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Berron D, Glanz W, Clark L, Basche K, Grande X, Güsten J, Billette OV, Hempen I, Naveed MH, Diersch N, Butryn M, Spottke A, Buerger K, Perneczky R, Schneider A, Teipel S, Wiltfang J, Johnson S, Wagner M, Jessen F, Düzel E. A remote digital memory composite to detect cognitive impairment in memory clinic samples in unsupervised settings using mobile devices. NPJ Digit Med 2024; 7:79. [PMID: 38532080 DOI: 10.1038/s41746-024-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/03/2024] [Indexed: 03/28/2024] Open
Abstract
Remote monitoring of cognition holds the promise to facilitate case-finding in clinical care and the individual detection of cognitive impairment in clinical and research settings. In the context of Alzheimer's disease, this is particularly relevant for patients who seek medical advice due to memory problems. Here, we develop a remote digital memory composite (RDMC) score from an unsupervised remote cognitive assessment battery focused on episodic memory and long-term recall and assess its construct validity, retest reliability, and diagnostic accuracy when predicting MCI-grade impairment in a memory clinic sample and healthy controls. A total of 199 participants were recruited from three cohorts and included as healthy controls (n = 97), individuals with subjective cognitive decline (n = 59), or patients with mild cognitive impairment (n = 43). Participants performed cognitive assessments in a fully remote and unsupervised setting via a smartphone app. The derived RDMC score is significantly correlated with the PACC5 score across participants and demonstrates good retest reliability. Diagnostic accuracy for discriminating memory impairment from no impairment is high (cross-validated AUC = 0.83, 95% CI [0.66, 0.99]) with a sensitivity of 0.82 and a specificity of 0.72. Thus, unsupervised remote cognitive assessments implemented in the neotiv digital platform show good discrimination between cognitively impaired and unimpaired individuals, further demonstrating that it is feasible to complement the neuropsychological assessment of episodic memory with unsupervised and remote assessments on mobile devices. This contributes to recent efforts to implement remote assessment of episodic memory for case-finding and monitoring in large research studies and clinical care.
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Affiliation(s)
- David Berron
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
- neotiv GmbH, Magdeburg, Germany.
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
| | - Lindsay Clark
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, US
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Kristin Basche
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, US
| | - Xenia Grande
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
| | - Jeremie Güsten
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
| | | | | | | | | | - Michaela Butryn
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Katharina Buerger
- German Center for Neurodegenerative Diseases, Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Ageing Epidemiology Research Unit (AGE), Imperial College London, London, UK
| | - Anja Schneider
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Stefan Teipel
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
- German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases, Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Sterling Johnson
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, US
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Michael Wagner
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases, Cologne, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.
- neotiv GmbH, Magdeburg, Germany.
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany.
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2
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De Anda‐Duran I, Sunderaraman P, Searls E, Moukaled S, Jin X, Popp Z, Karjadi C, Hwang PH, Ding H, Devine S, Shih LC, Low S, Lin H, Kolachalama VB, Bazzano L, Libon DJ, Au R. Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts. J Am Heart Assoc 2024; 13:e032733. [PMID: 38226519 PMCID: PMC10926794 DOI: 10.1161/jaha.123.032733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored. METHODS AND RESULTS A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive Z score (Global Cognitive Score [GCS]), and neuropsychological domain-specific Z scores. FHS participants' mean age was 57 (SD, 9.75) years, and 44% (179) were men. BHS participants' mean age was 49 (4.4) years, and 28% (16) were men. Participants in both cohorts with the lowest neuropsychological performance (lowest quartile, GCS1) demonstrated lower DANA digital scores. In the FHS, GCS1 participants had slower average response times and decreased cognitive efficiency scores in all DANA tasks (P<0.05). In BHS, participants in GCS1 had slower average response times and decreased cognitive efficiency scores for DANA Code Substitution and Go/No-Go tasks, although this was not statistically significant. In both cohorts, GCS was significantly associated with DANA tasks, such that higher GCS correlated with faster average response times (P<0.05) and increased cognitive efficiency (all P<0.05) in the DANA Code Substitution task. CONCLUSIONS Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a composite measure of traditional neuropsychological tests. This supports the potential of using smartphone-based assessments in cognitive screening across diverse populations and the scalability of digital assessments to community-dwelling individuals.
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Affiliation(s)
- Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Edward Searls
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Shirine Moukaled
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Xuanyi Jin
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Zachary Popp
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Sherral Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Honghuang Lin
- University of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Computer ScienceBoston UniversityBostonMAUSA
| | - Lydia Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - David J. Libon
- Department of PsychologyRowan UniversityMullica HillNJUSA
- New Jersey Institute of Successful AgingRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Rhoda Au
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
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3
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Butler J, Watermeyer TJ, Matterson E, Harper EG, Parra-Rodriguez M. The development and validation of a digital biomarker for remote assessment of Alzheimer's diseases risk. Digit Health 2024; 10:20552076241228416. [PMID: 38269369 PMCID: PMC10807338 DOI: 10.1177/20552076241228416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
Background Digital cognitive assessment is becoming increasingly widespread in ageing research and care, especially since the COVID-19 pandemic. Remote online collection provides opportunities for ageing and dementia professionals to collect larger datasets, increase the diversity of research participants and patients and offer cost-effective screening and monitoring methods for clinical practice and trials. However, the reliability of self-administered at-home tests compared to their lab-based counterparts often goes unexamined, compromising the validity of adopting such measures. Objective Our aim is to validate a self-administered web-based version of the visual short-term memory binding task (VSTMBT), a potential digital biomarker sensitive to Alzheimer's disease processes, suitable for use on personal devices. Methods A final cross-sectional sample of 37 older-adult (51-77 years) participants without dementia completed our novel self-administered version of the VSTMBT, both at home on a personal device and in the lab, under researcher-controlled conditions. Results ANOVA and Bayesian t-test found no significant differences between the task when it was remotely self-administered by participants at home compared to when it was taken under controlled lab conditions. Conclusions These results indicate the VSTMBT can provide reliable data when self-administered at-home using an online version of the task and on a personal device. This finding has important implications for remote screening and monitoring practices of older adults, as well as supporting clinical practices serving diverse patient communities. Future work will assess remote administration in older adults with cognitive impairment and diverse socio-economic and ethno-cultural backgrounds as well as a bench-to-bedside application.
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Affiliation(s)
- Joe Butler
- Faculty of Health Sciences and Wellbeing, Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, UK
- Faculty of Health and Wellbeing, School of Psychology, University of Sunderland, Sunderland, UK
- Faculty of Psychology, University of Anahuac Mexico, Mexico City, Mexico
| | - Tamlyn J Watermeyer
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, College of Medicine and Veterinary Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ellie Matterson
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
- Community Mental Health for Older People Team, Tees Esk & Wear NHS Foundation Trust, Durham, England, UK
| | - Emily G Harper
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
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Sokolovič L, Hofmann MJ, Mohammad N, Kukolja J. Neuropsychological differential diagnosis of Alzheimer's disease and vascular dementia: a systematic review with meta-regressions. Front Aging Neurosci 2023; 15:1267434. [PMID: 38020767 PMCID: PMC10657839 DOI: 10.3389/fnagi.2023.1267434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Diagnostic classification systems and guidelines posit distinguishing patterns of impairment in Alzheimer's (AD) and vascular dementia (VaD). In our study, we aim to identify which diagnostic instruments distinguish them. Methods We searched PubMed and PsychInfo for empirical studies published until December 2020, which investigated differences in cognitive, behavioral, psychiatric, and functional measures in patients older than 64 years and reported information on VaD subtype, age, education, dementia severity, and proportion of women. We systematically reviewed these studies and conducted Bayesian hierarchical meta-regressions to quantify the evidence for differences using the Bayes factor (BF). The risk of bias was assessed using the Newcastle-Ottawa-Scale and funnel plots. Results We identified 122 studies with 17,850 AD and 5,247 VaD patients. Methodological limitations of the included studies are low comparability of patient groups and an untransparent patient selection process. In the digit span backward task, AD patients were nine times more probable (BF = 9.38) to outperform VaD patients (β g = 0.33, 95% ETI = 0.12, 0.52). In the phonemic fluency task, AD patients outperformed subcortical VaD (sVaD) patients (β g = 0.51, 95% ETI = 0.22, 0.77, BF = 42.36). VaD patients, in contrast, outperformed AD patients in verbal (β g = -0.61, 95% ETI = -0.97, -0.26, BF = 22.71) and visual (β g = -0.85, 95% ETI = -1.29, -0.32, BF = 13.67) delayed recall. We found the greatest difference in verbal memory, showing that sVaD patients outperform AD patients (β g = -0.64, 95% ETI = -0.88, -0.36, BF = 72.97). Finally, AD patients performed worse than sVaD patients in recognition memory tasks (β g = -0.76, 95% ETI = -1.26, -0.26, BF = 11.50). Conclusion Our findings show inferior performance of AD in episodic memory and superior performance in working memory. We found little support for other differences proposed by diagnostic systems and diagnostic guidelines. The utility of cognitive, behavioral, psychiatric, and functional measures in differential diagnosis is limited and should be complemented by other information. Finally, we identify research areas and avenues, which could significantly improve the diagnostic value of cognitive measures.
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Affiliation(s)
- Leo Sokolovič
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Markus J. Hofmann
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Nadia Mohammad
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Abbatantuono C, Alfeo F, Clemente L, Lancioni G, De Caro MF, Livrea P, Taurisano P. Current Challenges in the Diagnosis of Progressive Neurocognitive Disorders: A Critical Review of the Literature and Recommendations for Primary and Secondary Care. Brain Sci 2023; 13:1443. [PMID: 37891810 PMCID: PMC10605551 DOI: 10.3390/brainsci13101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Screening for early symptoms of cognitive impairment enables timely interventions for patients and their families. Despite the advances in dementia diagnosis, the current nosography of neurocognitive disorders (NCDs) seems to overlook some clinical manifestations and predictors that could contribute to understanding the conversion from an asymptomatic stage to a very mild one, eventually leading to obvious disease. The present review examines different diagnostic approaches in view of neurophysiological and neuropsychological evidence of NCD progression, which may be subdivided into: (1) preclinical stage; (2) transitional stage; (3) prodromal or mild stage; (4) major NCD. The absence of univocal criteria and the adoption of ambiguous or narrow labels might complicate the diagnostic process. In particular, it should be noted that: (1) only neuropathological hallmarks characterize preclinical NCD; (2) transitional NCD must be assessed through proactive neuropsychological protocols; (3) prodromal/mild NCDs are based on cognitive functional indicators; (4) major NCD requires well-established tools to evaluate its severity stage; (5) insight should be accounted for by both patient and informants. Therefore, the examination of evolving epidemiological and clinical features occurring at each NCD stage may orient primary and secondary care, allowing for more targeted prevention, diagnosis, and/or treatment of both cognitive and functional impairment.
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Affiliation(s)
- Chiara Abbatantuono
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | - Federica Alfeo
- Department of Education, Communication and Psychology (For.Psi.Com), University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Livio Clemente
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | - Giulio Lancioni
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
- Lega F D’Oro Research Center, 60027 Osimo, Italy
| | - Maria Fara De Caro
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
| | | | - Paolo Taurisano
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari “Aldo Moro”, 70121 Bari, Italy; (C.A.); (L.C.); (G.L.); (M.F.D.C.)
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6
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Forno G, Parra MA, Thumala D, Villagra R, Cerda M, Zitko P, Ibañez A, Lillo P, Slachevsky A. The "when" matters: Evidence from memory markers in the clinical continuum of Alzheimer's disease. Neuropsychology 2023; 37:753-768. [PMID: 37227845 PMCID: PMC10522796 DOI: 10.1037/neu0000891] [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] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Cognitive assessment able to detect impairments in the early neuropathological stages of Alzheimer's disease (AD) is urgently needed. The visual short-term memory binding task (VSTMBT) and the Free and Cued Selective Reminding Test (FCSRT) have been recommended by the neurodegenerative disease working group as promising tests to aid in the early detection of AD. In this study, we investigated their complementary value across the clinical stages of the AD continuum. METHOD One hundred and seventeen older adults with subjective cognitive complaint (SCC), 79 with mild cognitive impairment (MCI), 31 patients with AD dementia (ADD), and 37 cognitively unimpaired (CU) subjects, underwent assessment with the VSTMBT and the picture version of the Spanish FCSRT. RESULTS After controlling for multiple comparisons, significant differences were found across groups. The VSTMBT was the only test that "marginally" differentiated between CU and SCC (d = 0.47, p = .052). Moreover, whereas the FCSRT showed a gradient (CU = SCC) > MCI > ADD, the VSTMBT gradient was CU > SCC > (MCI = ADD) suggesting that conjunctive binding deficits assessed by the latter may be sensitive to the very early stages of the disease. CONCLUSIONS Our results suggest that the VSTMBT and the FCSRT are sensitive to the clinical continuum of AD. Whereas the former detects changes in the early prodromal stages, the latter is more sensitive to the advanced prodromal stages of AD. These novel tests can aid in the early detection, monitor disease progression and response to treatment, and thus support drug development programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Gonzalo Forno
- School of Psychology, Universidad de los Andes, Santiago, Chile
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
| | - Mario A. Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Daniela Thumala
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, University of Chile, Santiago, Chile
- Interuniversity Center on Healthy Aging (Plan to Strengthen State Universities, Chilean Ministry of Education RED21993). Santiago, Chile
| | - Roque Villagra
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Centro de Parkinson (CENPAR), Santiago, Chile
| | - Mauricio Cerda
- Programa de Biología Integrativa, Instituto de Ciencias Biomédicas y Centro de Informática Médica y Telemedicina, Facultad de Medicina, Universidad de Chile
| | - Pedro Zitko
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Salud Global, Escuela de Salud Pública, Universidad de Chile
- Department of Health Services & Population Research, IoPPN, King’s College London
| | - Agustín Ibañez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, and National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), California, US; & Trinity College Dublin (TCD), Dublin, Ireland
| | - Patricia Lillo
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - Andrea Slachevsky
- Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, Institute of Biomedical Science (ICBM), Neuroscience and East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Memory and Neuropsychiatric Clinic, Neurology Department, Hospital del Salvador, SSMO & Faculty of Medicine, University of Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
- East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
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7
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Macchitella L, Tosi G, Giaquinto F, Iaia M, Rizzi E, Chiarello Y, Bertoux M, Angelelli P, Romano DL. Genuine Memory Deficits as Assessed by the Free and Cued Selective Reminding Test (FCSRT) in the Behavioural Variant of Frontotemporal Dementia. A Systematic Review and Meta-analysis Study. Neuropsychol Rev 2023:10.1007/s11065-023-09613-3. [PMID: 37736861 DOI: 10.1007/s11065-023-09613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/07/2023] [Indexed: 09/23/2023]
Abstract
The current diagnostic criteria for the behavioural variant of frontotemporal dementia (bvFTD) foresee a relative sparing of long-term memory. Although bvFTD patients were thought to report secondary memory deficits associated with prefrontal dysfunctions, some studies indicated the presence of a "genuine memory deficit" related to mesial temporal lobe dysfunctions. Among various neuropsychological tests, the Free and Cue Selective Reminding Test (FCSRT) has been recommended to distinguish genuine from apparent amnesia. We conducted a systematic review and a random effect Bayesian meta-analysis to evaluate the nature and severity of memory deficit in bvFTD. Our objective was to determine whether the existing literature offers evidence of genuine or apparent amnesia in patients with bvFTD, as assessed via the FCSRT. On 06/19/2021, we conducted a search across four databases (PMC, Scopus, Web of Science, and PubMed). We included all studies that evaluated memory performance using the FCSRT in patients with bvFTD, as long as they also included either cognitively unimpaired participants or AD groups. We tested publication bias through the Funnel plot and Egger's test. To assess the quality of studies, we used the Newcastle-Ottawa quality assessment scale adapted for cross-sectional studies. We included 16 studies in the meta-analysis. The results showed that bvFTD patients perform better than AD patients (pooled effects between 0.95 and 1.14), as their memory performance stands between AD and control groups (pooled effects between - 2.19 and - 1.25). Moreover, patients with bvFTD present both genuine and secondary memory disorders. As a major limitation of this study, due to our adoption of a rigorous methodology and stringent inclusion criteria, we ended up with just 16 studies. Nonetheless, our robust findings can contribute to the ongoing discussion on international consensus criteria for bvFTD and the selection of appropriate neuropsychological tools to facilitate the differential diagnosis between AD and bvFTD.
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Affiliation(s)
- Luigi Macchitella
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
- Scientific Institute I.R.C.C.S. "E. Medea", Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Piazza Di Summa, 72100, Brindisi, Italy
| | - Giorgia Tosi
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy.
- Department of Psychology, University of Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126, Milan, Italy.
| | - Francesco Giaquinto
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
| | - Marika Iaia
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
| | - Ezia Rizzi
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
| | - Ylenia Chiarello
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
| | - Maxime Bertoux
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, LiCEND, DISTALZ, 42 rue Paul Duez, 59000, Lille, France
| | - Paola Angelelli
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
| | - Daniele Luigi Romano
- Department of Human and Social Sciences, University of Salento, Piazza Tancredi 7, 73100, Lecce, Italy
- Department of Psychology, University of Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126, Milan, Italy
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8
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Batistuzzo MC, Sheshachala K, Alschuler DM, Hezel DM, Lewis-Fernándes R, de Joode NT, Vriend C, Lempert KM, Narayan M, Marincowitz C, Lochner C, Stein DJ, Narayanaswamy JC, van den Heuvel OA, Simpson HB, Wall M. Cross-national harmonization of neurocognitive assessment across five sites in a global study. Neuropsychology 2023; 37:284-300. [PMID: 35786960 PMCID: PMC10164281 DOI: 10.1037/neu0000838] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Cross-national work on neurocognitive testing has been characterized by inconsistent findings, suggesting the need for improved harmonization. Here, we describe a prospective harmonization approach in an ongoing global collaborative study. METHOD Visuospatial N-Back, Tower of London (ToL), Stop Signal task (SST), Risk Aversion (RA), and Intertemporal Choice (ITC) tasks were administered to 221 individuals from Brazil, India, the Netherlands, South Africa, and the USA. Prospective harmonization methods were employed to ensure procedural similarity of task implementation and processing of derived task measures across sites. Generalized linear models tested for between-site differences controlling for sex, age, education, and socioeconomic status (SES). Associations with these covariates were also examined and tested for differences by site with site-by-covariate interactions. RESULTS The Netherlands site performed more accurately on N-Back and ToL than the other sites, except for the USA site on the N-Back. The Netherlands and the USA sites performed faster than the other three sites during the go events in the SST. Finally, the Netherlands site also exhibited a higher tolerance for delay discounting than other sites on the ITC, and the India site showed more risk aversion than other sites on the RA task. However, effect size differences across sites on the five tasks were generally small (i.e., partial eta-squared < 0.05) after dropping the Netherlands (on ToL, N-Back, ITC, and SST tasks) and India (on the RA task). Across tasks, regardless of site, the N-Back (sex, age, education, and SES), ToL (sex, age, and SES), SST (age), and ITC (SES) showed associations with covariates. CONCLUSIONS Four out of the five sites showed only small between-site differences for each task. Nevertheless, despite our extensive prospective harmonization steps, task score performance deviated from the other sites in the Netherlands site (on four tasks) and the India site (on one task). Because the procedural methods were standardized across sites, and our analyses were adjusted for covariates, the differences found in cognitive performance may indicate selection sampling bias due to unmeasured confounders. Future studies should follow similar cross-site prospective harmonization procedures when assessing neurocognition and consider measuring other possible confounding variables for additional statistical control. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - Karthik Sheshachala
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Dianne M. Hezel
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
| | | | - Niels T. de Joode
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Chris Vriend
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Karolina M. Lempert
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Madhuri Narayan
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | - Clara Marincowitz
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Janardhanan C. Narayanaswamy
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | - Odile A. van den Heuvel
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Helen Blair Simpson
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
| | - Melanie Wall
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
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9
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Varela V, Evdokimidis I, Potagas C. Binding objects to their spatiotemporal context: Age gradient and neuropsychological correlates of What-Where-When task performance. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:214-226. [PMID: 34053387 DOI: 10.1080/23279095.2021.1924719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A number of recent studies have shown that the ability to accurately recall bound object and spatiotemporal aspects of an experienced event develops gradually in children and is greatly impaired in the elderly, reflecting developmental discontinuities in the integrity of the underlying medial temporal lobe network. Using a novel What-Where-When (WWW) visuospatial reconstruction task, the experiential memory performance of a group of healthy older adults (aged 60-80) was compared to that of a group of younger adults (aged 20-40). Both groups were equated on their general cognitive ability, their executive functioning, and on the presence of depression, anxiety, and stress symptomatology. As hypothesized, the performance of the older adults in the binding task was significantly lower, with younger participants recalling three times the amount of bound object and spatiotemporal triads than their older counterparts. Psychomotor speed was found to be lower in older adults and was the only neuropsychological index to significantly affect success on the WWW binding task. Based on this and other relevant studies, the selective associative memory impairment obtained using a non-verbal What-Where-When paradigm emerges as a marker for the detection of early pre-clinical signs of experiential memory pathology.
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Affiliation(s)
- Vasiliki Varela
- Eginition Hospital, Department of Neurology, School of Medicine, University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- Eginition Hospital, Department of Neurology, School of Medicine, University of Athens, Athens, Greece
| | - Constantin Potagas
- Eginition Hospital, Department of Neurology, School of Medicine, University of Athens, Athens, Greece
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10
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Mavragani A, Michels L, Schmidt A, Barinka F, de Bruin ED. Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41173. [PMID: 36745483 PMCID: PMC9941909 DOI: 10.2196/41173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components. OBJECTIVE This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called "Brain-IT") targeted to improve cognitive functioning in older adults with mNCD. METHODS A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the "Brain-IT" training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η2p) effect sizes will be calculated for all primary and secondary outcomes. RESULTS Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024. CONCLUSIONS This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization. TRIAL REGISTRATION ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41173.
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Affiliation(s)
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Filip Barinka
- Clinic for Neurology, Hirslanden Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
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11
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Lipnicki DM, Lam BCP, Mewton L, Crawford JD, Sachdev PS. Harmonizing Ethno-Regionally Diverse Datasets to Advance the Global Epidemiology of Dementia. Clin Geriatr Med 2023; 39:177-190. [PMID: 36404030 PMCID: PMC9767705 DOI: 10.1016/j.cger.2022.07.009] [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] [Indexed: 11/23/2022]
Abstract
Understanding dementia and cognitive impairment is a global effort needing data from multiple sources across diverse ethno-regional groups. Methodological heterogeneity means that these data often require harmonization to make them comparable before analysis. We discuss the benefits and challenges of harmonization, both retrospective and prospective, broadly and with a focus on data types that require particular sorts of approaches, including neuropsychological test scores and neuroimaging data. Throughout our discussion, we illustrate general principles and give examples of specific approaches in the context of contemporary research in dementia and cognitive impairment from around the world.
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Affiliation(s)
- Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia.
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
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12
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Arriola-Infante JE, García-Roldán E, Montiel-Herrera F, Maestre-Bravo R, Mendoza-Vázquez G, Marín-Cabañas AM, Méndez-Barrio C, Luque-Tirado A, Rodrigo-Herrero S, Sánchez-Arjona MB, Maillet D, Franco-Macías E. Using Cognitive Reserve to Create Norms for the TMA-93 (Relational Binding of Images). J Alzheimers Dis 2023; 95:119-129. [PMID: 37482991 DOI: 10.3233/jad-221110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND TMA-93 examines relational binding using images. Biomarker validation has demonstrated that it is discriminative for diagnosing early AD. The effect of cognitive reserve on TMA-93 performance remains unexplored and could improve the interpretative framework for using the test. OBJECTIVE To study the effect of cognitive reserve on TMA-93 performance and to provide new norms for the test that include its measurement. METHODS Cognitively unimpaired people aged 55 and over were systematically recruited for this cross-sectional normative study in southern Spain. Age, sex, and scores on the Cognitive Reserve Questionnaire (CRQ; maximum score: 25 points) were collected, and the TMA-93 was administered (maximum score: 30 points). Percentile-based reference data that captured combinations of socio-demographics variables with significant effect on TMA-93 performance were calculated. RESULTS 902 participants (62.5% female; age: median = 68, IQR = 61-75, range = 55-90) were included. CRQ total scores were globally low (median = 8, IQR = 5-13, range = 0-24). Cognitive reserve, including modifiable items as reading activity and intellectual gaming activity, and age mainly supported the TMA-93 total score variance. Sex seemed to have some influence in the elderly. TMA-93 total scores medians began to drop from 70-75 years old. Higher total score on the CRQ and, possibly, female sex determined a gentler slope. New norms based on these variables showed wide variations in scores for the 5th and 10th percentiles. CONCLUSION Visual relational binding ability depends on cognitive reserve, including modifiable items. The age-related binding deficit is buffered by higher cognitive reserve and, at older ages, by female sex.
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Affiliation(s)
| | - Ernesto García-Roldán
- Memory Unit, Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain
| | - Fátima Montiel-Herrera
- Memory Unit, Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain
| | - Rebeca Maestre-Bravo
- Memory Unit, Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain
| | | | | | - Carlota Méndez-Barrio
- Memory Unit, Department of Neurology, Juan Ramón Jiménez University Hospital, Huelva, Spain
| | - Andrea Luque-Tirado
- Memory Unit, Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain
| | - Silvia Rodrigo-Herrero
- Memory Unit, Department of Neurology, Juan Ramón Jiménez University Hospital, Huelva, Spain
| | | | - Didier Maillet
- Neurology Service, Hôspital Saint-Louis (AP-HP), Paris, France
| | - Emilio Franco-Macías
- Memory Unit, Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain
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13
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Bruderer-Hofstetter M, Gorus E, Cornelis E, Meichtry A, De Vriendt P. Influencing factors on instrumental activities of daily living functioning in people with mild cognitive disorder - a secondary investigation of cross-sectional data. BMC Geriatr 2022; 22:791. [PMID: 36217106 PMCID: PMC9552428 DOI: 10.1186/s12877-022-03476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding a strategy to reduce the impact of cognitive decline on everyday functioning in persons suffering from cognitive impairment is a public health priority. Instrumental activities of daily living (IADL) are key to everyday functioning. Hence, it is essential to understand the influencing factors on IADL to develop specific interventions to improve everyday functioning in persons with mild cognitive disorder. Therefore, this study aimed to 1) explore different influencing factors on IADL functioning considering all domains of the International Classification of Functioning, disability, and health and 2) rank these factors. METHODS We performed a secondary analysis of a cohort including participants with amnestic mild cognitive impairment (a-MCI) or mild Alzheimer's Dementia (mild AD). The IADL functioning model was used as a starting point to estimate the effects of cognitive and physical function factors and personal and environmental factors on IADL functioning using multiple linear regression analysis, including subgroup analysis in persons with a-MCI. We used standardized coefficient estimates to relate the size of the predictor effects in the final model. RESULTS We included 105 participants (64 a-MCI, 41 mild AD); the mean age was 81.9 years (SD 4.9), with 70% females. Based on a multi-step approach and model fit, the final model included IADL functioning as the response variable and memory, attention, executive function, vision and hearing, mobility, balance, education, and social support as predictors. The final model explained 75% of the variability. The significant predictors in the model were mobility, balance, attention, and education, and were the predictors with the most considerable effects based on standardized coefficient estimates. The subgroup analysis, including only a-MCI participants, revealed a similar pattern. CONCLUSION Our results confirm that IADL functioning in people with mild cognitive disorder is influenced by cognitive and physical function and personal factors. The study provides further insight into understanding IADL functioning impairments in persons with mild impaired cognition and may be used to develop specific non-pharmacological interventions.
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Affiliation(s)
- Marina Bruderer-Hofstetter
- School of Health Professions, Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400, Winterthur, Switzerland.
| | - Ellen Gorus
- Department Gerontology and Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Elise Cornelis
- Department of Occupational Therapy and Research & Development in Health & Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400, Winterthur, Switzerland
| | - Patricia De Vriendt
- Department Gerontology and Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing (MENT) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Programme, Ghent University, Ghent, Belgium
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14
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Parra MA, Calia C, Pattan V, Della Sala S. Memory markers in the continuum of the Alzheimer's clinical syndrome. Alzheimers Res Ther 2022; 14:142. [PMID: 36180965 PMCID: PMC9526252 DOI: 10.1186/s13195-022-01082-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The individual and complementary value of the Visual Short-Term Memory Binding Test (VSTMBT) and the Free and Cued Selective Reminding Test (FCSRT) as markers to trace the AD continuum was investigated. It was hypothesised that the VSTMBT would be an early indicator while the FCSRT would inform on imminent progression. METHODS Healthy older adults (n=70) and patients with mild cognitive impairment (MCI) (n=80) were recruited and followed up between 2012 and 2017. Participants with at least two assessment points entered the study. Using baseline and follow-up assessments four groups were defined: Older adults who were healthy (HOA), with very mild cognitive but not functional impairment (eMCI), and with MCI who did and did not convert to dementia (MCI converters and non-converters). RESULTS Only the VSTMBT predicted group membership in the very early stages (HOA vs eMCI). As the disease progressed, the FCSRT became a strong predictor excluding the VSTMB from the models. Their complementary value was high during the mid-prodromal stages and decreased in stages closer to dementia. DISCUSSION The study supports the notion that neuropsychological assessment for AD needs to abandon the notion of one-size-fits-all. A memory toolkit for AD needs to consider tools that are early indicators and tools that suggest imminent progression. The VSTMBT and the FSCRT are such tools.
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Affiliation(s)
- Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK.
| | - Clara Calia
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Vivek Pattan
- NHS Forth Valley, Stirling Community Hospital, Stirling, UK
| | - Sergio Della Sala
- Human Cognitive Neuroscience, Psychology Department, University of Edinburgh, Edinburgh, UK
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15
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Smith KM, Starr JM, Escudero J, Ibañez A, Parra MA. Abnormal Functional Hierarchies of EEG Networks in Familial and Sporadic Prodromal Alzheimer's Disease During Visual Short-Term Memory Binding. FRONTIERS IN NEUROIMAGING 2022; 1:883968. [PMID: 37555153 PMCID: PMC10406202 DOI: 10.3389/fnimg.2022.883968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 08/10/2023]
Abstract
Alzheimer's Disease (AD) shows both complex alterations of functional dependencies between brain regions and a decreased ability to perform Visual Short-Term Memory Binding (VSTMB) tasks. Recent advances in network neuroscience toward understanding the complexity of hierarchical brain function here enables us to establish a link between these two phenomena. Here, we study data on two types of dementia at Mild Cognitive Impairment (MCI) stage-familial AD patients (E280A mutation of the presenilin-1 gene) and elderly MCI patients at high risk of sporadic AD, both with age-matched controls. We analyzed Electroencephalogram (EEG) signals recorded during the performance of Visual Short-Term Memory (VSTM) tasks by these participants. Functional connectivity was computed using the phase-lag index in Alpha and Beta; and network analysis was employed using network indices of hierarchical spread (degree variance) and complexity. Hierarchical characteristics of EEG functional connectivity networks revealed abnormal patterns in familial MCI VSTMB function and sporadic MCI VSTMB function. The middle-aged familial MCI binding network displayed a larger degree variance in lower Beta compared to healthy controls (p = 0.0051, Cohen's d = 1.0124), while the elderly sporadic MCI binding network displayed greater hierarchical complexity in Alpha (p = 0.0140, Cohen's d = 1.1627). Characteristics in healthy aging were not shown to differ. These results indicate that activity in MCI exhibits cross-frequency network reorganization characterized by increased heterogeneity of node roles in the functional hierarchy. Aging itself is not found to cause VSTM functional hierarchy differences.
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Affiliation(s)
- Keith M. Smith
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John M. Starr
- Alzheimer Scotland Dementia Research Centre, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Javier Escudero
- School of Engineering, Institute for Digital Communications, University of Edinburgh, Edinburgh, United Kingdom
| | - Agustin Ibañez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute, UCSF, San Francisco, CA, United States
- Trinity College Institute of Neuroscience, Trintity College Dublin, Dublin, Ireland
| | - Mario A. Parra
- Trinity College Institute of Neuroscience, Trintity College Dublin, Dublin, Ireland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
- Neuroprogressive and Dementia Network, NHS Scotland, Glasgow, United Kingdom
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16
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Screening for neuropsychological assessment in the diagnostics of neurocognitive disorder. Int Psychogeriatr 2022; 34:519-521. [PMID: 35331358 DOI: 10.1017/s104161022200031x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Cheng H, Zhang Z, Zhang B, Zhang W, Wang J, Ni W, Miao Y, Liu J, Bi Y. Enhancement of Impaired Olfactory Neural Activation and Cognitive Capacity by Liraglutide, but Not Dapagliflozin or Acarbose, in Patients With Type 2 Diabetes: A 16-Week Randomized Parallel Comparative Study. Diabetes Care 2022; 45:1201-1210. [PMID: 35263425 DOI: 10.2337/dc21-2064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The comparative neuroprotective effects of different antidiabetes drugs have not been characterized in randomized controlled trials. Here, we investigated the therapeutic effects of liraglutide, dapagliflozin, or acarbose treatment on brain functional alterations and cognitive changes in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Thirty-six patients with type 2 diabetes inadequately controlled with metformin monotherapy were randomized to receive liraglutide, dapagliflozin, or acarbose treatment for 16 weeks. Brain functional MRI (fMRI) scan and a battery of cognitive assessments were evaluated pre- and postintervention in all subjects. RESULTS The 16-week treatment with liraglutide significantly enhanced the impaired odor-induced left hippocampal activation with Gaussian random field correction and improved cognitive subdomains of delayed memory, attention, and executive function (all P < 0.05), whereas dapagliflozin or acarbose did not. Structural equation modeling analysis demonstrated that such improvements of brain health and cognitive function could be partly ascribed to a direct effect of liraglutide on left hippocampal activation (β = 0.330, P = 0.022) and delayed memory (β = 0.410, P = 0.004) as well as to the metabolic ameliorations of reduced waist circumference, decreased body fat ratio, and elevated fasting insulin (all P < 0.05). CONCLUSIONS Our head-to-head study demonstrated that liraglutide enhanced impaired brain activation and restored impaired cognitive domains in patients with type 2 diabetes, whereas dapagliflozin and acarbose did not. The results expand the clinical application of liraglutide and provide a novel treatment strategy for individuals with diabetes and a high risk of cognitive decline.
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Affiliation(s)
- Haiyan Cheng
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.,Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhou Zhang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wen Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenyu Ni
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yingwen Miao
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiani Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.,Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Girtler N, Chincarini A, Brugnolo A, Doglione E, Orso B, Morbelli S, Massa F, Peira E, Biassoni E, Donniaquio A, Grisanti S, Pardini M, Arnaldi D, Nobili F. The Free and Cued Selective Reminding Test: Discriminative Values in a Naturalistic Cohort. J Alzheimers Dis 2022; 87:887-899. [DOI: 10.3233/jad-215043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Neuropsychological assessment is still the basis for the first evaluation of patients with cognitive complaints. The Free and Cued Selective Reminding Test (FCSRT) generates several indices that could have different accuracy in the differential diagnosis between Alzheimer’s disease (AD) and other disorders. Objective: In a consecutive series of naturalistic patients, the accuracy of the FCSRT indices in differentiating patients with either mild cognitive impairment (MCI) due to AD or AD dementia from other competing conditions was evaluated. Methods: We evaluated the accuracy of the seven FCSRT indices in differentiating patients with AD from other competing conditions in 434 consecutive outpatients, either at the MCI or at the early dementia stage. We analyzed these data through the receiver operating characteristics curve, and we then generated the odds-ratio map of the two indices with the best discriminative value between pairs of disorders. Results: The immediate and the delayed free total recall, the immediate total recall, and the index of sensitivity of cueing were the most useful indices and allowed to distinguish AD from dementia with Lewy bodies and psychiatric conditions with very high accuracy. Accuracy was instead moderate in distinguishing AD from behavioral variant frontotemporal dementia, vascular cognitive impairment, and other conditions. Conclusion: By using odd-ratio maps and comparison-customized cut-off scores, we confirmed that the FCSRT represents a useful tool to characterize the memory performance of patients with MCI and thus to assist the clinician in the diagnosis process, though with different accuracy values depending on the clinical hypothesis.
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Affiliation(s)
- Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Andrea Brugnolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Beatrice Orso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Enrico Peira
- Istituto Nazionale di Fisica Nucleare (INFN), Genova, Italy
| | - Erica Biassoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Donniaquio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Stefano Grisanti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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19
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Maher C, Calia C. The effect of illiteracy on performance in screening tools for dementia: A meta-analysis. J Clin Exp Neuropsychol 2022; 43:945-966. [PMID: 35200100 DOI: 10.1080/13803395.2022.2040433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Research indicates that many tools designed for screening dementia are affected by literacy level. The objective of this study was to estimate the overall effects of this confounding factor. A meta-analysis was conducted to evaluate differences in performance in dementia screening tools between literate and illiterate individuals. METHOD Electronic databases were searched from 1975 to June 2021 to identify empirical studies examining performance in dementia screening tools in literate and illiterate individuals over 50 years old. Data for effect sizes, participant demographic information, and study information were extracted. RESULTS We identified 27 studies methodologically suitable for meta-analysis. Multi-level random-effects modeling demonstrated a significant overall effect, with literate participants scoring significantly higher than illiterate participants (g = -1.2, 95% CI = -1.47, -0.95, p < .001). Moderator analyses indicated significant effects of test type and the presence of cognitive impairment on the extent of the difference in performance between literate and illiterate participants. The difference in performance between groups was smaller in screening tests modified for illiterate individuals (p < .01), and in individuals with cognitive impairment (p < .001). CONCLUSIONS Our findings substantiate the unsuitability of many dementia screening tools for individuals who are illiterate. The results of this systematic review and meta-analysis emphasize the need for the development and validation of tools that are suitable for individuals of all abilities.
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Affiliation(s)
- Caragh Maher
- Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Clara Calia
- Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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20
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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21
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Florean I, Penolazzi B, Menichelli A, Pastore M, Cattaruzza T, Mazzon G, Manganotti P. Using the ATN system as a guide for the neuropsychological assessment of Alzheimer's disease. J Clin Exp Neuropsychol 2022; 43:926-943. [PMID: 35166171 DOI: 10.1080/13803395.2022.2036327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Many studies have attempted to determine whether Alzheimer's disease (AD) in-vivo biomarkers can predict neuropsychological performance since pathophysiological changes precede cognitive changes by several years. Nonetheless, neuropsychological measures can also detect cognitive deterioration in cognitively normal individuals with AD-positive biomarkers. Recent studies have investigated whether cognitive measures can be used as a proxy for biomarkers. This is a crucial issue since biomarker analysis is expensive, invasive, and not yet widespread in clinical practice. However, these studies have so far considered only one or two classes of AD biomarkers. Here, we aim at preliminarily evaluating whether and which neuropsychological measures can discriminate individuals that have been classified according to the full scheme of biomarkers known as ATN system. This scheme groups biomarkers as a function of the three main AD-related pathologic processes they measure (i.e., β-amyloidosis, tauopathy, and neurodegeneration) to provide an unbiased and descriptive definition of the Alzheimer's continuum. METHOD Biomarkers and neuropsychological data from 78 patients (70.01 ± 9.15 years; 38 females) with suspected cognitive decline were extracted from a medical database. Participants' biomarker profiles were classified into the following ATN categories: normal AD biomarkers; Alzheimer's continuum; non-AD pathologic change. Data were analyzed using a Bayesian approach, to guarantee reliable result interpretation of data stemming from small samples. RESULTS The discrimination ability of each neuropsychological measure varied depending on the pairs of ATN categories compared. The best-discriminating predictor in the Alzheimer's continuum vs. normal biomarkers comparison was the figure naming ability. In contrast, in the Alzheimer's continuum vs. non-AD pathologic change comparison the best predictor was the wordlist forgetting rate. CONCLUSIONS Although the study was exploratory in nature, the proposed methodological approach may have the potential to identify the best neuropsychological measures for estimating AD neuropathological changes, leading to a more biologically informed use of neuropsychological assessment.
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Affiliation(s)
- Irene Florean
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Alina Menichelli
- Rehabilitation Unit, Department of Medicine, Surgery and Health Sciences, Maggiore City Hospital Asugi, Trieste, Italy
| | - Massimiliano Pastore
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Tatiana Cattaruzza
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital Asugi, University of Trieste, Trieste, Italy
| | - Giulia Mazzon
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital Asugi, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital Asugi, University of Trieste, Trieste, Italy
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Abstract
Recently, Alzheimer's Disease International (ADI) stressed that around 75% of people living with dementia globally are still not receiving a diagnosis. In this commentary, I reflect on how efforts towards better cognitive assessments, particularly of memory, can be aligned and harmonized to contribute to such needs. I highlight some barriers that ongoing collaborations and trials are facing and their potential drivers. I suggest some strategies that can help overcome them and in so doing, integrate research agendas. We need to ignite the debate towards strategies that can help level the playfield to tackle Alzheimer's disease with true global solutions.
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Affiliation(s)
- Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK
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23
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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24
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Fernández G, Parra MA. Oculomotor Behaviors and Integrative Memory Functions in the Alzheimer's Clinical Syndrome. J Alzheimers Dis 2021; 82:1033-1044. [PMID: 34151787 DOI: 10.3233/jad-201189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Biological information drawn from eye-tracking metrics is providing evidence regarding drivers of cognitive decline in Alzheimer's disease. In particular, pupil size has proved useful to investigate cognitive performance during online activities. OBJECTIVE To investigate the oculomotor correlates of impaired performance of patients with mild Alzheimer's Clinical Syndrome (ACS) on a recently developed memory paradigm, namely the Short-Term Memory Binding Test (STMBT). METHODS We assessed a sample of eighteen healthy controls (HC) and eighteen patients with a diagnosis of mild ACS with the STMBT while we recorded their oculomotor behaviors using pupillometry and eye-tracking. RESULTS As expected, a group (healthy controls versus ACS) by condition (Unbound Colours versus Bound Colours) interaction was found whereby behavioral group differences were paramount in the Bound Colours condition. Healthy controls' pupils dilated significantly more in the Bound Colours than in the Unbound Colours condition, a discrepancy not observed in ACS patients. Furthermore, ROC analysis revealed the abnormal pupil behaviors distinguished ACS patients from healthy controls with values of sensitivity and specify of 100%, thus outperforming both recognition scores and gaze duration. CONCLUSION The biological correlates of Short-Term Memory Binding impairments appear to involve a network much wider than we have thought to date, which expands across cortical and subcortical structures. We discuss these findings focusing on their implications for our understanding of neurocognitive phenotypes in the preclinical stages of Alzheimer's disease and potential development of cognitive biomarkers that can support ongoing initiatives to prevent dementia.
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Affiliation(s)
- Gerardo Fernández
- Chief Scientific Officer, ViewMind Inc., New York, NY, USA.,Axis Neurociencias, Bahía Blanca, Argentina.,Instituto de Investigaciones en Ingeniería Eléctrica (IIIE) (UNS-CONICET), Bahía Blanca, Buenos Aires, Argentina
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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25
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Grande X, Berron D, Maass A, Bainbridge WA, Düzel E. Content-specific vulnerability of recent episodic memories in Alzheimer's disease. Neuropsychologia 2021; 160:107976. [PMID: 34314781 PMCID: PMC8434425 DOI: 10.1016/j.neuropsychologia.2021.107976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
Endel Tulving's episodic memory framework emphasizes the multifaceted re-experiencing of personal events. Indeed, decades of research focused on the experiential nature of episodic memories, usually treating recent episodic memory as a coherent experiential quality. However, recent insights into the functional architecture of the medial temporal lobe show that different types of mnemonic information are segregated into distinct neural pathways in brain circuits empirically associated with episodic memory. Moreover, recent memories do not fade as a whole under conditions of progressive neurodegeneration in these brain circuits, notably in Alzheimer's disease. Instead, certain memory content seem particularly vulnerable from the moment of their encoding while other content can remain memorable consistently across individuals and contexts. We propose that these observations are related to the content-specific functional architecture of the medial temporal lobe and consequently to a content-specific impairment of memory at different stages of the neurodegeneration. To develop Endel Tulving's inspirational legacy further and to advance our understanding of how memory function is affected by neurodegenerative conditions such as Alzheimer's disease, we postulate that it is compelling to focus on the representational content of recent episodic memories. The functional anatomy of episodic memory segregates different memory content. Alzheimer's disease may cause content-specific loss of recent memories Content-specific memorability across individuals changes with Alzheimer's disease. Content-specific assessment could provide new insights into episodic memory in health and disease
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Affiliation(s)
- Xenia Grande
- German Center for Neurodegenerative Diseases, Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto von Guericke University Magdeburg, Germany.
| | - David Berron
- German Center for Neurodegenerative Diseases, Magdeburg, Germany; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Anne Maass
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | | | - Emrah Düzel
- German Center for Neurodegenerative Diseases, Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto von Guericke University Magdeburg, Germany; Institute of Cognitive Neuroscience, University College London, United Kingdom.
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26
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Hirsch JA, Cuesta GM, Fonzetti P, Comaty J, Jordan BD, Cirio R, Levin L, Abrahams A, Fry KM. Expanded Exploration of the Auditory Naming Test in Patients with Dementia. J Alzheimers Dis 2021; 81:1763-1779. [PMID: 33998546 DOI: 10.3233/jad-210322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. OBJECTIVE To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. METHODS Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). RESULTS Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. CONCLUSION The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.
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Affiliation(s)
- Joseph A Hirsch
- Department of Psychiatry, Lenox Hill Hospital, Northwell Health, New York, NY, USA.,Department of Psychology, Pace University, New York, NY, USA
| | - George M Cuesta
- New York Harbor Healthcare System, Veterans Health Administration, New York, NY, USA.,New York University Langone Medical Center, New York, NY, USA
| | | | | | - Barry D Jordan
- Rancho Los Amigos National Rehabilitation Hospital, Downey, CA, USA
| | | | - Leanne Levin
- New York Medical College, Department of Medicine, Valhalla, NY, USA
| | | | - Kathleen M Fry
- George E. Wahlen Department of Veterans Affairs Medical Center, Department of Psychology, Salt Lake City, UT, USA
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27
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Archetti D, Young AL, Oxtoby NP, Ferreira D, Mårtensson G, Westman E, Alexander DC, Frisoni GB, Redolfi A. Inter-Cohort Validation of SuStaIn Model for Alzheimer's Disease. Front Big Data 2021; 4:661110. [PMID: 34095821 PMCID: PMC8173213 DOI: 10.3389/fdata.2021.661110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder which spans several years from preclinical manifestations to dementia. In recent years, interest in the application of machine learning (ML) algorithms to personalized medicine has grown considerably, and a major challenge that such models face is the transferability from the research settings to clinical practice. The objective of this work was to demonstrate the transferability of the Subtype and Stage Inference (SuStaIn) model from well-characterized research data set, employed as training set, to independent less-structured and heterogeneous test sets representative of the clinical setting. The training set was composed of MRI data of 1043 subjects from the Alzheimer’s disease Neuroimaging Initiative (ADNI), and the test set was composed of data from 767 subjects from OASIS, Pharma-Cog, and ViTA clinical datasets. Both sets included subjects covering the entire spectrum of AD, and for both sets volumes of relevant brain regions were derived from T1-3D MRI scans processed with Freesurfer v5.3 cross-sectional stream. In order to assess the predictive value of the model, subpopulations of subjects with stable mild cognitive impairment (MCI) and MCIs that progressed to AD dementia (pMCI) were identified in both sets. SuStaIn identified three disease subtypes, of which the most prevalent corresponded to the typical atrophy pattern of AD. The other SuStaIn subtypes exhibited similarities with the previously defined hippocampal sparing and limbic predominant atrophy patterns of AD. Subject subtyping proved to be consistent in time for all cohorts and the staging provided by the model was correlated with cognitive performance. Classification of subjects on the basis of a combination of SuStaIn subtype and stage, mini mental state examination and amyloid-β1-42 cerebrospinal fluid concentration was proven to predict conversion from MCI to AD dementia on par with other novel statistical algorithms, with ROC curves that were not statistically different for the training and test sets and with area under curve respectively equal to 0.77 and 0.76. This study proves the transferability of a SuStaIn model for AD from research data to less-structured clinical cohorts, and indicates transferability to the clinical setting.
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Affiliation(s)
- Damiano Archetti
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alexandra L Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Neil P Oxtoby
- Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Gustav Mårtensson
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Daniel C Alexander
- Department of Computer Science, UCL Centre for Medical Image Computing, London, United Kingdom
| | - Giovanni B Frisoni
- Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.,Laboratory of Alzheimer's Neuroimaging and Epidemiology - LANE, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Kozlova I, Parra MA, Titova N, Gantman M, Sala SD. Alzheimer's Disease and Parkinson Dementia Distinguished by Cognitive Marker. Arch Clin Neuropsychol 2021; 36:307-315. [PMID: 32101280 DOI: 10.1093/arclin/acz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Temporary memory binding (TMB) has been shown to be specifically affected by Alzheimer's disease (AD) when it is assessed via free recall and titrating the task demands to equate baseline performance across patients. METHODS Patients with Parkinson's disease (PD) were subdivided into patients with and without cognitive impairment and compared with AD and amnestic mild cognitive impairment (aMCI) patients on their performance on the TMB. RESULTS The results show that only patients with AD dementia present with impaired TMB performance. Receiver operating characteristic curve analyses showed that TMB holds high sensitivity and specificity for aMCI and AD relative to PD groups and healthy controls. CONCLUSION The TMB is sensitive to the neurodegenerative mechanisms leading to AD dementia but not to those underpinning PD dementia. As such, TMB task can aid the differential diagnosis of these common forms of dementia.
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Affiliation(s)
- Irina Kozlova
- Human Cognitive Neuroscience, Psychology Department, University of Edinburgh, UK
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
- Alzheimer's Scotland Dementia Research Centre, Edinburgh University, UK
- Autonomous University of the Caribbean, Barranquilla, Colombia
| | - Nataliya Titova
- Neurology and Neurosurgery Department, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Maria Gantman
- Department of Alzheimer's Diseases and Related Disorders, Mental Health Research Centre, Moscow, Russia
| | - Sergio Della Sala
- Human Cognitive Neuroscience, Psychology Department, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
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Laguarta J, Subirana B. Longitudinal Speech Biomarkers for Automated Alzheimer's Detection. FRONTIERS IN COMPUTER SCIENCE 2021. [DOI: 10.3389/fcomp.2021.624694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We introduce a novel audio processing architecture, the Open Voice Brain Model (OVBM), improving detection accuracy for Alzheimer's (AD) longitudinal discrimination from spontaneous speech. We also outline the OVBM design methodology leading us to such architecture, which in general can incorporate multimodal biomarkers and target simultaneously several diseases and other AI tasks. Key in our methodology is the use of multiple biomarkers complementing each other, and when two of them uniquely identify different subjects in a target disease we say they are orthogonal. We illustrate the OBVM design methodology by introducing sixteen biomarkers, three of which are orthogonal, demonstrating simultaneous above state-of-the-art discrimination for two apparently unrelated diseases such as AD and COVID-19. Depending on the context, throughout the paper we use OVBM indistinctly to refer to the specific architecture or to the broader design methodology. Inspired by research conducted at the MIT Center for Brain Minds and Machines (CBMM), OVBM combines biomarker implementations of the four modules of intelligence: The brain OS chunks and overlaps audio samples and aggregates biomarker features from the sensory stream and cognitive core creating a multi-modal graph neural network of symbolic compositional models for the target task. In this paper we apply the OVBM design methodology to the automated diagnostic of Alzheimer's Dementia (AD) patients, achieving above state-of-the-art accuracy of 93.8% using only raw audio, while extracting a personalized subject saliency map designed to longitudinally track relative disease progression using multiple biomarkers, 16 in the reported AD task. The ultimate aim is to help medical practice by detecting onset and treatment impact so that intervention options can be longitudinally tested. Using the OBVM design methodology, we introduce a novel lung and respiratory tract biomarker created using 200,000+ cough samples to pre-train a model discriminating cough cultural origin. Transfer Learning is subsequently used to incorporate features from this model into various other biomarker-based OVBM architectures. This biomarker yields consistent improvements in AD detection in all the starting OBVM biomarker architecture combinations we tried. This cough dataset sets a new benchmark as the largest audio health dataset with 30,000+ subjects participating in April 2020, demonstrating for the first time cough cultural bias.
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Tomino C, Ilari S, Solfrizzi V, Malafoglia V, Zilio G, Russo P, Proietti S, Marcolongo F, Scapagnini G, Muscoli C, Rossini PM. Mild Cognitive Impairment and Mild Dementia: The Role of Ginkgo biloba (EGb 761 ®). Pharmaceuticals (Basel) 2021; 14:ph14040305. [PMID: 33915701 PMCID: PMC8065464 DOI: 10.3390/ph14040305] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/17/2022] Open
Abstract
Mild cognitive impairment (MCI) and dementia are clinically prevalent in the elderly. There is a high risk of cognitive decline in patients diagnosed with MCI or dementia. This review describes the effectiveness of Ginkgo biloba leaf special extract EGb 761® for the treatment of dementia syndromes and EGb 761® combination therapy with other medications for symptomatic dementia. This drug has shown convincing results, improving cognitive function, neuropsychiatric symptoms and consequent reduction of caregiver stress and maintenance of autonomy in patients with age-related cognitive decline, MCI and mild to moderate dementia. Currently, there is little evidence to support the combination therapy with anti-dementia drugs and, therefore, more evidence is needed to evaluate the role of EGb 761® in mixed therapy.
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Affiliation(s)
- Carlo Tomino
- Scientific Direction, IRCCS San Raffaele Roma, 00166 Rome, Italy; (C.T.); (S.P.)
| | - Sara Ilari
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University “Magna Graecia” of Catanzaro, 88201 Catanzaro, Italy; (S.I.); (C.M.)
| | - Vincenzo Solfrizzi
- Clinica Medica “Frugoni” and Geriatric Medicine-Memory Unit, University of Bari Aldo Moro, 70122 Bari, Italy;
| | - Valentina Malafoglia
- Institute for Research on Pain, ISAL Foundation, Torre Pedrera, 47922 Rimini, Italy;
| | - Guglielmo Zilio
- Scientific Department, Schwabe Pharma Italia S.r.l., 39044 Egna, Italy;
| | - Patrizia Russo
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy;
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta, 247, 00166 Rome, Italy
- Correspondence: or
| | - Stefania Proietti
- Scientific Direction, IRCCS San Raffaele Roma, 00166 Rome, Italy; (C.T.); (S.P.)
| | - Federica Marcolongo
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy;
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Carolina Muscoli
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University “Magna Graecia” of Catanzaro, 88201 Catanzaro, Italy; (S.I.); (C.M.)
| | - Paolo Maria Rossini
- Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Roma, 00163 Rome, Italy;
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31
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Al-Harrasi AM, Iqbal E, Tsamakis K, Lasek J, Gadelrab R, Soysal P, Kohlhoff E, Tsiptsios D, Rizos E, Perera G, Aarsland D, Stewart R, Mueller C. Motor signs in Alzheimer's disease and vascular dementia: Detection through natural language processing, co-morbid features and relationship to adverse outcomes. Exp Gerontol 2021; 146:111223. [PMID: 33450346 DOI: 10.1016/j.exger.2020.111223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Motor signs in patients with dementia are associated with a higher risk of cognitive decline, institutionalisation, death and increased health care costs, but prevalences differ between studies. The aims of this study were to employ a natural language processing pipeline to detect motor signs in a patient cohort in routine care; to explore which other difficulties occur co-morbid to motor signs; and whether these, as a group and individually, predict adverse outcomes. METHODS A cohort of 11,106 patients with dementia in Alzheimer's disease, vascular dementia or a combination was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was devised in order to establish the presence of motor signs (bradykinesia, Parkinsonian gait, rigidity, tremor) recorded around the time of dementia diagnosis. We examined the co-morbidity profile of patients with these symptoms and used Cox regression models to analyse associations with survival and hospitalisation, adjusting for twenty-four potential confounders. RESULTS Less than 10% of patients were recorded to display any motor sign, and tremor was most frequently detected. Presence of motor signs was associated with younger age at diagnosis, neuropsychiatric symptoms, poor physical health and higher prescribing of psychotropics. Rigidity was independently associated with a 23% increased mortality risk after adjustment for confounders (p = 0.014). A non-significant trend for a 15% higher risk of hospitalisation was detected in those with a recorded Parkinsonian gait (p = 0.094). CONCLUSIONS With the exception of tremor, motor signs appear to be under-recorded in routine care. They are part of a complex clinical picture and often accompanied by neuropsychiatric and functional difficulties, and thereby associated with adverse outcomes. This underlines the need to establish structured examinations in routine clinical practice via easy-to-use tools.
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Affiliation(s)
- Ahmed M Al-Harrasi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Sultan Qaboos University Hospital, Muscat, Oman
| | - Ehtesham Iqbal
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Konstantinos Tsamakis
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; National and Kapodistrian University of Athens, School of Medicine, Second Department of Psychiatry, University General Hospital 'ATTIKON', Athens, Greece
| | - Judista Lasek
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Enno Kohlhoff
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Dimitrios Tsiptsios
- Neurophysiology Department, Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - Emmanouil Rizos
- National and Kapodistrian University of Athens, School of Medicine, Second Department of Psychiatry, University General Hospital 'ATTIKON', Athens, Greece
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dag Aarsland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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Brugnolo A, Girtler N, Doglione E, Orso B, Massa F, Donegani MI, Bauckneht M, Morbelli S, Arnaldi D, Nobili F, Pardini M. Brain Resources: How Semantic Cueing Works in Mild Cognitive Impairment due to Alzheimer's Disease (MCI-AD). Diagnostics (Basel) 2021; 11:diagnostics11010108. [PMID: 33445437 PMCID: PMC7826532 DOI: 10.3390/diagnostics11010108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Semantic cues in the Free and Cued Selective Reminding Test (FCRST) play a key role in the neuropsychological diagnosis of Amnesic Mild Cognitive Impairment due to Alzheimer’s Disease (MCI-AD); however, the neural bases of their impact of recall abilities are only partially understood. Here, we thus decided to investigate the relationships between brain metabolism and the FCSRT Index of Sensitivity of Cueing (ISC) in patients with MCI-AD and in healthy controls (HC). Materials: Thirty MCI-AD patients (age: 74.7 ± 5.7 years; education: 9.6 ± 4.6 years, MMSE score: 24.8 ± 3.3, 23 females) and seventeen HC (age: 66.5 ± 11.1 years; education: 11.53 ± 4.2 years, MMSE score: 28.4 ± 1.14, 10 females) who underwent neuropsychological evaluation and brain F-18 fluorodeoxyglucose Positron Emission Tomography (FDG-PET) were included in the study. Results: ISC was able to differentiate HC from MCI-AD subjects as shown by a ROC analysis (AUC of 0.978, effect size Hedges’s g = 2.89). MCI-AD subjects showed significant hypometabolism in posterior cortices, including bilateral inferior Parietal Lobule and Precuneus and Middle Temporal gyrus in the left hemisphere (VOI-1) compared to HC. ISC was positively correlated with brain metabolism in a single cluster (VOI-2) spanning the left prefrontal cortex (superior frontal gyrus) and anterior cingulate cortex (ACC) in the patient group (R2 = 0.526, p < 0.001), but not in HC. Mean uptake values of VOI-2 did not differ between HC and MCI-AD. The structural connectivity analysis showed that VOI-2 is connected with the temporal pole, the cingulate gyrus and the posterior temporal cortices in the left hemisphere. Conclusion: In MCI-AD, the relative preservation of frontal cortex metabolic levels and their correlation with the ISC suggest that the left frontal cortices play a significant role in maintaining a relatively good memory performance despite the presence of posterior hypometabolism in MCI-AD.
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Affiliation(s)
- Andrea Brugnolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
- Clinical Psychology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-353778
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
- Clinical Psychology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Elisa Doglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
| | - Beatrice Orso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
| | - Maria Isabella Donegani
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (M.I.D.); (M.B.); (S.M.)
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (M.I.D.); (M.B.); (S.M.)
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Silvia Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (M.I.D.); (M.B.); (S.M.)
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
- Neurology Clinics, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
- Neurology Clinics, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child health (DINOGMI), University of Genoa, 16132 Genova, Italy; (N.G.); (E.D.); (B.O.); (F.M.); (D.A.); (F.N.); (M.P.)
- Neurology Clinics, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Lauretani F, Longobucco Y, Ferrari Pellegrini F, De Iorio AM, Fazio C, Federici R, Gallini E, La Porta U, Ravazzoni G, Roberti MF, Salvi M, Zucchini I, Pelà G, Maggio M. Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs. Front Psychol 2020; 11:569629. [PMID: 33324282 PMCID: PMC7725681 DOI: 10.3389/fpsyg.2020.569629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is characterized by the decline and deterioration of functional cells and results in a wide variety of molecular damages and reduced physical and mental capacity. The knowledge on aging process is important because life expectancy is expected to rise until 2050. Aging cannot be considered a homogeneous process and includes different trajectories characterized by states of fitness, frailty, and disability. Frailty is a dynamic condition put between a normal functional state and disability, with reduced capacity to cope with stressors. This geriatric syndrome affects physical, neuropsychological, and social domains and is driven by emotional and spiritual components. Sarcopenia is considered one of the determinants and the biological substrates of physical frailty. Physical and cognitive frailty are separately approached during daily clinical practice. The concept of motoric cognitive syndrome has partially changed this scenario, opening interesting windows toward future approaches. Thus, the purpose of this manuscript is to provide an excursus on current clinical practice, enforced by aneddoctical cases. The analysis of the current state of the art seems to support the urgent need of comprehensive organizational model incorporating physical and cognitive spheres in the same umbrella.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Aurelio Maria De Iorio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Chiara Fazio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Raffaele Federici
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Elena Gallini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Umberto La Porta
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giulia Ravazzoni
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Maria Federica Roberti
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
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Rossini PM, Cappa SF, Lattanzio F, Perani D, Spadin P, Tagliavini F, Vanacore N. The Italian INTERCEPTOR Project: From the Early Identification of Patients Eligible for Prescription of Antidementia Drugs to a Nationwide Organizational Model for Early Alzheimer's Disease Diagnosis. J Alzheimers Dis 2020; 72:373-388. [PMID: 31594234 DOI: 10.3233/jad-190670] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease is the most common age-related neurodegenerative disorder and its burden on patients, families, and society grows significantly with lifespan. Early modifications of risk-enhancing lifestyles and treatment initiation expand personal autonomy and reduce management costs. Many clinical trials with potentially disease-modifying drugs are devoted to mild cognitive impairment (MCI) prodromal-to-Alzheimer's disease. The identification of biomarkers for early diagnosis may thus be crucial for early intervention and identification of high-risk subjects, the most appropriate target of new drugs as soon as they will be discovered. INTERCEPTOR is a strategic project by the Italian Ministry of Health and the Italian Medicines Agency (AIFA), aiming to validate the best combination (highly accurate, non-invasive, available on the whole national territory and financially sustainable) of biomarkers and organizational model for early diagnosis. 500 MCI subjects will be enrolled at baseline and followed-up for 3 years for at least 400 of them in order to define a "hub & spoke" nationwide model with recruiting (spokes) centers for MCI identification and expert (hubs) centers for risk diagnosis.
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Affiliation(s)
- Paolo Maria Rossini
- Area of Neuroscience, University Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy.,Institute of Neurology, Catholic University, Rome, Italy
| | - Stefano F Cappa
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.,IRCCS St. John of God, Brescia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Spadin
- President "Associazione Italiana Malattia di Alzheimer" - AIMA, Italy
| | | | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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Franco-Macías E, Rodrigo-Herrero S, Luque-Tirado A, Méndez-Barrio C, Medina-Rodriguez M, Graciani-Cantisán E, Sánchez-Arjona MB, Maillet D. Reliability and Feasibility of the Memory Associative Test TMA-93. J Alzheimers Dis Rep 2020; 4:431-440. [PMID: 33283164 PMCID: PMC7683101 DOI: 10.3233/adr-200215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Memory tests focused on binding may be more sensitive to diagnose Alzheimer’s disease (AD) at an early phase. TMA-93 examines relational binding by images. Objective: Evaluate the reliability (internal consistency and inter-rater and test-retest reliability) and feasibility of the TMA-93 in a clinic setting with low-educated individuals and limited face-to-face time per patient. Methods: The study was undertaken in a neurology outpatient clinic of a hospital in Southern Spain. The internal consistency of the TMA-93 was estimated in 35 patients with amnestic mild cognitive impairment (aMCI) and 40 healthy controls (HCs). The inter-rater reliability (by two raters) and feasibility (by recording the percentage of participants who completed the test, and by timing the administration time) were evaluated in HCs (n = 16), aMCI patients (n = 18), and mild dementia patients (n = 15). The test-retest reliability for the TMA-93 total score was studied in 51 HCs tested by the same examiner 2–4 months apart. The internal consistency was estimated by Cronbach’s alpha. The inter-rater and test-retest reliability was quantified by the intraclass correlation coefficient (ICC). The administration time was compared by diagnosis. Results: The internal consistency was “optimal” (Cronbach’s alpha = 0.936). The test-retest reliability was “good” [ICC = 0.802 (CI 95% = 0.653–0.887)]. The inter-rater reliability was “optimal” [ICC = 0.999, (CI 95% = 0.999–1)]. All participants completed the test. The administration time ranged from less than 3 min in HCs to 6 min in aMCI patients, and 7 min in mild dementia patients. Conclusion: Good feasibility and reliability support using the TMA-93 for examining visual relational binding, particularly in the context of low-educational attainment and limited time per patient.
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Affiliation(s)
- Emilio Franco-Macías
- Unidad de Memoria, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Silvia Rodrigo-Herrero
- Unidad de Memoria. Servicio de Neurología, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Andrea Luque-Tirado
- Unidad de Memoria, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carlota Méndez-Barrio
- Unidad de Memoria. Servicio de Neurología, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Manuel Medina-Rodriguez
- Unidad de Memoria, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Didier Maillet
- Service de Neurologie, Hôpital Saint-Louis (AP-HP), Paris, France
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[Memory clinics in Germany-structural requirements and areas of responsibility]. DER NERVENARZT 2020; 92:708-715. [PMID: 33025072 PMCID: PMC8257515 DOI: 10.1007/s00115-020-01007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 01/06/2023]
Abstract
Hintergrund Gedächtnisambulanzen (GA) sind auf (Differenzial‑)Diagnostik, Therapie, Aufklärung, Management und Beratung von kognitiven Störungen im Alter und deren Risikostadien spezialisierte Einrichtungen. In der Praxis haben sie sehr unterschiedliche Organisationsformen. Aufgrund der wachsenden diagnostischen Möglichkeiten bei neurodegenerativen Erkrankungen, dem steigenden Bedarf an Früherkennung und Prädiktion sowie absehbaren neuen diagnostischen Verfahren und krankheitsmodifizierenden Therapien ist eine Vereinheitlichung der strukturellen Voraussetzungen und Aufgabenbereiche für GA sinnvoll. Ziel der Arbeit Der Artikel macht Vorschläge für strukturelle und organisatorische Voraussetzungen, Aufgaben sowie einheitliche Arbeitsweisen von GA in Deutschland. Methoden Expertenkonsens von Psychiatern, Neurologen und Geriatern aus universitären und außeruniversitären Einrichtungen. Ergebnisse Gedächtnisambulanzen sollen den Facharztstandard für Psychiatrie und/oder Neurologie vorhalten und sich in ihrer Arbeitsweise bez. (Differenzial‑)Diagnostik und Therapie von Demenzen eng an der S3-Leitlinie (S3LL-)Demenz orientieren. In Bezug auf Früherkennung und Prädiktion neurodegenerativer Erkrankungen gehen sie über die S3LL-Demenz hinaus. So werden leichte kognitive Störungen (MCI) als Risiko- oder auch Prodromalstadien neurodegenerativer Demenzen verstanden und Biomarker regelhaft für eine ätiologische (Früh- und Differenzial‑)Diagnostik eingesetzt. Es soll eine enge Vernetzung mit den diagnostischen Fachdisziplinen bestehen. Ferner sollen sie Beratung zu sozialen und rechtlichen Fragen sowie Angehörigenberatung anbieten. Aktuelle Erkenntnisse aus der Forschung sollen durch sie frühzeitig in die Versorgung integriert werden. GA sind damit regionale Expertenzentren. Diskussion Gedächtnisambulanzen implementieren den evidenzbasierten Standard in Diagnostik und Therapie in die klinische Versorgung von Patienten mit kognitiven Störungen im Alter. Zusätzlich führen sie diagnostische und therapeutische Innovationen in die Versorgung dieser Patienten ein. Ihre Rolle in der Regelversorgung muss gestärkt werden, wobei auch Finanzierungsfragen geklärt werden müssen, da die derzeitigen Finanzierungsmodelle in der Regel nicht kostendeckend sind.
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Bruderer-Hofstetter M, Dubbelman MA, Meichtry A, Koehn F, Münzer T, Jutten RJ, Scheltens P, Sikkes SAM, Niedermann K. Cross-cultural adaptation and validation of the Amsterdam Instrumental Activities of Daily Living questionnaire short version German for Switzerland. Health Qual Life Outcomes 2020; 18:323. [PMID: 33008394 PMCID: PMC7530958 DOI: 10.1186/s12955-020-01576-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
Background Instrumental Activities of Daily Living (IADL) limitations are associated with reduced health-related quality of life for people with mild cognitive impairment (MCI). For these people, the assessment of IADL is crucial to the diagnostic process, as well as for the evaluation of new interventions addressing MCI. The Amsterdam IADL Questionnaire Short Version (A-IADL-Q-SV) is an established assessment tool with good psychometric properties that has been shown to be robust to cultural differences in Western countries. The aims of this study were to: (1) cross-culturally adapt and validate the A-IADL-Q-SV for the German-speaking population of Switzerland; (2) investigate its cultural comparability; and (3) evaluate further psychometric properties. Methods The A-IADL-Q-SV German was pretested on clinicians and participants in a memory clinic setting. The psychometric properties and cultural comparability of the questionnaire were investigated in memory clinic settings including participants with MCI or mild dementia, as well as participants with normal cognition recruited from the community. Item response theory (IRT) was applied to investigate measurement invariance by means of differential item functioning to assess item bias. Additionally, the test–retest reliability on scale level, the construct validity through hypothesis testing and the discriminant validity of the A-IADL-Q-SV German were evaluated. Results Ninety-six informants of participants with normal cognition, MCI or mild dementia completed the A-IADL-Q-SV German. The basic assumptions for IRT scoring were met. No meaningful differential item functioning for culture was detected between the Swiss and Dutch reference samples. High test–retest reliability on scale level (ICC 0.93; 95% CI 0.9–0.96) was found. More than 75% of the observed correlations between the A-IADL-Q-SV German and clinical measures of cognition and functional status were found to be in the direction and of the magnitude hypothesized. The A-IADL-Q-SV German was shown to be able to discriminate between participants with normal cognition and MCI, as well as MCI and mild dementia. Conclusions The A-IADL-Q-SV German is a psychometrically robust measurement tool for a Swiss population with normal cognition, MCI and mild dementia. Thus, it provides a valuable tool to assess IADL functioning in clinical practices and research settings in Switzerland. Trial registration This study was registered retrospectively in July 2019 on ClinicalTrials.gov (NCT04012398).
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Affiliation(s)
- Marina Bruderer-Hofstetter
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Mark A Dubbelman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Florian Koehn
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland.,Department of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roos J Jutten
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Karin Niedermann
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
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Norton DJ, Parra MA, Sperling RA, Baena A, Guzman-Velez E, Jin DS, Andrea N, Khang J, Schultz A, Rentz DM, Pardilla-Delgado E, Fuller J, Johnson K, Reiman EM, Lopera F, Quiroz YT. Visual short-term memory relates to tau and amyloid burdens in preclinical autosomal dominant Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2020; 12:99. [PMID: 32825838 PMCID: PMC7442980 DOI: 10.1186/s13195-020-00660-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/28/2020] [Indexed: 11/15/2022]
Abstract
Background Over the past decade, visual short-term memory (VSTM) binding tests have been shown to be one of the most sensitive behavioral indicators of Alzheimer’s disease (AD), especially when they require the binding of multiple features (e.g., color and shape). Recently, it has become possible to directly measure amyloid and tau levels in vivo via positron emission tomography (PET). To this point, these behavioral and neurochemical markers have not been compared in humans with AD or at risk for it. Methods In a cross-sectional study, we compared VSTM performance to tau and amyloid concentrations, measured by PET, in individuals certain to develop AD by virtue of their inheritance of the presenilin-1 E280A mutation. These included 21 clinically unimpaired subjects and 7 subjects with early mild cognitive impairment (MCI), as well as 30 family members who were not carriers of the mutation. Results We found that VSTM performance correlated strongly with tau in entorhinal cortex and inferior temporal lobe, and also with amyloid when examining asymptomatic carriers only. The condition requiring binding was not preferentially linked to tau—in fact, the non-binding “shape only” condition showed a stronger relationship. Conclusions The results confirm VSTM’s status as an early marker of AD pathology and raise interesting questions as to the course of binding-specific versus non-binding aspects of VSTM in early AD.
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Affiliation(s)
- Daniel J Norton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA.,Gordon College, Wenham, MA, USA
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.,Autonomous University of the Caribbean, Barranquilla, Colombia
| | - Reisa A Sperling
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana Baena
- Grupo de Neurociencias, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Edmarie Guzman-Velez
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | - David S Jin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | - Nicholas Andrea
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | | | - Aaron Schultz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Dorene M Rentz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | - Enmanuelle Pardilla-Delgado
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | - Joshua Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA
| | - Keith Johnson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | | | - Francisco Lopera
- Grupo de Neurociencias, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA. .,Grupo de Neurociencias, Universidad de Antioquia, Medellin, Antioquia, Colombia. .,Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Rm 10.014, Boston, MA, 02129, USA.
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Early diagnosis of Alzheimer’s disease: the role of biomarkers including advanced EEG signal analysis. Report from the IFCN-sponsored panel of experts. Clin Neurophysiol 2020; 131:1287-1310. [DOI: 10.1016/j.clinph.2020.03.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
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Rossini PM, Miraglia F, Alù F, Cotelli M, Ferreri F, Di Iorio R, Iodice F, Vecchio F. Neurophysiological Hallmarks of Neurodegenerative Cognitive Decline: The Study of Brain Connectivity as A Biomarker of Early Dementia. J Pers Med 2020; 10:E34. [PMID: 32365890 PMCID: PMC7354555 DOI: 10.3390/jpm10020034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Neurodegenerative processes of various types of dementia start years before symptoms, but the presence of a "neural reserve", which continuously feeds and supports neuroplastic mechanisms, helps the aging brain to preserve most of its functions within the "normality" frame. Mild cognitive impairment (MCI) is an intermediate stage between dementia and normal brain aging. About 50% of MCI subjects are already in a stage that is prodromal-to-dementia and during the following 3 to 5 years will develop clinically evident symptoms, while the other 50% remains at MCI or returns to normal. If the risk factors favoring degenerative mechanisms are modified during early stages (i.e., in the prodromal), the degenerative process and the loss of abilities in daily living activities will be delayed. It is therefore extremely important to have biomarkers able to identify-in association with neuropsychological tests-prodromal-to-dementia MCI subjects as early as possible. MCI is a large (i.e., several million in EU) and substantially healthy population; therefore, biomarkers should be financially affordable, largely available and non-invasive, but still accurate in their diagnostic prediction. Neurodegeneration initially affects synaptic transmission and brain connectivity; methods exploring them would represent a 1st line screening. Neurophysiological techniques able to evaluate mechanisms of synaptic function and brain connectivity are attracting general interest and are described here. Results are quite encouraging and suggest that by the application of artificial intelligence (i.e., learning-machine), neurophysiological techniques represent valid biomarkers for screening campaigns of the MCI population.
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Affiliation(s)
- Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy; (F.M.); (F.A.); (F.I.); (F.V.)
| | - Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy; (F.M.); (F.A.); (F.I.); (F.V.)
| | - Francesca Alù
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy; (F.M.); (F.A.); (F.I.); (F.V.)
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di DioFatebenefratelli, 25125 Brescia, Italy;
| | - Florinda Ferreri
- Department of Neuroscience, Unit of Neurology and Neurophysiology, University of Padua, 35100 Padua, Italy;
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, 70100 Kuopio, Finland
| | - Riccardo Di Iorio
- Neurology Unit, IRCCS Polyclinic A. Gemelli Foundation, 00168 Rome, Italy;
| | - Francesco Iodice
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy; (F.M.); (F.A.); (F.I.); (F.V.)
- Neurology Unit, IRCCS Polyclinic A. Gemelli Foundation, 00168 Rome, Italy;
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy; (F.M.); (F.A.); (F.I.); (F.V.)
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Laguarta J, Hueto F, Subirana B. COVID-19 Artificial Intelligence Diagnosis Using Only Cough Recordings. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:275-281. [PMID: 34812418 PMCID: PMC8545024 DOI: 10.1109/ojemb.2020.3026928] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022] Open
Abstract
Goal: We hypothesized that COVID-19 subjects, especially including asymptomatics, could be accurately discriminated only from a forced-cough cell phone recording using Artificial Intelligence. To train our MIT Open Voice model we built a data collection pipeline of COVID-19 cough recordings through our website (opensigma.mit.edu) between April and May 2020 and created the largest audio COVID-19 cough balanced dataset reported to date with 5,320 subjects. Methods: We developed an AI speech processing framework that leverages acoustic biomarker feature extractors to pre-screen for COVID-19 from cough recordings, and provide a personalized patient saliency map to longitudinally monitor patients in real-time, non-invasively, and at essentially zero variable cost. Cough recordings are transformed with Mel Frequency Cepstral Coefficient and inputted into a Convolutional Neural Network (CNN) based architecture made up of one Poisson biomarker layer and 3 pre-trained ResNet50's in parallel, outputting a binary pre-screening diagnostic. Our CNN-based models have been trained on 4256 subjects and tested on the remaining 1064 subjects of our dataset. Transfer learning was used to learn biomarker features on larger datasets, previously successfully tested in our Lab on Alzheimer's, which significantly improves the COVID-19 discrimination accuracy of our architecture. Results: When validated with subjects diagnosed using an official test, the model achieves COVID-19 sensitivity of 98.5% with a specificity of 94.2% (AUC: 0.97). For asymptomatic subjects it achieves sensitivity of 100% with a specificity of 83.2%. Conclusions: AI techniques can produce a free, non-invasive, real-time, any-time, instantly distributable, large-scale COVID-19 asymptomatic screening tool to augment current approaches in containing the spread of COVID-19. Practical use cases could be for daily screening of students, workers, and public as schools, jobs, and transport reopen, or for pool testing to quickly alert of outbreaks in groups. General speech biomarkers may exist that cover several disease categories, as we demonstrated using the same ones for COVID-19 and Alzheimer's.
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Affiliation(s)
| | - Ferran Hueto
- MIT AutoID Laboratory Cambridge MA 02139 USA
- Harvard University Cambridge MA 02138 USA
| | - Brian Subirana
- MIT AutoID Laboratory Cambridge MA 02139 USA
- Harvard University Cambridge MA 02138 USA
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The striatum, the hippocampus, and short-term memory binding: Volumetric analysis of the subcortical grey matter's role in mild cognitive impairment. NEUROIMAGE-CLINICAL 2019; 25:102158. [PMID: 31918064 PMCID: PMC7036699 DOI: 10.1016/j.nicl.2019.102158] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
Hippocampal atrophy plays no role in short-term memory binding. The globus pallidus could be part of the brain network supporting binding. Total brain atrophy does not correlate with striatal grey matter atrophy in MCI. Striatal grey matter atrophy reflects in total brain atrophy in controls. Hippocampal and parahippocampal volumes correlate in MCI and controls.
Background Deficits in short-term memory (STM) binding are a distinguishing feature of preclinical stages leading to Alzheimer's disease (AD). However, the neuroanatomical correlates of conjunctive STM binding are largely unexplored. Here we examine the possible association between the volumes of hippocampi, parahippocampal gyri, and grey matter within the subcortical structures – all found to have foci that seemingly correlate with basic daily living activities in AD patients - with cognitive tests related to conjunctive STM binding. Materials and methods Hippocampal, thalamic, parahippocampal and corpus striatum volumes were semi-automatically quantified in brain magnetic resonance images from 25 cognitively normal people and 21 patients with Mild Cognitive Impairment (MCI) at high risk of AD progression, who undertook a battery of cognitive tests and the short-term memory binding test. Associations were assessed using linear regression models and group differences were assessed using the Mann-Whitney U test. Results Hippocampal and parahippocampal gyrus volumes differed between MCI and control groups. Although the grey matter volume in the globus pallidus (r = -0.71, p < 0.001) and parahippocampal gyry (r = -0.63, p < 0.05) correlated with a STM binding task in the MCI group, only the former remained associated with STM binding deficits in MCI patients, after correcting for age, gender and years of education (β = -0.56,P = 0.042) although with borderline significance. Conclusions Loss of hippocampal volume plays no role in the processing of STM binding. Structures within the basal ganglia, namely the globus pallidus, could be part of the extrahippocampal network supporting binding. Replication of this study in large samples is now needed.
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Parra MA, Butler S, McGeown WJ, Brown Nicholls LA, Robertson DJ. Globalising strategies to meet global challenges: the case of ageing and dementia. J Glob Health 2019; 9:020310. [PMID: 31777656 PMCID: PMC6858988 DOI: 10.7189/jogh.09.020310] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Alzheimer’s Scotland Dementia Research Centre, Edinburgh University, UK
- Autonomous University of the Caribbean, Barranquilla, Colombia
| | - Stephen Butler
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Equal contribution, sorted alphabetically by surname
| | - William J. McGeown
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Equal contribution, sorted alphabetically by surname
| | - Louise A Brown Nicholls
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Equal contribution, sorted alphabetically by surname
| | - David J Robertson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Equal contribution, sorted alphabetically by surname
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Düzel E, Thyrian JR, Berron D. [Innovation in diagnostics-mobile technologies]. DER NERVENARZT 2019; 90:914-920. [PMID: 31420690 DOI: 10.1007/s00115-019-0773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Progressive cognitive deficits are the main clinical symptom of Alzheimer's disease; however, the precise recording of cognitive deficits and assessment of their progression pose major problems in patient care and early interventions. OBJECTIVE Which problems for care and early intervention result from the current practice of cognitive assessment of patients with memory problems and which opportunities arise from the use of mobile apps? MATERIAL AND METHODS Evaluation of current care structures, discussion of basic work, expert recommendations and current developments. RESULTS The current practice of the pencil and paper-based diagnostics of cognitive deficits, which is temporally and spatially bound to a clinical environment, constrains the feasibility, validity and reliability of cognitive assessment and the quantification of progression. This limits the meaningful use of further diagnostic measures, such as magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analyses. Recent progress in mobile app-based technologies, illustrated here with the example of the neotiv app, can help to overcome these problems. CONCLUSION Mobile app-based technologies can help to improve the cognitive assessment of patients with the main symptom of memory complaints. They can reduce overuse and underuse of diagnostic and therapeutic pathways and enable a targeted and meaningful use of advanced diagnostics. In addition, they can structure risk-modifying preventive measures, identify iatrogenic impairment of cognition and in this respect also strengthen patient competence.
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Affiliation(s)
- Emrah Düzel
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland. .,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Greifswald, Greifswald, Deutschland.,Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - David Berron
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Schweden
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Bonnechère B, Van Vooren M, Bier JC, De Breucker S, Van Hove O, Van Sint Jan S, Feipel V, Jansen B. The Use of Mobile Games to Assess Cognitive Function of Elderly with and without Cognitive Impairment. J Alzheimers Dis 2019; 64:1285-1293. [PMID: 29991133 DOI: 10.3233/jad-180224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the past few years numerous mobile games have been developed to train the brain. There is a lack of information about the relation between the scores obtained in these games and the cognitive abilities of the patients. OBJECTIVE The aim of this study was to determine whether or not mobile games can be used to assess cognitive abilities of elderly. METHODS Twenty healthy young adults, 29 old patients with cognitive impairments (Mini-Mental State Exam (MMSE) [20- 24]) and 27-aged controls participated in this study. Scores obtained in 7 mobile games were correlated with MMSE and the Addenbrooke's Cognitive Evaluation revised (ACE-R). RESULTS Statistically significant differences were found for all games between patients with cognitive impairments and the aged controls. Correlations between the average scores of the games and the MMSE and ACE-R are significant (R = 0.72 [p < 0.001] and R = 0.81 [p < 0.001], respectively). CONCLUSION Scores of cognitive mobile games could be used as an alternative to MMSE and ACE-R to evaluate cognitive function of aged people with and without cognitive impairment at least when MMSE is higher than 20/30.
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Affiliation(s)
- Bruno Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Brussels, Belgium.,Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Brussels, Belgium.,imec, Leuven, Belgium
| | - Mélissa Van Vooren
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Brussels, Belgium.,Department of Geriatric, Erasme Hospital, Brussels, Belgium
| | | | | | - Olivier Van Hove
- Department of Chest and Thoracic Surgery, Erasme Hospital, Brussels, Belgium
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Brussels, Belgium.,imec, Leuven, Belgium
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Parra MA, Calia C, García AF, Olazarán-Rodríguez J, Hernandez-Tamames JA, Alvarez-Linera J, Della Sala S, Fernandez Guinea S. Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test. Arch Gerontol Geriatr 2019; 83:114-120. [DOI: 10.1016/j.archger.2019.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
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Johnen A, Bertoux M. Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond. Front Neurol 2019; 10:594. [PMID: 31231305 PMCID: PMC6568027 DOI: 10.3389/fneur.2019.00594] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.
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Affiliation(s)
- Andreas Johnen
- Section for Neuropsychology, Department of Neurology, University Hospital Münster, Münster, Germany
| | - Maxime Bertoux
- Univ Lille, Inserm UMR 1171 Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
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Radakovic R, McGrory S, Chandran S, Swingler R, Pal S, Stephenson L, Colville S, Newton J, Starr JM, Abrahams S. The brief Dimensional Apathy Scale: A short clinical assessment of apathy. Clin Neuropsychol 2019; 34:423-435. [PMID: 31154933 DOI: 10.1080/13854046.2019.1621382] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Apathy is a prominent syndrome across neurodegenerative diseases. The Dimensional Apathy Scale (DAS) assesses three apathy subtypes-executive, emotional, and initiation-and is sensitive and valid in amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and Parkinson's disease. This study describes the development of the brief DAS (b-DAS), which will enable apathy to be swiftly detected in the clinic.Method: 102 ALS and 102 AD patients' previously collected data were used. Mokken analyses were performed on item-level data of each informant/carer-rated DAS subscale (executive, emotional, and initiation) for the initial scale reduction. Item-total correlational analyses against standard apathy (convergent validity criteria) and depression (divergent validity criteria) measures and qualitative examination of items aided final item selection. Receiver operating curve analysis determined optimal cutoffs for the reduced subscales.Results: Mokken analyses suggested unidimensionality of each DAS subscale. Three items were removed that failed to satisfy monotone homogeneity model requirements, three items were removed due to validity criteria not being met, and six items were removed due to a combination of lower item scalability and item-total correlations. Item-theme examination further reduced the b-DAS to nine items, three per subscale, with a supplemental awareness deficit assessment being added. Sensitivity- and specificity-based optimal cutoffs were calculated for each b-DAS subscale.Conclusions: This study presents the b-DAS, an informant/carer-based robust yet short multidimensional apathy instrument with good convergent and divergent validity, with recommended clinical cutoffs. The b-DAS is appropriate for use in the clinic and for research to quickly and comprehensively screen for apathy subtype impairments.
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Affiliation(s)
- Ratko Radakovic
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah McGrory
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Judy Newton
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
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Burke SL, Naseh M, Rodriguez MJ, Burgess A, Loewenstein D. Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations. PSYCHOLOGY & NEUROSCIENCE 2019; 12:144-168. [PMID: 31649798 PMCID: PMC6812579 DOI: 10.1037/pne0000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | | | - Aaron Burgess
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - David Loewenstein
- Center on Aging as the Center for Cognitive Neuroscience and Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami
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50
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Pawlowski M, Joksch V, Wiendl H, Meuth SG, Duning T, Johnen A. Apraxia screening predicts Alzheimer pathology in frontotemporal dementia. J Neurol Neurosurg Psychiatry 2019; 90:562-569. [PMID: 30305323 DOI: 10.1136/jnnp-2018-318470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Frontotemporal dementia (FTD) is a heterogeneous clinical syndrome linked to diverse types of underlying neuropathology. Diagnosis is mainly based on clinical presentation and accurate prediction of underlying neuropathology remains difficult. METHODS We present a large cohort of patients with FTD spectrum diseases (n=84). All patients were thoroughly characterised by cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers, neuroimaging, neuropsychological testing and standardised apraxia screening. RESULTS A potential AD pathology was found in 43% of patients with FTD. CSF AD biomarker levels positively correlated with AD-typical apraxia scores in patients with FTD. The discriminative power of apraxia test results indicative of AD pathology was high (sensitivity: 90%, specificity: 66%). CONCLUSIONS Apraxia is common in neurodegenerative dementias but under-represented in clinical workup and diagnostic criteria. Standardised apraxia screening may serve as bedside test to objectify an AD-typical apraxia profile as an early and robust sign of AD pathology in patients with FTD.
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Affiliation(s)
| | - Viktoria Joksch
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Johnen
- Department of Neurology, University Hospital Münster, Münster, Germany
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