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Yan E, Butris N, Alhamdah Y, Kapoor P, Lovblom LE, Islam S, Saripella A, Wong J, Tang-Wai DF, Mah L, Alibhai SMH, Tartaglia MC, He D, Chung F. The utility of remote cognitive screening tools in identifying cognitive impairment in older surgical patients: An observational cohort study. J Clin Anesth 2024; 97:111557. [PMID: 39047531 DOI: 10.1016/j.jclinane.2024.111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
STUDY OBJECTIVES To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen. DESIGN Multicenter prospective study. SETTING Remote preoperative assessments. PATIENTS 307 non-cardiac surgical patients aged ≥65 years. MEASUREMENTS Prevalence, Cohen's kappa (κ). MAIN RESULTS The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR: 2.81; 95% CI: 1.04, 7.68). Obstructive sleep apnea (OSA) (OR: 3.10; 95% CI: 1.26, 7.71) and functional disability (OR: 3.74; 95% CI: 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR: 1.56; 95% CI: 1.01, 2.41), male sex (OR: 3.08; 95% CI: 1.09, 9.40), and higher pain level (OR: 1.21; 95% CI: 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR: 1.33; 95% CI: 1.03, 1.73), male sex (OR: 2.02; 95% CI: 1.09, 3.83), and higher pain level (OR: 1.15; 95% CI: 1.02, 1.30) were associated with a positive T-MoCA screen. CONCLUSIONS The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients.
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Affiliation(s)
- Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Yasmin Alhamdah
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - David F Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Linda Mah
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Geriatric Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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Liu H, Topping A, Guo P. Intergenerational engagement with Asian residents in long-term care facilities: a mixed method systematic review. Front Public Health 2024; 12:1422134. [PMID: 39081361 PMCID: PMC11286590 DOI: 10.3389/fpubh.2024.1422134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/05/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Asian countries are experiencing a rapid rise in their aging populations. Cognitive and physical decline associated with aging can limit social interaction. This particularly impacts on those residing in long-term care facilities and engagement with children and young people. Intergenerational engagement has known benefits on the health and wellbeing of older people, it is unclear what the impact of intergeneration engagement interventions might have on older people in Asian long-term care settings. This review aims to evaluate the effectiveness and experiences of intergenerational engagement with older people in long-term care facilities in Asia. Methods Ten databases were searched to locate empirical studies of any design published in English or Chinese from January 2000 to June 2023. The search was limited to papers reporting effectiveness and/or experiences of intergenerational engagement on older people residing in Asian long-term care settings. The protocol was registered with PROSPERO (CRD42023413935) and followed PRISMA guidelines for reporting. A convergent design employing narrative synthesis was used to synthesize and integrate findings. Results From initial searches, 1,092 records were identified, of which 13 studies were retained for the review: 7 quantitative (including 1 randomized controlled trial, 1 cross-sectional observational design, and 5 quasi-experimental designs), 3 qualitative, and 3 mixed methods. Included studies were of variable quality. Quantitative evidence revealed that intergenerational engagement reduced depression (4.47 vs. 8.67, p = 0.005), negative emotions (14.11 vs. 16.56, p = 0.030), and feelings of loneliness (p < 0.01) among older people; and increased quality of life (mean change = -1.91; 95% CI = -3.18, -0.64) and strengthens interpersonal interactions (p = 0.025). Qualitative insights suggested that intergenerational engagement could foster emotional bonds, enhance intergenerational relationships, promote lifelong learning, satisfy social needs and improve older peoples' overall quality of life. However, some challenges such as language differences and noise levels can hinder successful implementation of intergenerational engagement. Conclusion This review indicates that intergenerational engagement can reduce depression and loneliness, improve quality of life, and strengthen social bonds for older individuals in Asian long-term care facilities. Despite some challenges, the evidence underlines its potential to meet the emotional and social needs of older people. Recognizing and addressing delivery challenges is essential for effective implementation. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023413935, identifier: CRD42023413935.
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Affiliation(s)
- Hao Liu
- University of Birmingham, School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Anne Topping
- University of Birmingham, School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ping Guo
- University of Birmingham, School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham, United Kingdom
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3
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Ge X, Qiao Y, Choi J, Raman R, Ringman JM, Shiand Y. Enhanced Association of Tau Pathology and Cognitive Impairment in Mild Cognitive Impairment Subjects with Behavior Symptoms. J Alzheimers Dis 2022; 87:557-568. [PMID: 35342088 DOI: 10.3233/jad-215555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) individuals with neuropsychiatric symptoms (NPS) are more likely to develop dementia. OBJECTIVE We sought to understand the relationship between neuroimaging markers such as tau pathology and cognitive symptoms both with and without the presence of NPS during the prodromal period of Alzheimer's disease. METHODS A total of 151 MCI subjects with tau positron emission tomographic (PET) scanning with 18F AV-1451, amyloid-β (Aβ) PET scanning with florbetapir or florbetaben, magnetic resonance imaging, and cognitive and behavioral evaluations were selected from the Alzheimer's Disease Neuroimaging Initiative. A 4-group division approach was proposed using amyloid (A-/A+) and behavior (B-/B+) status: A-B-, A-B+, A+B-, and A+B+. Pearson's correlation test was conducted for each group to examine the association between tau deposition and cognitive performance. RESULTS No statistically significant association between tau deposition and cognitive impairment was found for subjects without behavior symptoms in either the A-B-or A+B-groups after correction for false discovery rate. In contrast, tau deposition was found to be significantly associated with cognitive impairment in entorhinal cortex and temporal pole for the A-B+ group and nearly the whole cerebrum for the A+B+ group. CONCLUSION Enhanced associations between tauopathy and cognitive impairment are present in MCI subjects with behavior symptoms, which is more prominent in the presence of elevated amyloid pathology. MCI individuals with NPS may thus be at greater risk for further cognitive decline with the increase of tau deposition in comparison to those without NPS.
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Affiliation(s)
- Xinting Ge
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,School of Information Science and Engineering, Shandong Normal University, Jinan, Shandong, China.,School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuchuan Qiao
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jiyoon Choi
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, CA, USA
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, CA, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yonggang Shiand
- Laboratory of Neuro Imaging (LONI), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Wang X, Li F, Gao Q, Jiang Z, Abudusaimaiti X, Yao J, Zhu H. Evaluation of the Accuracy of Cognitive Screening Tests in Detecting Dementia Associated with Alzheimer's Disease: A Hierarchical Bayesian Latent Class Meta-Analysis. J Alzheimers Dis 2022; 87:285-304. [PMID: 35275533 DOI: 10.3233/jad-215394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) are neuropsychological tests commonly used by physicians for screening cognitive dysfunction of Alzheimer's disease (AD). Due to different imperfect reference standards, the performance of MoCA and MMSE do not reach consensus. It is necessary to evaluate the consistence and differentiation of MoCA and MMSE in the absence of a gold standard for AD. OBJECTIVE We aimed to assess the accuracy of MoCA and MMSE in screening AD without a gold standard reference test. METHODS Studies were identified from PubMed, Web of Science, CNKI, Chinese Wanfang Database, China Science and Technology Journal Database, and Cochrane Library. Our search was limited to studies published in English and Chinese before August 2021. A hierarchical Bayesian latent class model was performed in meta-analysis when the gold standard was absent. RESULTS A total of 67 studies comprising 5,554 individuals evaluated for MoCA and 76,862 for MMSE were included in this meta-analysis. The pooled sensitivity was 0.934 (95% CI 0.906 to 0.954) for MoCA and 0.883 (95% CI 0.859 to 0.903) for MMSE, while the pooled specificity was 0.899 (95% CI 0.859 to 0.928) for MoCA and 0.903 (95% CI 0.879 to 0.923) for MMSE. MoCA was useful to rule out dementia associated with AD with lower negative likelihood ratio (LR-) (0.074, 95% CI 0.051 to 0.108). MoCA showed better performance with higher diagnostic odds ratio (DOR) (124.903, 95% CI 67.459 to 231.260). CONCLUSION MoCA had better performance than MMSE in screening dementia associated with AD from patients with mild cognitive impairment or healthy controls.
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Affiliation(s)
- Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Fengjie Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Zhen Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Xiayidanmu Abudusaimaiti
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Jiangyue Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China
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ELbedewy RMS, ELOKL M. Can a combination of two neuropsychological tests screen for mild neurocognitive disorder better than each test alone? A cross-sectional study. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00048-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Early symptoms of dementia may not be apparent and are sometimes even concealed during short office visits initiated for other complaints. The aim of the study is to find out if the combined use of VF/CDT, VF/BNT, or CDT/BNT could improve the accuracy of detecting mild NCD in an outpatient setting, compared with either test used alone.
Participants
Community-dwelling older adults, attending the outpatient Geriatrics Clinic at Ain Shams University hospitals between June 1, 2017 and January 31, 2018. All participants received a comprehensive geriatric assessment (CGA) which included the mini-mental state examination test. Participants with a score of less than 24 and fulfil DSM5 criteria for mild neurocognitive disorder (NCD) are considered cognitively impaired otherwise are considered normal. Then participants were further examined by the Arabic versions of CDT, BNT, and VF animal category.
Results
We recruited 143 male and female participants mean age 67.17 ± 5.41, females are 56.6%, and 48.9% of all participants have mild NCD according to DSM5 criteria. AUC for individual neurocognitive tests in illiterates is 0.893 for clock drawing test, 0.907 for verbal fluency animal category, and 0.904 for Boston naming test, while AUC for neurocognitive test combinations in illiterates is 0.932 for VF + CDT, 0.917 for VF + BNT, and 0.932 for BNT + CDT. On the other hand, AUC for individual neurocognitive tests in educated participants is 0.925 for clock drawing test, 0.921 for verbal fluency animal category, and 0.907 for Boston naming test, whereas AUC for neurocognitive test combinations in educated participants is 0.958 for VF + CDT, 0.963 for VF + BNT, and 0.953 for BNT + CDT.
Conclusion
From the current study, we can conclude that any of the studied combinations have better diagnostic accuracy (although small) than individual test in both literate and illiterate older adults.
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Harding BN, Floyd JS, Scherrer JF, Salas J, Morley JE, Farr SA, Dublin S. Methods to identify dementia in the electronic health record: Comparing cognitive test scores with dementia algorithms. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2020; 8:100430. [PMID: 32553526 DOI: 10.1016/j.hjdsi.2020.100430] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/27/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Epidemiologic studies often use diagnosis codes to identify dementia outcomes. It remains unknown to what extent cognitive screening test results add value in identifying dementia cases in big data studies leveraging electronic health record (EHR) data. We examined test scores from EHR data and compared results with dementia algorithms. METHODS This retrospective cohort study included patients 60+ years of age from Kaiser Permanente Washington (KPWA) during 2013-2018 and the Veterans Health Affairs (VHA) during 2012-2015. Results from the Mini Mental State Examination (MMSE) and the Saint Louis University Mental Status Examination (SLUMS) cognitive screening exams, were classified as showing dementia or not. Multiple dementia algorithms were created using combinations of diagnosis codes, pharmacy records, and specialty care visits. Correlations between test scores and algorithms were assessed. RESULTS 3,690 of 112,917 KPWA patients and 2,981 of 102,981 VHA patients had cognitive test results in the EHR. In KPWA, dementia prevalence ranged from 6.4%-8.1% depending on the algorithm used and in the VHA, 8.9%-12.1%. The algorithm which best agreed with test scores required ≥2 dementia diagnosis codes in 12 months; at KPWA, 14.8% of people meeting this algorithm had an MMSE score, of whom 65% had a score indicating dementia. Within VHA, those figures were 6.2% and 77% respectively. CONCLUSIONS Although cognitive test results were rarely available, agreement was good with algorithms requiring ≥2 dementia diagnosis codes, supporting the accuracy of this algorithm. IMPLICATIONS These scores may add value in identifying dementia cases for EHR-based research studies.
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Affiliation(s)
- Barbara N Harding
- Department of Medicine, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | - James S Floyd
- Department of Medicine, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Department of Epidemiology, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Cardiovascular Health Research Unit, University of Washington, 1730 Minor Ave, Seattle, WA, 98195, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Harry S. Truman Veterans Administration Medical Center, Research Service, 800 Hospital Drive, Columbia, MO, 65201, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Harry S. Truman Veterans Administration Medical Center, Research Service, 800 Hospital Drive, Columbia, MO, 65201, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Susan A Farr
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Saint Louis Veterans Affairs Medical Center, Research Service, John Cochran Division, 915 North Grand Blvd, St. Louis, MO, 63106, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA; Department of Epidemiology, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA
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Cecato JF, Balduino E, Fuentes D, Martinelli JE. Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study. Clinics (Sao Paulo) 2020; 75:e1435. [PMID: 32159611 PMCID: PMC7053250 DOI: 10.6061/clinics/2020/e1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.
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Chorwe-Sungani G, Chipps J. Validity and utility of instruments for screening of depression in women attending antenatal clinics in Blantyre district in Malawi. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1432136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- G Chorwe-Sungani
- Kamuzu College of Nursing, University of Malawi , Blantyre, Malawi
- University of the Western Cape , Bellville, South Africa
| | - J Chipps
- Kamuzu College of Nursing, University of Malawi , Blantyre, Malawi
- University of the Western Cape , Bellville, South Africa
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Höller Y, Bathke AC, Uhl A, Strobl N, Lang A, Bergmann J, Nardone R, Rossini F, Zauner H, Kirschner M, Jahanbekam A, Trinka E, Staffen W. Combining SPECT and Quantitative EEG Analysis for the Automated Differential Diagnosis of Disorders with Amnestic Symptoms. Front Aging Neurosci 2017; 9:290. [PMID: 28936173 PMCID: PMC5594223 DOI: 10.3389/fnagi.2017.00290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/23/2017] [Indexed: 12/17/2022] Open
Abstract
Single photon emission computed tomography (SPECT) and Electroencephalography (EEG) have become established tools in routine diagnostics of dementia. We aimed to increase the diagnostic power by combining quantitative markers from SPECT and EEG for differential diagnosis of disorders with amnestic symptoms. We hypothesize that the combination of SPECT with measures of interaction (connectivity) in the EEG yields higher diagnostic accuracy than the single modalities. We examined 39 patients with Alzheimer's dementia (AD), 69 patients with depressive cognitive impairment (DCI), 71 patients with amnestic mild cognitive impairment (aMCI), and 41 patients with amnestic subjective cognitive complaints (aSCC). We calculated 14 measures of interaction from a standard clinical EEG-recording and derived graph-theoretic network measures. From regional brain perfusion measured by 99mTc-hexamethyl-propylene-aminoxime (HMPAO)-SPECT in 46 regions, we calculated relative cerebral perfusion in these patients. Patient groups were classified pairwise with a linear support vector machine. Classification was conducted separately for each biomarker, and then again for each EEG- biomarker combined with SPECT. Combination of SPECT with EEG-biomarkers outperformed single use of SPECT or EEG when classifying aSCC vs. AD (90%), aMCI vs. AD (70%), and AD vs. DCI (100%), while a selection of EEG measures performed best when classifying aSCC vs. aMCI (82%) and aMCI vs. DCI (90%). Only the contrast between aSCC and DCI did not result in above-chance classification accuracy (60%). In general, accuracies were higher when measures of interaction (i.e., connectivity measures) were applied directly than when graph-theoretical measures were derived. We suggest that quantitative analysis of EEG and machine-learning techniques can support differentiating AD, aMCI, aSCC, and DCC, especially when being combined with imaging methods such as SPECT. Quantitative analysis of EEG connectivity could become an integral part for early differential diagnosis of cognitive impairment.
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Affiliation(s)
- Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University of SalzburgSalzburg, Austria
| | - Andreas Uhl
- Multimedia Signal Processing and Security Lab, Department of Computer Sciences, Paris Lodron University of SalzburgSalzburg, Austria
| | - Nicolas Strobl
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
| | - Adelheid Lang
- Department of Psychology, Centre for Cognitive Neuroscience, Paris Lodron University of SalzburgSalzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of SalzburgSalzburg, Austria.,Department of Neurology, Franz Tappeiner HospitalMerano, Italy
| | - Fabio Rossini
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
| | - Harald Zauner
- Cardiovascular and Neurological Rehabilitation CenterGroßgmain, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
| | | | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University of SalzburgSalzburg, Austria
| | - Wolfgang Staffen
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University of SalzburgSalzburg, Austria
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Valeriano-Lorenzo L. Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer's Dementia in Population with Low Educational Level. Front Aging Neurosci 2017; 9:278. [PMID: 28878665 PMCID: PMC5572224 DOI: 10.3389/fnagi.2017.00278] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background/Aims: Short tests to early detection of the cognitive impairment are necessary in primary care setting, particularly in populations with low educational level. The aim of this study was to assess the performance of Memory Alteration Test (M@T) to discriminate controls, patients with amnestic Mild Cognitive Impairment (aMCI) and patients with early Alzheimer’s Dementia (AD) in a sample of individuals with low level of education. Methods: Cross-sectional study to assess the performance of the M@T (study test), compared to the neuropsychological evaluation (gold standard test) scores in 247 elderly subjects with low education level from Lima-Peru. The cognitive evaluation included three sequential stages: (1) screening (to detect cases with cognitive impairment); (2) nosological diagnosis (to determinate specific disease); and (3) classification (to differentiate disease subtypes). The subjects with negative results for all stages were considered as cognitively normal (controls). The test performance was assessed by means of area under the receiver operating characteristic (ROC) curve. We calculated validity measures (sensitivity, specificity and correctly classified percentage), the internal consistency (Cronbach’s alpha coefficient), and concurrent validity (Pearson’s ratio coefficient between the M@T and Clinical Dementia Rating (CDR) scores). Results: The Cronbach’s alpha coefficient was 0.79 and Pearson’s ratio coefficient was 0.79 (p < 0.01). The AUC of M@T to discriminate between early AD and aMCI was 99.60% (sensitivity = 100.00%, specificity = 97.53% and correctly classified = 98.41%) and to discriminate between aMCI and controls was 99.56% (sensitivity = 99.17%, specificity = 91.11%, and correctly classified = 96.99%). Conclusions: The M@T is a short test with a good performance to discriminate controls, aMCI and early AD in individuals with low level of education from urban settings.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,GESIDLima, Peru.,Instituto Nacional de Salud del NiñoLima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Medicina de Rehabilitación, Instituto Peruano de NeurocienciasLima, Peru
| | - Sheila Castro-Suarez
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias NeurológicasLima, Peru
| | - José Cuenca-Alfaro
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
| | - Lucía Valeriano-Lorenzo
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
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11
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Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:1139-1150. [PMID: 26891238 DOI: 10.1002/gps.4444] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/21/2015] [Accepted: 01/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE People with amnestic mild cognitive impairment (aMCI) are at an increased risk of developing dementia. Efficient ways of identifying this 'at risk' population are required for larger-scale research studies. This systematic review describes the diagnostic accuracy of brief cognitive tests for detecting aMCI. METHODS Fifteen databases were searched from 1999 to July 2013 to identify papers for inclusion. Prospective studies assessing the diagnostic test accuracy of simple and brief cognitive tests for identifying people with aMCI against a reference standard (Petersen criteria) were included. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Predictive validity and test-retest reliability were also extracted, when provided. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Thirty-nine studies assessing 42 index tests were included. The Montreal Cognitive Assessment was the most comprehensively assessed test with evidence of high sensitivity for aMCI and good test-retest reliability, but low specificity was reported by the only study judged to be at low risk of bias. Other brief cognitive tests that include an assessment of word recall and multi-task tests that assess several cognitive domains were also found to exhibit high sensitivities and reasonable specificities. However, the confidence of the findings was affected by overall low quality of the contributing studies. CONCLUSION Several brief cognitive tests have shown promising diagnostic test accuracy results for identifying aMCI. However, concerns over the quality of the constituent studies and lack of evidence on the predictive validity of these tests mean that new validation studies are warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Seline Ozer
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK. .,School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - Claire Champ
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Melanie Burke
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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12
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Rubínová E, Nikolai T, Marková H, Siffelová K, Laczó J, Hort J, Vyhnálek M. Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: can more detailed scoring systems do the work? J Clin Exp Neuropsychol 2014; 36:1076-83. [PMID: 25486502 DOI: 10.1080/13803395.2014.977233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. METHOD Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. RESULTS Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p < .001) and increased specificity (43.8%), but did not increase sensitivity, which remained high (85.4%). CONCLUSIONS A simple 6-point scoring system for the Clock Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods.
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Affiliation(s)
- Eva Rubínová
- a International Clinical Research Center, St. Anne's University Hospital Brno , Brno , Czech Republic
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13
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Abstract
BACKGROUND Identifying dementia in primary care could minimize the impact of a late intervention; however, it shows high rates of misdiagnosis. One of the reasons seems to be the lack of knowledge of adequate cognitive screening instruments. This is a systematic review of the available instruments for the primary care context. METHOD For this systematic review, articles were collected according to the following combined key terms: "cognitive screening" and "dementia" and "primary care" and "review". Studies should be reviews focusing on cognitive screening instruments best used in primary care setting. RESULTS Thirteen reviews were selected. In total, it was considered 34 cognitive screening instruments. Half of the instruments can be applied in an adequate time-limit for primary care context. Memory is the most commonly assessed cognitive function (91%). Almost half of the tests are mentioned to have influence of education or cultural factors (44%). CONCLUSION Tests such as 6CIT, AMT, GPCOG, Mini-Cog, MIS, MoCA, and STMS seem to be good alternatives to the use of the Mini-Mental State Examination when considering factors such as application time, sensitivity, specificity, and number of studies. However, there is a wide range of tests with different characteristics, therefore it is recommended that the professional gets some expertise in a few number of instruments in order to be able to choose which to use, or use in combination, depending on the setting and the profile of the patient.
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14
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Forlenza OV, Diniz BS, Stella F, Teixeira AL, Gattaz WF. Mild cognitive impairment. Part 1: clinical characteristics and predictors of dementia. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35:178-85. [PMID: 23904025 DOI: 10.1590/1516-4446-2012-3503] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 09/08/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To critically review and evaluate existing knowledge on the conceptual limits and clinical usefulness of the diagnosis of mild cognitive impairment (MCI) and the neuropsychological assessment and short- and long-term prognosis thereof. METHODS We conducted a systematic search of the PubMed and Web of Science electronic databases, limited to articles published in English between 1999 and 2012. Based on the search terms mild cognitive impairment or MCI and epidemiology or diagnosis, we retrieved 1,698 articles, of which 248 were critically eligible (cross-sectional and longitudinal studies); the abstracts of the remaining 1,450 articles were also reviewed. RESULTS A critical review on the MCI construct is provided, including conceptual and diagnostic aspects; epidemiological relevance; clinical assessment; prognosis; and outcome. The distinct definitions of cognitive impairment, MCI included, yield clinically heterogeneous groups of individuals. Those who will eventually progress to dementia may present with symptoms consistent with the definition of MCI; conversely, individuals with MCI may remain stable or return to normal cognitive function. CONCLUSION On clinical grounds, the cross-sectional diagnosis of MCI has limited prognostic relevance. The characterization of persistent and/or progressive cognitive deficits over time is a better approach for identification of cases at the pre-dementia stages, particularly if these cognitive abnormalities are consistent with the natural history of incipient Alzheimer's disease.
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Affiliation(s)
- Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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15
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de Gobbi Porto FH, Spíndola L, de Oliveira MO, Figuerêdo do Vale PH, Orsini M, Nitrini R, Dozzi Brucki SM. A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints. Neurol Int 2013; 5:e16. [PMID: 24147213 PMCID: PMC3794451 DOI: 10.4081/ni.2013.e16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/03/2013] [Accepted: 05/06/2013] [Indexed: 12/12/2022] Open
Abstract
It is not easy to differentiate patients with mild cognitive impairment (MCI) from subjective memory complainers (SMC). Assessments with screening cognitive tools are essential, particularly in primary care where most patients are seen. The objective of this study was to evaluate the diagnostic accuracy of screening cognitive tests and to propose a score derived from screening tests. Elderly subjects with memory complaints were evaluated using the Mini Mental State Examination (MMSE) and the Brief Cognitive Battery (BCB). We added two delayed recalls in the MMSE (a delayed recall and a late-delayed recall, LDR), and also a phonemic fluency test of letter P fluency (LPF). A score was created based on these tests. The diagnoses were made on the basis of clinical consensus and neuropsychological testing. Receiver operating characteristic curve analyses were used to determine area under the curve (AUC), the sensitivity and specificity for each test separately and for the final proposed score. MMSE, LDR, LPF and delayed recall of BCB scores reach statistically significant differences between groups (P=0.000, 0.03, 0.001 and 0.01, respectively). Sensitivity, specificity and AUC were MMSE: 64%, 79% and 0.75 (cut off <29); LDR: 56%, 62% and 0.62 (cut off <3); LPF: 71%, 71% and 0.71 (cut off <14); delayed recall of BCB: 56%, 82% and 0.68 (cut off <9). The proposed score reached a sensitivity of 88% and 76% and specificity of 62% and 75% for cut off over 1 and over 2, respectively. AUC were 0.81. In conclusion, a score created from screening tests is capable of discriminating MCI from SMC with moderate to good accurancy.
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Affiliation(s)
- Fábio Henrique de Gobbi Porto
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Cognitive Disorders Reference Center, das Clínicas Hospital, University of São Paulo
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16
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Dias EDM, Giollo LT, Martinelli DD, Mazeti C, Júnior HM, Vilela-Martin JF, Yugar-Toledo JC. Carotid intima-media thickness is associated with cognitive deficiency in hypertensive patients with elevated central systolic blood pressure. Cardiovasc Ultrasound 2012; 10:41. [PMID: 23078629 PMCID: PMC3495224 DOI: 10.1186/1476-7120-10-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background The role of hypertension in the loss of cognitive function is controversial. Relationships between hypertension and increases in cerebral vascular resistance, diffused lesions and multiple lacunar infarcts of the white matter are well known. Thus, the objectives of this study were: to evaluate the relationship between hypertension and cognitive dysfunction (CD), identify risk factors and determine the association between early markers of vascular disease and CD in hypertensive individuals. Methods Two hundred individuals aged between 40 and 80 years old were evaluated in this cross-sectional prospective study. Fifty participants were controls (CT). The remaining 150 hypertensive patients were subdivided into two groups, those with CD (HCD) and those without CD (HNCD). All participants underwent clinical evaluations and biochemical blood tests were performed. CD was investigated using the Mini Mental State Examination (MMSE) following the guidelines for its use in Brazil. The impact of hypertension on the arterial bed was assessed by identifying and measuring changes in the intima-media thickness (IMT) by vascular ultrasonography of the carotid arteries and analyses of the central blood pressure and Augmentation Index by applanation tonometry of the radial artery. Results There were no significant differences in the total cholesterol, high-density lipoprotein cholesterol and triglycerides plasma concentrations between the three groups. The serum creatinine and estimated glomerular filtration rate were within normal ranges for all three groups. A significantly lower MMSE score was recorded for the HCD Group compared to the HNCD and CT Groups (p-value < 0.05). The IMT was significantly different between the HNCD and HCD Groups (p-value = 0.0124). A significant difference in the IMT was also observed between hypertensive patients and the CT Group (p-value < 0.0001). Age, low-density cholesterol, high-density cholesterol, triglycerides and IMT increased the Odds Ratio for cognitive dysfunction. The central systolic pressure was significantly higher in the HCD and HNCD Groups compared to CT Group (p-value < 0.0001). Conclusions Hypertensive patients with CD have changes in the vascular morphology characterized by an increased carotid IMT, enhanced atherosclerotic lipid profile and impaired hemodynamic functional manifested by elevated central systolic blood pressure.
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Affiliation(s)
- Eros da Mota Dias
- Hypertension Clinic, Department of Internal Medicine, State Medical School of São José do Rio Preto, Brazil
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17
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Charchat-Fichman H, Oliveira RM, da Silva AM. Performance of Brazilian children on phonemic and semantic verbal fluency tasks. Dement Neuropsychol 2011; 5:78-84. [PMID: 29213727 PMCID: PMC5619301 DOI: 10.1590/s1980-57642011dn05020004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The most used verbal fluency paradigms are semantic and letter fluency tasks.
Studies suggest that these paradigms access semantic memory and executive
function and are sensitive to frontal lobe disturbances. There are few studies
in Brazilian samples on these paradigms.
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Affiliation(s)
- Helenice Charchat-Fichman
- Doutorado, Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Rosinda Martins Oliveira
- Doutorado, Departamento de Psicometria, Instituto de Psicologia, Universidade ederal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
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18
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Araujo NBD, Barca ML, Engedal K, Coutinho ESF, Deslandes AC, Laks J. Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression. Clinics (Sao Paulo) 2011; 66:623-7. [PMID: 21655757 PMCID: PMC3093793 DOI: 10.1590/s1807-59322011000400017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 01/17/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare verbal fluency among Alzheimer's disease, Parkinson's disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS Patients from an outpatient university center with a clinical diagnosis of Alzheimer's disease, Parkinson's disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson's disease, major depression, and Alzheimer's disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS The mean digit span and verbal fluency scores were lower in patients with Alzheimer's disease (n = 34) than in patients with major depression (n = 52) or Parkinson's disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer's disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson's disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson's disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer's disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS Verbal fluency provides a better characterization of Alzheimer's disease, major depression, and Parkinson's disease, even at later stages.
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Affiliation(s)
- Narahyana Bom de Araujo
- Laboratory of Exercise, EEFD-related Neuroscience, Federal University of Rio de Janeiro, RJ, Brazil.
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19
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Christofoletti G, Oliani MM, Bucken-Gobbi LT, Gobbi S, Beinotti F, Stella F. Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia. Clinics (Sao Paulo) 2011; 66:613-8. [PMID: 21655755 PMCID: PMC3093791 DOI: 10.1590/s1807-59322011000400015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/06/2010] [Accepted: 01/13/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5%. RESULTS Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients.
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Affiliation(s)
- Gustavo Christofoletti
- Universidade Federal de Mato Grosso do Sul, Health and Biological Sciences Center, Campo Grande, MS, Brazil.
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20
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Ferretti REDL, Damin AE, Brucki SMD, Morillo LS, Perroco TR, Campora F, Moreira EG, Balbino ÉS, Lima MDCDA, Battela C, Ruiz L, Grinberg LT, Farfel JM, Leite REP, Suemoto CK, Pasqualucci CA, Rosemberg S, Saldiva PHN, Jacob-Filho W, Nitrini R. Post-Mortem diagnosis of dementia by informant interview. Dement Neuropsychol 2010; 4:138-144. [PMID: 29213677 PMCID: PMC5619173 DOI: 10.1590/s1980-57642010dn40200011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/20/2010] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. OBJECTIVES To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. METHODS A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. RESULTS Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. CONCLUSIONS The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- University of ABC
| | - Antonio Eduardo Damin
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Lilian Schafirovits Morillo
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
| | - Tibor Rilho Perroco
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Psychiatry,University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Flávia Campora
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Eliza Guccione Moreira
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Érika Silvério Balbino
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | | | - Camila Battela
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lumena Ruiz
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Lea Tenenholz Grinberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- Department of Neurology, University of California, San
Francisco
| | - José Marcelo Farfel
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Renata Elaine Paraiso Leite
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
| | - Carlos Augusto Pasqualucci
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
- São Paulo Autopsy Service
| | - Sérgio Rosemberg
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo
Medical School, São Paulo SP, Brazil
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- Department of Pathology, University of São Paulo
Medical School, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Brazilian Brain Bank of the Aging Brain Study Group -
Laboratory of Medical Investigations 22 (LIM 22)
- RCCD, Reference Center for Cognitive Disorders,
University of São Paulo Medical School, São Paulo SP, Brazil
- Department of Neurology, University of São Paulo
Medical School, São Paulo SP, Brazil
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