIMERS RESEARCH & THERAPY 2016; 8:9. [PMID: 26899835 PMCID: PMC4762168 DOI: 10.1186/s13195-016-0176-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022]
Abstract
Background Specific cutoff scores on the Mini Mental State Examination (MMSE) and the Logical Memory (LM) test are used to determine inclusion in Alzheimer’s disease (AD) clinical trials and diagnostic studies. These screening measures have known psychometric limitations, but no study has examined the diagnostic accuracy of the cutoff scores used to determine entry into AD clinical trials and diagnostic studies. Methods ClinicalTrials.gov entries were reviewed for phases II and III active and recruiting AD studies using the MMSE and LM for inclusion. The diagnostic accuracy of MMSE and LM-II cutoffs used in AD trials and diagnostic studies was examined using 23,438 subjects with normal cognition, mild cognitive impairment (MCI), and AD dementia derived from the National Alzheimer’s Coordinating Center database. Results MMSE and LM cutoffs used in current AD clinical trials and diagnostic studies had limited diagnostic accuracy, particularly for distinguishing between normal cognition and MCI, and MCI from AD dementia. The MMSE poorly discriminated dementia stage. Conclusions The MMSE and LM may result in inappropriate subject enrollment in large-scale, multicenter studies designed to develop therapeutics and diagnostic methods for AD.
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