Screening for Normal Cognition, Mild Cognitive Impairment, and Dementia with the Korean Dementia Screening Questionnaire

Evaluating the Validity and Reliability of the Korean Version of the Scales for Outcomes in Parkinson's Disease-Cognition

OBJECTIVE

The Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) was developed to assess cognition in patients with Parkinson's disease (PD). In this study, we aimed to evaluate the validity and reliability of the Korean version of the SCOPACog (K-SCOPA-Cog).

METHODS

We enrolled 129 PD patients with movement disorders from 31 clinics in South Korea. The original version of the SCOPA-Cog was translated into Korean using the translation-retranslation method. The test-retest method with an intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient were used to assess reliability. Spearman's rank correlation analysis with the Montreal Cognitive Assessment-Korean version (MOCA-K) and the Korean Mini-Mental State Examination (K-MMSE) were used to assess concurrent validity.

RESULTS

The Cronbach's alpha coefficient was 0.797, and the ICC was 0.887. Spearman's rank correlation analysis revealed a significant correlation with the K-MMSE and MOCA-K scores (r = 0.546 and r = 0.683, respectively).

CONCLUSION

Our.

RESULTS

demonstrate that the K-SCOPA-Cog has good reliability and validity.

A screening method for mild cognitive impairment in elderly individuals combining bioimpedance and MMSE

We investigated a screening method for mild cognitive impairment (MCI) that combined bioimpedance features and the Korean Mini-Mental State Examination (K-MMSE) score. Data were collected from 539 subjects aged 60 years or older at the Gwangju Alzheimer's & Related Dementias (GARD) Cohort Research Center, A total of 470 participants were used for the analysis, including 318 normal controls and 152 MCI participants. We measured bioimpedance, K-MMSE, and the Seoul Neuropsychological Screening Battery (SNSB-II). We developed a multiple linear regression model to predict MCI by combining bioimpedance variables and K-MMSE total score and compared the model's accuracy with SNSB-II domain scores by the area under the receiver operating characteristic curve (AUROC). We additionally compared the model performance with several machine learning models such as extreme gradient boosting, random forest, support vector machine, and elastic net. To test the model performances, the dataset was divided into a training set (70%) and a test set (30%). The AUROC values of SNSB-II scores were 0.803 in both sexes, 0.840 for males, and 0.770 for females. In the combined model, the AUROC values were 0.790 (0.773) for males (and females), which were significantly higher than those from the model including MMSE scores alone (0.723 for males and 0.622 for females) or bioimpedance variables alone (0.640 for males and 0.615 for females). Furthermore, the accuracies of the combined model were comparable to those of machine learning models. The bioimpedance-MMSE combined model effectively distinguished the MCI participants and suggests a technique for rapid and improved screening of the elderly population at risk of cognitive impairment.

A Framework for Best Practices and Readiness in the Advent of Anti-Amyloid Therapy for Early Alzheimer's Disease in Asia

Advances in biomarker-based diagnostic modalities, recent approval of anti-amyloid monoclonal antibodies for early Alzheimer's disease (AD; mild cognitive impairment or mild dementia due to AD) and late-stage clinical development of other disease-modifying therapies for AD necessitate a significant paradigm shift in the early detection, diagnosis and management of AD. Anti-amyloid monoclonal antibodies target the underlying pathophysiological mechanisms of AD and have demonstrated a significant reduction in the rate of clinical decline in cognitive and functional outcome measures in patients with early AD. With growing recognition of the benefit of early interventions in AD, an increasing number of people may seek diagnosis for their subjective cognitive problems in an already busy medical system. Various factors such as limited examination time, lack of expertise for cognitive assessment and limited access to specialized tests can impact diagnostic accuracy and timely detection of AD. To overcome these challenges, a new model of care will be required. In this paper, we provide practical guidance for institutional readiness for anti-amyloid therapies for early AD in Asia, in terms of best practices for identifying eligible patients and diagnosing them appropriately, safe administration of anti-amyloid monoclonal antibodies and monitoring of treatment, managing potential adverse events such as infusion reactions and amyloid-related imaging abnormalities, and cross-disciplinary collaboration. Education and training will be the cornerstone for the establishment of new pathways of care for the identification of patients with early AD and delivery of anti-amyloid therapies in a safe and efficient manner to eligible patients.

Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea

Introduction

Non-alcoholic fatty liver disease (NAFLD) is known to be associated with metabolic syndrome of which diabetes is an important component. Although diabetes is a known risk factor for dementia, studies on the association between NAFLD and dementia still produce conflicting results. This study aimed to determine whether NAFLD would be a risk factor for the development of dementia in an elderly population.

Method

This study included 107,369 subjects aged ≥60 years in the Korean National Health Insurance Service-Senior cohort, entered in 2009 and followed up until 2015. NAFLD was diagnosed by calculating fatty liver index (FLI). Subjects were screened for dementia at baseline using a Korean Dementia Screening Questionnaire, and dementia was diagnosed using ICD-10 codes. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection.

Results

From 107,369 subjects, 65,690 stroke- and dementia-free subjects without chronic hepatitis B or C or excessive alcohol drinking were selected for evaluation. Having NAFLD, determined by FLI, was associated with increased risk of dementia development (adjusted odds ratio [AOR] 1.493; 95% confidence interval [CI] 1.214-1.836). The increased risk of dementia in NAFLD subjects was independent of type 2 diabetes (AOR 1.421; 95% CI 1.013-1.994, in subjects with diabetes: AOR 1.540; 95% CI 1.179- 2.010, in subjects without diabetes).

Conclusion

In this population-based nested case-control study, having NAFLD increased the risk of dementia in elderly individuals, independent of accompanying diabetes.

Pet Insects May Improve Physical Performance and Sleep in Community-Dwelling Frail Elderly People with Chronic Diseases: A Single-Arm Interventional Pilot Study

Purpose

Animal-assisted intervention (AAI) is an effective intervention that improves the mental and physical health. However, few have examined the efficacy of pet insects as a form of AAI for prefrail and frail elderly. This study aimed to ascertain the effects of pet insects on physical performance and psychological health in community-dwelling frail elderly individuals with a chronic disease.

Patients and Methods

This study was an 8 week prospective single-arm interventional pilot study that enrolled prefrail and frail community-dwelling adults aged 70 years and older, all of whom had a chronic disease and attended a daycare facility. Pet insects and appropriate equipment were provided, and supporting programs were used to educate participants about how to rear the insects and how to get close to them. Pre- and post-interventional physical and psychological functions were evaluated.

Results

A total of 23 subjects (mean age, 82.78 years) were enrolled in the final analysis. The timed up-and-go-test (TUG) was used to measure functional mobility, and grip strength was used as a measure of muscle strength; both showed significant changes after the 8-week intervention (Δ = -0.35±0.73 sec, P = 0.034; and Δ = 0.73±0.99 kg, P = 0.002, respectively). In addition, the insomnia severity index (ISI) and average sleep duration improved significantly (Δ = -2.91±5.64, P = -0.021; and Δ = 0.87±1.98, P = 0.047, respectively). There were no significant changes in the results of other psychometric tests. Logistic regression analysis using the forward stepwise selection method revealed that the baseline ISI score and the absence of other comorbidities were significantly associated with the probability of positive changes in both the TUG and HS tests after the intervention.

Conclusion

Pet insects may be an effective and easily applicable type of AAI, which improves physical function and sleep in prefrail and frail elderly individuals.

Association of cardiovascular health with the risk of dementia in older adults

It has been becoming important to identify modifiable risk factors to prevent dementia. We investigated the association of individual and combined cardiovascular health (CVH) on dementia risk in older adults. From the National Health Insurance Service of Korea-Senior database, 191,013 participants aged ≥ 65 years without prior dementia or cerebrovascular diseases who had check-ups between 2004 and 2012 were assessed. Participants were stratified into three groups according to the number of optimal levels of CVH (low, 0-2; moderate, 3-4; and high CVH status, 5-6) and grouped by levels of individual CVH metrics, the number of optimal CVH metrics, and the CVH score. Over a median follow-up of 6.2 years, 34,872 participants were diagnosed with dementia. Compared with low CVH status, moderate and high CVH status were associated with a decreased risk of dementia (hazard ratio [95% confidence interval], 0.91 [0.89-0.92] for moderate; 0.78 [0.75-0.80] for high CVH status) including Alzheimer's and vascular dementia. The risk of dementia decreased with an increase in the number of optimal CVH metrics (0.94 [0.93-0.94] per additional optimal metric) and with an increase in the CVH score (0.93 [0.93-0.94] per 1-point increase). After censoring for stroke, the association of CVH metrics with dementia risk was consistently observed. Among individual metrics, physical activity had the strongest association with the risk of dementia. In an older Asian population without prior dementia or cerebrovascular disease, a consistent relationship was observed between the improvement of a composite metric of CVH and the reduced risk of dementia.

Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment

Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.

Reference interval and the role of plasma oligomeric beta amyloid in screening of risk groups for cognitive dysfunction at health checkups

BACKGROUND

Alzheimer's disease (AD) has a prolonged preclinical stage characterized by cognitive dysfunction. Simple, reliable, and noninvasive biomarkers reflecting the pathogenesis of AD are needed for screening cognitive dysfunction in primary health care. The aims of this study were to determine (1) the potential utility of the Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) value in cognitive assessments and (2) the reference interval (RI) of plasma MDS-OAβ values in the general population.

METHODS

This prospective study consecutively recruited 1,594 participants who underwent health checkups including cognitive function examination at 16 health-promotion centers in Korea between December 2020 and January 2021. The inBlood^TM OAβ test (PeopleBio, Gyeonggi-do, Republic of Korea) was utilized to quantify MDS-OAβ values in plasma. The reference subjects were obtained among those with normal general cognition on cognitive screening tools. RIs were established according to the CLSI C28-A3 guidelines.

RESULTS

The median MDS-OAβ value was higher in subjects with Korean Dementia Screening Questionnaire-Cognition (KDSQ-C) scores ≥8 than in those with KDSQ-C scores of 6-7 (P = 0.013). The median MDS-OAβ value was higher in subjects with Mini-Mental State Examination for Dementia Screening (MMSE-DS) scores of 21-26 than in those with MMSE-DS scores ≥27 (P = 0.011). The RI (one-side upper 95th percentile) of the MDS-OAβ value was 0.80 ng/mL (95% confidence interval = 0.78-0.82) in those aged ≥50 years.

CONCLUSIONS

The plasma MDS-OAβ value reflects cognitive function as assessed using the KDSQ-C and MMSE-DS. RIs obtained from a large and cognitively healthy community-based sample are presented.

Nonlinear Phase Synchronization Analysis of EEG Signals in Amnesic Mild Cognitive Impairment with Type 2 Diabetes Mellitus

Studying the nonlinear synchronization of electroencephalogram (EEG) in type 2 diabetic mellitus (T2DM) to find the EEG characteristics related to cognitive impairment is beneficial to the early prevention and diagnosis of mild cognitive impairment. Correlation between probabilities of recurrence (CPR) is a nonlinear phase synchronization method based on recurrence and recurrence probability, which had shown its superiority in detecting epilepsy. In this study, CPR method was used for the first time to analyze the synchronization of eye-closed resting EEG signals with T2DM. The 27 participants were divided into amnesic mild cognitive impairment (aMCI) group (17 case) and control group (10 cases with age and education matched). The CPR values in two groups were statistically analyzed by Mann-Whitney U test, and the correlation between EEG synchronization and cognitive function was studied by Spearman's correlation. The results showed that aMCI group had lower CPR values at each electrode pair than control group, and two groups had decreased CPR values with the increase of the spatial distance of the electrode pair in inter hemispheric. The CPR values were significantly different in frontal, parietal and temporal regions in intra hemispheric between two groups. The CPR values of C3-F7, F4-C4 and FP2-T6 were significantly positively correlated with the MOCA values. This study showed that the synchronization values of EEG signals obtained by the CPR method were significantly different between aMCI and control group, and they were the EEG characteristics associated with cognitive impairment in T2DM.

Late-life depression, subjective cognitive decline, and their additive risk in incidence of dementia: A nationwide longitudinal study

OBJECTIVE

Late-life depression and subjective cognitive decline (SCD) are significant risk factors for dementia. However, studies with a large sample size are needed to clarify their independent and combined risks for subsequent dementia.

METHODS

This nationwide population-based cohort study included all individuals aged 66 years who participated in the National Screening Program between 2009 and 2013 (N = 939,099). Subjects were followed from the day they underwent screening to the diagnosis of dementia, death, or the last follow-up day (December 31, 2017).

RESULTS

Depressive symptom presentation, recent depressive disorder, and SCD independently increased dementia incidence with adjusted hazard ratio (aHR) of 1.286 (95% CI:1.255-1.318), 1.697 (95% CI:1.621-1.776), and 1.748 (95% CI: 689-1.808) respectively. Subjects having both SCD and depression had a higher risk (aHR = 2.466, 95% CI:2.383-2.551) of dementia than having depression (aHR = 1.402, 95% CI:1.364-1.441) or SCD (aHR = 1.748, 95% CI:1.689-1.808) alone.

CONCLUSIONS

Depressive symptoms, depressive disorder, and SCD are independent risk factors for dementia. Co-occurring depression and SCD have an additive effect on the risk of dementia; thus, early intervention and close follow up are necessary for patients with co-occurring SCD and depression.

Association between Hearing Loss and Cognitive Disorder: A Nationwide Population-Based Study

PURPOSE

To investigate the relationship between hearing loss and cognitive disorder with memory dysfunction in South Korea using data from the Korean Health Insurance claims database for 2009-2015.

MATERIALS AND METHODS

We analyzed cross-sectional data of 66-year-old individuals who completed the Korea National Health and Nutrition Examination Surveys. Auditory function was evaluated using pure-tone audiometric testing. Cognitive disorder with memory dysfunction was assessed using standardized scores of the Prescreening Korean Dementia Screening Questionnaire.

RESULTS

Among 1815835 participants at the age of 66 years, the prevalence of unilateral hearing loss was 5.84%, and that of bilateral hearing loss was 3.40%. The normal cognitive group comprised 86.35% of the participants, and the high-risk group for cognitive disorder with memory dysfunction totaled 13.65% of the participants. The bilateral hearing loss group had the highest percentage of subjects who responded "sometimes or frequently" to all five questions about cognitive disorder with memory dysfunction, compared to the normal hearing group or the unilateral hearing loss group. After adjusting for sex, smoking status, alcohol intake, exercise, income, diabetes, hypertension, dyslipidemia, and depression, the odds ratios for cognitive disorder with memory dysfunction was 1.183 [95% confidence interval (CI): 1.163-1.203] for bilateral hearing loss and 1.141 (95% CI: 1.126-1.156) for unilateral hearing loss, compared to the normal cognitive group.

CONCLUSION

Hearing loss has a significant effect on cognitive function in the Korean population. In our study, individuals with bilateral hearing loss showed poorer cognitive function than those with unilateral hearing loss.

A Comparative Study on the Predictive Value of Different Resting-State Functional Magnetic Resonance Imaging Parameters in Preclinical Alzheimer's Disease

Objective: Diverse resting-state functional magnetic resonance imaging (rs-fMRI) studies showed that rs-fMRI might be able to reflect the earliest detrimental effect of cerebral beta-amyloid (Aβ) pathology. However, no previous studies specifically compared the predictive value of different rs-fMRI parameters in preclinical AD. Methods: A total of 106 cognitively normal adults (Aβ+ group = 66 and Aβ- group = 40) were included. Three different rs-fMRI parameter maps including functional connectivity (FC), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were calculated. Receiver operating characteristic (ROC) curve analyses were utilized to compare classification performance of the three rs-fMRI parameters. Results: FC maps showed the best classifying performance in ROC curve analysis (AUC, 0.915, p < 0.001). Good but weaker performance was achieved by using ReHo maps (AUC, 0.836, p < 0.001) and fALFF maps (AUC, 0.804, p < 0.001). The brain regions showing the greatest discriminative power included the left angular gyrus for FC, left anterior cingulate for ReHo, and left middle frontal gyrus for fALFF. However, among the three measurements, ROI-based FC was the only measure showing group difference in voxel-wise analysis. Conclusion: Our results strengthen the idea that rs-fMRI might be sensitive to earlier changes in spontaneous brain activity and FC in response to cerebral Aβ retention. However, further longitudinal studies with larger sample sizes are needed to confirm their utility in predicting the risk of AD.

The Effectiveness of Acupuncture Treatment for Patients with Alzheimer’s Disease: A Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to evaluate the effectiveness of acupuncture treatment for the symptoms of Alzheimer’s disease (AD). There were 11 databases searched for randomized controlled trials using acupuncture treatment for AD. The risk-of-bias assessment tool of the Cochrane Library was used to evaluate the quality of each study. Using the Review Manager (RevMan), a meta-analysis was performed using risk ratio, mean difference, 95% confidence interval, and random effect model. There were 32 studies selected, all of which were conducted in China. There were 16 studies where acupuncture was used as the intervention, and 23 studies used Donepezil as the control group. Acupoint GV20 was most frequently selected during the treatment. The Mini Mental State Examination (MMSE) was the most frequently used outcome variable. A period of 12 weeks was the most common treatment duration. As a result of meta-analysis (<i>n</i> = 25), acupuncture improved the MMSE and activities of daily living scores. Electroacupuncture improved the Alzheimer Disease Assessment Scale-Cognitive Subscale, and scalp acupuncture improved the MMSE score for AD. Acupuncture alleviates the symptoms of AD. However, further research is necessary to provide a better level of evidence.

Mild cognitive impairment, dementia, and cognitive dysfunction screening using machine learning

Objective

To develop a machine learning algorithm to identify cognitive dysfunction based on neuropsychological screening test results.

Methods

This retrospective study included 955 participants: 341 participants with dementia (dementia), 333 participants with mild cognitive impairment (MCI), and 341 participants who were cognitively healthy. All participants underwent evaluations including the Mini-Mental State Examination and the Montreal Cognitive Assessment. Each participant’s caregiver or informant was surveyed using the Korean Dementia Screening Questionnaire at the same visit. Different machine learning algorithms were applied, and their overall accuracies, Cohen’s kappa, receiver operating characteristic curves, and areas under the curve (AUCs) were calculated.

Results

The overall screening accuracies for MCI, dementia, and cognitive dysfunction (MCI or dementia) using a machine learning algorithm were approximately 67.8% to 93.5%, 96.8% to 99.9%, and 75.8% to 99.9%, respectively. Their kappa statistics ranged from 0.351 to 1.000. The AUCs of the machine learning models were statistically superior to those of the competing screening model.

Conclusion

This study suggests that a machine learning algorithm can be used as a supportive tool in the screening of MCI, dementia, and cognitive dysfunction.

Conversion From The Korean Dementia Screening Questionnaire To The Informant Questionnaire On Cognitive Decline In The Elderly

PURPOSE

The ability to convert scores between cognitive measurements would facilitate the longitudinal assessment of cognition in clinical practice and the comparison and synthesis of cognitive data from international, multicenter, or longitudinal studies. The primary aim of this study was to apply a simple and reliable method for converting scores from the Korean Dementia Screening Questionnaire (KDSQ) to those of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

PATIENTS AND METHODS

A total of 627 participants, with and without cognitive dysfunction, received both the KDSQ and the IQCODE at the same visit. The scores of both tools were calculated, and equipercentile equating was used to create a method for converting scores from the KDSQ to the IQCODE.

RESULTS

KDSQ scores were highly correlated with IQCODE scores (Pearson r = 0.905, P < 0.01). We developed scores for converting the KDSQ to the IQCODE using equipercentile equating and log-linear smoothing. We provide an easy-to-use table that enables the conversion of KDSQ scores to IQCODE scores.

CONCLUSION

We delivered a simple and reliable method for converting scores from the KDSQ to the IQCODE. The conversion score table reported here enables direct and easy comparison of these cognitive measurements in older adults.