Mini-Mental State Examination and Montreal Cognitive Assessment as Tools for Following Cognitive Changes in Alzheimer's Disease Neuroimaging Initiative Participants

Exploring easily accessible neurophysiological biomarkers for predicting Alzheimer's disease progression: a systematic review

Alzheimer disease (AD) remains a significant global health concern. The progression from preclinical stages to overt dementia has become a crucial point of interest for researchers. This paper reviews the potential of neurophysiological biomarkers in predicting AD progression, based on a systematic literature search following PRISMA guidelines, including 55 studies. EEG-based techniques have been predominantly employed, whereas TMS studies are less common. Among the investigated neurophysiological measures, spectral power measurements and event-related potentials-based measures, including P300 and N200 latencies, have emerged as the most consistent and reliable biomarkers for predicting the likelihood of conversion to AD. In addition, TMS-based indices of cortical excitability and synaptic plasticity have also shown potential in assessing the risk of conversion to AD. However, concerns persist regarding the methodological discrepancies among studies, the accuracy of these neurophysiological measures in comparison to established AD biomarkers, and their immediate clinical applicability. Further research is needed to validate the predictive capabilities of EEG and TMS measures. Advancements in this area could lead to cost-effective, reliable biomarkers, enhancing diagnostic processes and deepening our understanding of AD pathophysiology.

Pathogenesis, diagnostics, and therapeutics for Alzheimer's disease: Breaking the memory barrier

Alzheimer's disease (AD) is the most common cause of dementia and accounts for 60-70 % of all cases. It affects millions of people worldwide. AD poses a substantial economic burden on societies and healthcare systems. AD is a progressive neurodegenerative disorder characterized by cognitive decline, memory loss, and impaired daily functioning. As the prevalence of AD continues to increase, understanding its pathogenesis, improving diagnostic methods, and developing effective therapeutics have become paramount. This comprehensive review delves into the intricate mechanisms underlying AD, explores the current state of diagnostic techniques, and examines emerging therapeutic strategies. By revealing the complexities of AD, this review aims to contribute to the growing body of knowledge surrounding this devastating disease.

Effects of traditional Chinese medicine on outcomes and costs of dementia care: results from a retrospective real-world study

OBJECTIVES

This study aims to assess the impact of Traditional Chinese Medicine (TCM) on dementia patients, utilizing real-world data. Specifically, it seeks to evaluate how TCM influences clinical outcomes by examining changes in the Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) scores, as well as its effect on medical expenses over a two-year period. Data from a multi-center research database spanning from 2004 to 2021 will be used to achieve these objectives, addressing the current gap in empirical data concerning intuitive outcomes and cognitive function assessments.

METHODS

Propensity score matching was adopted to improve comparability among the intervention and control groups. Due to repeated dependent variable measurements, the generalized estimating equation was used to control for socio-demographic characteristics, regional characteristics, and Western medicine treatments for dementia.

RESULTS

After propensity score matching, a total of 441 research subjects were included: 90 in the TCM intervention group and 351 in the non-TCM intervention group. The results of multivariate regression analysis showed that compared with the non-TCM intervention group, the MMSE scores in the TCM intervention group increased by 0.608 points each year. The annual change in CDR scores in the TCM intervention group was 0.702 times that of the non-TCM utilization group. After TCM intervention, annual outpatient expenses increased by US$492.2, hospitalization expenses increased by US$324.3, and total medical expenses increased by US$815.9, compared with the non-intervention group.

CONCLUSIONS

TCM interventions significantly decelerate cognitive decline in dementia patients, evidenced by slower reductions in MMSE scores and mitigated increases in CDR scores. However, these benefits are accompanied by increased medical expenses, particularly for outpatient care. Future healthcare strategies should balance the cognitive benefits of TCM with its economic impact, advocating for its inclusion in dementia care protocols.

Ten-words recall test: an effective tool to differentiate mild cognitive impairment from subjective cognitive decline

Introduction

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are stages 2 and 3, respectively, of the Alzheimer's continuum. The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog's) ten-words recall test is a validated method for the early detection of cognitive impairment in Alzheimer's disease. However, limited studies have investigated its ability to differentiate between SCD and MCI.

Methods

203 participants with SCD and 62 participants with MCI underwent multiple neuropsychological assessments. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MOCA-B) served as brief global cognition tests. A binary logistic regression model was used to analyze the potential factors affecting MCI. The accuracy of the ten-words recall test was assessed using the area under the receiver operating characteristic (ROC) and the area under the curve (AUC).

Results

The neuropsychological assessment revealed significant differences in the ten-words recall test scores between the SCD (median age 61 years; 70.44% female) and MCI (median age 64 years; 61.29% female) groups (p < 0.001), with the MCI group scoring the highest. Using a cut-off value of 3.15 for the ten-words recall test, sensitivity for distinguishing MCI from SCD reached 87%, while specificity stood at 61% (AUC 0.777, p < 0.001). DeLong's test indicated no statistically significant difference in the ten-words recall test's ability to distinguish between SCD and MCI compared to the total score of ADAS-Cog (AUC 0.833, p) and MMSE (AUC 0.784, p > 0.05). However, a significant difference was observed when compared to MoCA-B (AUC 0.973, p < 0.001). In the population with an education level of ≤ 9 years, the optimal cut-off value for the ten-words recall test was 3.15, yielding a sensitivity of 91% and a specificity of 45% (AUC = 0.674, p = 0.030). In the population with an education level > 9 years, the optimal cut-off value was 3.63, resulting in a sensitivity of 79% and a specificity of 71% (AUC = 0.785, p < 0.001).

Discussion

The ten-words recall test from the ADAS-cog may detect MCI early owing to its simplicity and quick administration. It is an effective and convenient tool for rapidly identifying mild cognitive impairment.

The nervous system and associated disorders

Disorders of the nervous system, encompassing the brain, spinal cord and peripheral nerves, have emerged as a significant public health issue, with profound implications for individuals worldwide. These conditions result in significant morbidity and mortality. Many patients with neurological disorders often have comorbidities, further complicating their clinical presentation. Therefore, nurses must possess a comprehensive understanding of the nervous system and its associated disorders to formulate detailed care plans that address the unique needs of each patient. This article aims to explore the underlying pathophysiology of some of the most prevalent neurological disorders and how this informs effective patient assessment and diagnostic strategies. A further article will build on this to consider patient assessment and formulating a care plan in more detail.

The diagnostic value of cognitive assessment indicators for mild cognitive impairment (MCI)

OBJECTIVE

This study aims to evaluate and analyze the standard diagnostic methods for mild cognitive impairment (MCI).

METHODS

This study used a prospective case-control study to examine baseline data and diagnostic indicators in a population of elderly with MCI. Based on different cognitive abilities, this study divided MCI and healthy control groups. The diagnostic indicators included CDT, MOCA, MMSE, PSQI, MBI, DST, HAMD, AD-related blood markers, and olfactory testing. The diagnostic value of each indicator was done using the ROC curve.

RESULTS

This study included 240 adult participants, 135 in the health group and 105 in the MCI group. A comparison of baseline data revealed statistically significant differences between the two groups regarding age, blood glucose, MMSE, CTD, MOCA, ability to perform daily living, AD-related blood indices and olfactory tests (all p < 0.05). Logistic regression analysis statistically showed that age, MOCA, and CDT were independent diagnostic factors for MCI (all p < 0.05). Combining these three indicators has the best diagnostic specificity (92.54%). AD-related blood and olfactory tests indices had only moderate diagnostic values (AUC: 0.7-0.8).

CONCLUSION

Age, MOCA, and CDT are good indicators for diagnosing early-stage MCI. AD-related blood indices and olfactory tests can serve as valuable adjuncts in diagnosing MCI.

The Major Hypotheses of Alzheimer's Disease: Related Nanotechnology-Based Approaches for Its Diagnosis and Treatment

Alzheimer's disease (AD) is a well-known chronic neurodegenerative disorder that leads to the progressive death of brain cells, resulting in memory loss and the loss of other critical body functions. In March 2019, one of the major pharmaceutical companies and its partners announced that currently, there is no drug to cure AD, and all clinical trials of the new ones have been cancelled, leaving many people without hope. However, despite the clear message and startling reality, the research continued. Finally, in the last two years, the Food and Drug Administration (FDA) approved the first-ever medications to treat Alzheimer's, aducanumab and lecanemab. Despite researchers' support of this decision, there are serious concerns about their effectiveness and safety. The validation of aducanumab by the Centers for Medicare and Medicaid Services is still pending, and lecanemab was authorized without considering data from the phase III trials. Furthermore, numerous reports suggest that patients have died when undergoing extended treatment. While there is evidence that aducanumab and lecanemab may provide some relief to those suffering from AD, their impact remains a topic of ongoing research and debate within the medical community. The fact is that even though there are considerable efforts regarding pharmacological treatment, no definitive cure for AD has been found yet. Nevertheless, it is strongly believed that modern nanotechnology holds promising solutions and effective clinical strategies for the development of diagnostic tools and treatments for AD. This review summarizes the major hallmarks of AD, its etiological mechanisms, and challenges. It explores existing diagnostic and therapeutic methods and the potential of nanotechnology-based approaches for recognizing and monitoring patients at risk of irreversible neuronal degeneration. Overall, it provides a broad overview for those interested in the evolving areas of clinical neuroscience, AD, and related nanotechnology. With further research and development, nanotechnology-based approaches may offer new solutions and hope for millions of people affected by this devastating disease.

Cognitive impairment in diffuse axonal injury patients with favorable outcome

Background and purpose

Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome.

Methods

The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis.

Results

Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex (r = 0.361, p = 0.014), admission Glasgow Coma Scale (GCS) (r = 0.402, p = 0.006), and years of education (r = 0.581, p < 0.001). Return of consciousness (r = -0.753, p < 0.001), Marshall CT (r = -0.328, p = 0.026), age (r = -0.654, p < 0.001), and DAI grade (r = -0.403, p = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory (r = 0.838, p < 0.001), abstraction (r = 0.843, p < 0.001), and calculation (r = 0.782, p < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory (r = 0.904, p < 0.001), calculation (r = 0.799, p = 0.006), orientation (r = 0.801, p = 0.005), and executive function (r = 0.869, p = 0.001).

Conclusion

DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.