1
|
Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Flicker L, Pachana NA, Kordick S, Strivens E. Validation of the Kimberley Cognitive Assessment (KICA-Cog) for Torres Strait Islander Peoples. Australas J Ageing 2024. [PMID: 38497228 DOI: 10.1111/ajag.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/13/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. METHODS Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. RESULTS A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. CONCLUSIONS The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.
Collapse
Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Queensland, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Sciences, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Kordick
- Faculty of Business, Justice & Behavioural Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
2
|
Glutamatergic dysfunction in Schizophrenia. Transl Psychiatry 2022; 12:500. [PMID: 36463316 PMCID: PMC9719533 DOI: 10.1038/s41398-022-02253-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
The NMDA-R hypofunction model of schizophrenia started with the clinical observation of the precipitation of psychotic symptoms in patients with schizophrenia exposed to PCP or ketamine. Healthy volunteers exposed to acute low doses of ketamine experienced mild psychosis but also negative and cognitive type symptoms reminiscent of the full clinical picture of schizophrenia. In rodents, acute systemic ketamine resulted in a paradoxical increase in extracellular frontal glutamate as well as of dopamine. Similar increase in prefrontal glutamate was documented with acute ketamine in healthy volunteers with 1H-MRS. Furthermore, sub-chronic low dose PCP lead to reductions in frontal dendritic tree density in rodents. In post-mortem ultrastructural studies in schizophrenia, a broad reduction in dendritic complexity and somal volume of pyramidal cells has been repeatedly described. This most likely accounts for the broad, subtle progressive cortical thinning described with MRI in- vivo. Additionally, prefrontal reductions in the obligatory GluN1 subunit of the NMDA-R has been repeatedly found in post-mortem tissue. The vast 1H-MRS literature in schizophrenia has documented trait-like small increases in glutamate concentrations in striatum very early in the illness, before antipsychotic treatment (the same structure where increased pre-synaptic release of dopamine has been reported with PET). The more recent genetic literature has reliably detected very small risk effects for common variants involving several glutamate-related genes. The pharmacological literature has followed two main tracks, directly informed by the NMDA-R hypo model: agonism at the glycine site (as mostly add-on studies targeting negative and cognitive symptoms); and pre-synaptic modulation of glutamatergic release (as single agents for acute psychosis). Unfortunately, both approaches have failed so far. There is little doubt that brain glutamatergic abnormalities are present in schizophrenia and that some of these are related to the etiology of the illness. The genetic literature directly supports a non- specific etiological role for glutamatergic dysfunction. Whether NMDA-R hypofunction as a specific mechanism accounts for any important component of the illness is still not evident. However, a glutamatergic model still has heuristic value to guide future research in schizophrenia. New tools to jointly examine brain glutamatergic, GABA-ergic and dopaminergic systems in-vivo, early in the illness, may lay the ground for a next generation of clinical trials that go beyond dopamine D2 blockade.
Collapse
|
3
|
Mukaetova-Ladinska EB, De Lillo C, Arshad Q, Subramaniam HE, Maltby JJ. DEMENTIA COGNITIVE ASSESSMENT: NEED FOR AN INCLUSIVE TOOL DESIGN. Curr Alzheimer Res 2022; 19:265-273. [PMID: 35293294 DOI: 10.2174/1567205019666220315092008] [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: 01/04/2022] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Elizabeta B Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behavour, Unievrsity of Leicester
- The Evington Center, Leicesterhire Partnership NHS Trust, Leicester
| | - Carlo De Lillo
- Department of Neuroscience, Psychology and Behavour, Unievrsity of Leicester
| | - Qadeer Arshad
- Department of Neuroscience, Psychology and Behavour, Unievrsity of Leicester
| | | | - John J Maltby
- Department of Neuroscience, Psychology and Behavour, Unievrsity of Leicester
| |
Collapse
|
4
|
Omranifard V, Abounoori M, Babakhanian M, Ebrahimi A, Akouchekian S, Shafiei K, Khosravifar S. Translation and psychometric properties of the Persian version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+). Aging Med (Milton) 2021; 4:135-145. [PMID: 34250432 PMCID: PMC8251871 DOI: 10.1002/agm2.12153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the validity and reliability of the Persian version of Health of the Nation Outcome Scales for Elderly People (HoNOS65+) in Iran's elderly population. METHODS The scale English version translated to Persian using a forward and backward translation method. The scale was filled for two elderly population groups (inpatient and outpatients) (N = 300). Simultaneously with HoNOS+65, the Clinical Global Impressions Scale (CGI) was completed. Two separate therapists were filled HoNOS+65 for thirty-one patients (inter-rater reliability test). In general, content validity, consistency, confirmatory factor analyses (CFA), convergent validity, and criterion validity were examined. RESULTS Using exploratory factor analysis, three factors were extracted. Inter-rater reliability in some items has a slight agreement. Content validity ratio (0.75) and index (0.90) were calculated for each item. Cronbach's alpha total score was 0.82. According to the largest modification indices, CFA showed satisfactory fit indices. The convergent validity between HoNOS +65 and CGI was (r = 0/71, sig = 0.000). Finally, the optimal cut-off point was achieved 13. Sensitivity and specificity for the HoNOS +65 were 88.89% and 81.16%, respectively, with the Youden index of 0.7005. CONCLUSION The Persian version of HoNOS65+ has high reliability, validity, specificity, and sensitivity in multidimensional assessment of Iranian geriatric mental health.
Collapse
Affiliation(s)
- Victoria Omranifard
- Department of PsychiatryBehavioral Sciences Research CentreSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mahdi Abounoori
- Student Research CommitteeSchool of MedicineMazandaran University of Medical SciencesSariIran
| | - Masoudeh Babakhanian
- Social Determinants of Health Research CenterSemnan University of Medical SciencesSemnanIran
| | - Amrollah Ebrahimi
- Behavioral Science Research CenterMedicine SchoolIsfahan University of Medical SciencesIsfahanIran
| | - Shahla Akouchekian
- Department of PsychiatryNoor HospitalIsfahan University of Medical SciencesIsfahanIran
| | - Katayoun Shafiei
- Department of PsychiatryIsfahan University of Medical SciencesIsfahanIran
| | - Shaghayegh Khosravifar
- Department of PsychiatrySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| |
Collapse
|
5
|
Jacklin K, Pitawanakwat K, Blind M, O'Connell ME, Walker J, Lemieux AM, Warry W. Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada. Innov Aging 2020; 4:igaa038. [PMID: 33072890 PMCID: PMC7545789 DOI: 10.1093/geroni/igaa038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Objectives Dementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this study was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada. Research Design and Methods We used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Indigenous Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n = 15) and a focus group consultation with local health professionals (n = 7). Results Each question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis, and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes. Discussion and Implications The research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.
Collapse
Affiliation(s)
- Kristen Jacklin
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth.,Memory Keepers Medical Discovery Team - Health Equity, University of Minnesota Medical School Duluth
| | | | - Melissa Blind
- Memory Keepers Medical Discovery Team - Health Equity, University of Minnesota Medical School Duluth
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada
| | - Andrine M Lemieux
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth
| | - Wayne Warry
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth.,Memory Keepers Medical Discovery Team - Health Equity, University of Minnesota Medical School Duluth
| |
Collapse
|
6
|
Single-Dose Memantine Improves Cortical Oscillatory Response Dynamics in Patients with Schizophrenia. Neuropsychopharmacology 2017; 42:2633-2639. [PMID: 28425497 PMCID: PMC5686499 DOI: 10.1038/npp.2017.81] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 01/25/2023]
Abstract
Aberrant gamma-band (30-80 Hz) oscillations may underlie cognitive deficits in schizophrenia (SZ). Gamma oscillations and their regulation by NMDA receptors can be studied via their evoked power (γEP) and phase locking (γPL) in response to auditory steady-state stimulation; these auditory steady-state responses (ASSRs) may be biomarkers for target engagement and early therapeutic effects. We previously reported that memantine, an NMDA receptor antagonist, enhanced two biomarkers of early auditory information processing: prepulse inhibition and mismatch negativity (MMN) in SZ patients and healthy subjects (HS). Here, we describe memantine effects on γEP and γPL in those subjects. SZ patients (n=18) and HS (n=14) received memantine 20 mg (p.o.) and placebo over 2 test days in a double-blind, randomized, counterbalanced, cross-over design. The ASSR paradigm (1 ms, 85 dB clicks in 250-0.5 s trains at a frequency of 40 Hz; 0.5 s inter-train interval) was used to assess γEP and γPL. SZ patients had reduced γEP and γPL; memantine enhanced γEP and γPL (p<0.025 and 0.002, respectively) in both SZ and HS. In patients, significant correlations between age and memantine effects were detected for γEP and γPL: greater memantine sensitivity on γEP and γPL were present in younger SZ patients, similar to our reported findings with MMN. Memantine acutely normalized cortical oscillatory dynamics associated with NMDA receptor dysfunction in SZ patients. Ongoing studies will clarify whether these acute changes predict beneficial clinical, neurocognitive and functional outcomes. These data support the use of gamma-band ASSR as a translational end point in pro-cognitive drug discovery and early-phase clinical trials.
Collapse
|
7
|
Memantine add-on to antipsychotic treatment for residual negative and cognitive symptoms of schizophrenia: a meta-analysis. Psychopharmacology (Berl) 2017; 234:2113-2125. [PMID: 28508107 DOI: 10.1007/s00213-017-4616-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/25/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE We examined whether memantine add-on to antipsychotic treatment is beneficial in schizophrenia treatment. OBJECTIVE This systematic review and meta-analysis aimed to achieve stronger evidence on the efficacy and safety of memantine add-on for treating schizophrenia. METHODS We analyzed double-blind, randomized, placebo-controlled trials of memantine add-on treatment in schizophrenia patients receiving antipsychotics. The primary outcomes were amelioration of negative symptoms and all-cause discontinuation. Dichotomous outcomes are presented as risk ratios (RRs), and continuous outcomes are presented as mean differences (MDs) or standardized mean differences (SMDs). RESULTS Eight studies (n = 448) were included. Although memantine add-on treatment was superior to placebo for ameliorating negative symptoms (SMD = -0.96, p = 0.006, I 2 = 88%; N = 7, n = 367) in the Positive and Negative Syndrome Scale general subscale (MD = -1.62, p = 0.002, I 2 = 0%; N = 4, n = 151) and Mini-Mental Status Examination score (MD = -3.07, p < 0.0001, I 2 = 21%; N = 3, n = 83), there were no statistically significant differences in the amelioration of overall (SMD = -0.75, p = 0.06, I 2 = 86%; N = 5, n = 271), positive (SMD = -0.46, p = 0.07, I 2 = 80%; N = 7, n = 367), and depressive symptoms (SMD = -0.127, p = 0.326, I 2 = 0%; N = 4, n = 201); all-cause discontinuation (RR = 1.34, p = 0.31, I 2 = 0%; N = 8, n = 448); and individual adverse events (fatigue, dizziness, headache, nausea, constipation) between the groups. For negative symptoms, the significant heterogeneity disappeared when risperidone studies alone were considered (I 2 = 0%). However, memantine add-on treatment remained superior to placebo (SMD = -1.29, p = 0.00001). Meta-regression analysis showed that patient age was associated with memantine-associated amelioration of negative symptoms (slope = 0.171, p = 0.0206). CONCLUSIONS Memantine add-on treatment may be beneficial for treating psychopathological symptoms (especially negative symptoms) in schizophrenia patients. The negative-symptom effect size may be associated with younger adult schizophrenia patients.
Collapse
|
8
|
Bentvelzen A, Aerts L, Seeher K, Wesson J, Brodaty H. A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite. J Am Med Dir Assoc 2017; 18:826-837. [PMID: 28283381 DOI: 10.1016/j.jamda.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The diagnosis of dementia and the management of its associated symptoms are aided by high-quality assessment tools. However, there is disagreement on the optimal tools among abundant alternatives and lack of consistent quality standards across the different domains of dementia-related change (ie, cognition, severity, function, behavioral and psychological symptoms, delirium, quality of life). Standardization is difficult because the relevance of a measurement tool for health professionals may depend on the clinical setting and on the dementia type and severity. To address this need, we conducted a comprehensive and clinically relevant evidence-based review of dementia-related tools and present a set of recommended tools, the Dementia Outcomes Measurement Suite. The review revealed that considerable development has occurred in terms of assessment of persons with mild cognitive impairment, executive dysfunction, cognitively mediated functional change, and apathy. More research is needed to develop and validate tools to assess health-related quality of life and specific symptoms of dementia including anxiety, wandering, and repetitive vocalizations. This extensive overview of the quality of different measures may serve as a guide for health professionals clinically and for researchers developing new or improved dementia assessment tools.
Collapse
Affiliation(s)
- Adam Bentvelzen
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Liesbeth Aerts
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Katrin Seeher
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Jacqueline Wesson
- Aging Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia; Center for Healthy Brain Aging (CHeBA), University of New South Wales Australia, Sydney, Australia.
| |
Collapse
|