The Neurobehavioral Cognitive Status Examination: A Brief But Differentiated Approach to Cognitive Assessment

Utility of VSRAD for diagnosing Alzheimer’s disease in patients screened for dementia

Article

Full-text available

Apr 2020
J INT MED RES

Objective To investigate the utility of the voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD). Methods Clinical data from patients who underwent screening for dementia using VSRAD and the Japanese version of COGNISTAT, the Neurobehavioral Cognitive Status Examination, were retrospectively investigated to specify the domains of cognitive function that correlate with the statistical mean value of positive Z-scores in the target volume-of-interest (VOI). A receiver operating characteristic (ROC) curve was constructed to assess the mean value of positive Z-scores in discriminating patients with AD. Results A total of 72 patients were included (18 male and 54 female; 15 patients with AD). The mean value of positive Z-scores in the target VOI was significantly correlated with standardized COGNISTAT scores for Orientation and Memory in all patients (r = –0.35 and –0.38, respectively). ROC curve analysis revealed that a cut-off of 1.57 for mean value of positive Z-scores in the target VOI provided 69.4% accuracy in discriminating patients with AD, with a sensitivity of 0.80 and specificity of 0.67. Conclusions The results evinced the value of VSRAD in diagnosing AD. The degree of atrophy represented by the target VOI may reflect impairments in Orientation and Memory, which are early stage symptoms observed in AD.

Translation, cultural adaptation, and validation of Cognistat for its use in Arabic-speaking population with acquired brain injury

Article

Oct 2019

Background: The use of cognitive assessment tools is central to the detection of cognitive impairment in acquired brain injury patients. Cognistat is a commonly used cognitive screening tool that can detect cognitive deficits among patients with neurological and psychiatric conditions. Cognistat examines different major ability areas including level of language, construction, memory, calculation, reasoning, consciousness, orientation and attention. To date, Cognistat has not been translated/adapted for use in Arabic-speaking countries. Aim: The aim of this paper is to provide normative data for the use of Cognistat in Arabic-speaking populations with acquired brain injury. Design: Cross-cultural validation study. Setting: Inpatient TBI and stroke rehabilitation ward in a rehabilitation hospital. Population: A total of 107 healthy Arabic-speaking adults and 62 acquired brain injury patients were involved in the study. Methods: After the completion of the cross-cultural adaptation process, psychometric properties of the adapted cognitive tool were evaluated. Results: The Arabic version of Cognistat was found to have acceptable internal consistency, and the test-retest reliability showed high stability of scores over time. For concurrent validity, patients' performance on the Arabic version of Cognistat and the Mini-Mental State Examination were compared with excellent correlations overall. Significant differences between the performance of patients and the control group were found on all sub-tests. Conclusions: The Arabic version of Cognistat appears to be a valid and reliable cognitive screening tool. It is anticipated that the Arabic version of Cognistat will be widely used in the Arabic-speaking countries, allowing for a very precise evaluation of cognitive deficits in acquired brain injury patients. Clinical rehabilitation impact: As part of the rehabilitation process, health care professionals are regularly required to test patients' cognitive abilities using appropriate measures. The findings of the study provide key solutions for the clinical assessment of Arabic populations: such cognitive tools could help improve the cognitive rehabilitation practice for the Arabic population by offering validated, reliable, and culturally adapted tests in the Arabic language.

Inter- and intra-rater reliability of cognitive assessment conducted by assistive robot for older adults living in the community: a preliminary study

Article

Full-text available

Oct 2024
PSYCHOGERIATRICS

Background The purpose of this study was to reveal inter‐ and intra‐rater reliability of the detailed evaluation of cognitive function by assistive robot for older adults. Methods We investigated the inter‐rater and test–retest reliability. Neurobehavioral Cognitive Status Examination was conducted twice for each participant using an assistive robot and the examiner respectively (Experiment 1). The order of these two tests was randomly selected and the interval between them was 1 week. In Experiment 2, we investigated the test–retest reliability of the first robot test and this additional robot test was conducted approximately 6 weeks after Experiment 1. Results Fifty‐one (13 men and 38 women, mean age: 80.5 ± 5.6 years) participants went through Experiment 1 and 29 of those (eight men and 21 women, mean age: 80.4 ± 4.8 years) completed Experiment 2. In Experiment 1, the interclass coefficient (ICC) in orientation was in the high range and its Cronbach's α was 0.919, rated as excellent internal consistency. On the other hand, other items did not show positive results. In Experiment 2, the ICCs in orientation, attention, and repetition were in the adequate range, while other items showed marginal or low range. Conclusions Orientation was supposed to be utilised for figuring out initial symptoms of dementia. In the future, as robot functions become more high‐tech, a partner robot might be able to measure the symptoms and severity of dementia.

Depression and time perspectives in patients with brain tumors: Novel measurements in the Circle Test

Article

Full-text available

Jan 2021

Background Tumors trigger both depression and anxiety about death because they can be terminal. However, the relationship between depression and time perspective in patients with life-threatening diseases remains unclear. In this study, we examined the effects of depression on time perspective in patients with brain tumors using a projective method, i.e., the Circle Test. Methods Participants (40 depressed patients, Dp; 35 non-depressed patients, NDp; and 40 healthy non-depressed controls, NDc) were administered the Circle Test of time perspectives and self-rating depression scales before and after surgery. The Circle Test data were analyzed using traditional indices, i.e., time dominance and relatedness, and novel measurements, i.e., time area and proportion. Results Although the traditional indices showed no differences, the results for the novel measurements differed among the Dp, NDp, and NDc groups. The overall time perspective was smaller in the Dp group than in the NDc group; furthermore, the proportions of the future and past perspectives were higher and lower, respectively, in the Dp group compared to the NDp group. Limitations Patients with brain tumors and depressed controls could not be compared, because no healthy control was depressed. Differences in depression-related changes in time perspective between patients with brain tumors and healthy controls should be examined in future studies. Conclusions Depressed patients with brain tumors may experience changes in time perspectives according to the results for our novel measurements, and this might play an important role in treatment adherence.

Cognitive impairment and its consequences in everyday life

Book

Full-text available

Apr 2015

Maria M Johansson

Dementia diagnostics in primary care : with a focus on cognitive testing

Book

Full-text available

Oct 2019

Anna Segernäs

Evaluación neuropsicológica basada en los procesos: revisión de la evidencia y propuesta para la mejora de las herramientas de cribado de demencia

Article

Jan 2017
REV NEUROLOGIA

El Ejercicio Físico como variable determinante en la mejora significativa del rendimiento cognitivo en adultos mayores. Una revisión sistemática.

Chapter

Full-text available

Jul 2023

Se revisa y analiza en la literatura si el ejercicio físico funciona como variable determinante en la mejora significativa del funcionamiento cognitivo en adultos mayores, con o sin deterioro, mediante revisión sistemática, conforme a los principios de la metodología PRISMA propuesta a nivel internacional. Se seleccionan 20 artículos de las bases de datos PubMed y REDIB, con un total de 2723 participantes, de los cuales 2220 son sometidos a una intervención de ejercicio físico. Respecto a los resultados reportados por los estudios, en el 90% de los casos se objetiva una mejora significativa en el funcionamiento cognitivo de los participantes, ya sea general o específica en algún dominio, luego de una intervención de entrenamiento físico. Del total de los participantes que fueron sometidos a una intervención de ejercicio, el 96% presenta mejoras significativas en el rendimiento cognitivo. El dominio cognitivo que obtiene mayor cantidad de mejoras en los participantes, es el de funciones ejecutivas y sus subdominios; y la modalidad de actividad física que predomina es la de actividad aeróbica y de resistencia. Considerando lo dicho, comienza a quedar claro que la actividad física, y en particular la aeróbica, resulta beneficiosa de manera significativa para el funcionamiento cognitivo, sobre todo a nivel ejecutivo, de los adultos mayores, con o sin deterioro y en más de una función específica. Este hecho resulta esperanzador, no sólo para la prevención del deterioro cognitivo en edades avanzadas, sino también para el mantenimiento y mejoramiento del funcionamiento cognitivo en poblaciones sanas y en todas las fases de deterioro cognitivo. Palabras clave: Ejercicio físico, Rendimiento cognitivo, Adultos mayores.

Safety and efficacy of etomidate in combination with oxycodone in painless gastroscopic procedures in the elderly: A prospective randomized controlled trial study

Article

Full-text available

Jan 2023
MEDICINE

Objective: Etomidate is often combined in rapid succession during induction of anesthesia. However, the effect of pretreatment with oxycodone on recovery of cognitive function and adverse effects has rarely been studied. We conducted a prospective randomized controlled trial to compare etomidate alone with etomidate combined with oxycodone in elderly patients undergoing painless gastroscopy. Methods: Hundred elderly patients undergoing painless gastroscopy were divided into a control and an observation group, with 50 cases in each group. The age, gender, height, weight, body mass index and American Society of Anesthesiologists physical status (I/II) of patients in both groups were recorded. The recovery of cognitive function was compared in both groups using the Neurobehavioral Cognitive Status Examination. Adverse events, including somatic motor reactions, hypotension, bradycardia, myocardial tremor, nausea and vomiting, and injection pain, were also recorded in both groups. Moreover, heart rate, peripheral capillary oxygen saturation, systolic blood pressure, and diastolic blood pressure were evaluated in the 2 groups at different time points. Results: A total of 100 patients were enrolled in this study. The demographic characteristics in the 2 groups were not significantly different (P > .05). Regarding the recovery of cognitive functions, more subjects in the observation group passed the memory, arithmetic and orientation test than in the control group (P < .05). Fewer adverse events such as dynamic body reactions, cardiac tremor, nausea and vomiting, and injection pain occurred in the observation group than in the control group (P < .05). During anesthesia and after awakening, the results of peripheral capillary oxygen saturation, systolic blood pressure and diastolic blood pressure were better in the observation group than in the control group (P < .05). Conclusion: Etomidate in combination with oxycodone for painless gastroscopic operation in the elderly is a safe and effective anesthetic strategy.

Impacto de los programas de estimulación en adultos mayores con demencia que asisten a un centro de día

Article

Full-text available

Dec 2014

Las demencias son un problema de salud pública a nivel mundial con serias implicaciones sociomédicas y económicas. El centro de día para adultos mayores con demencia (CDAMD) representa una opción a nivel comunitario para el apoyo de la población afectada y sus familias. Objetivo: describir los resultados a 6 y 12 meses de intervenciones realizadas en el CDAMD en pacientes con demencia. Material y métodos: se trata de un ensayo clínico abierto. La población de estudio fue una muestra por conveniencia, integrada por 16 adultos mayores (AM) con demencia en etapa de leve a moderada, usuarios de un CDAMD de la ciudad de México. A quienes se les realizó evaluaciones cognitivas de funcionalidad y severidad de la demencia. Se compararon las evaluaciones pre y posintervención (a los 12 meses). Resultados: el 63% fueron mujeres, la edad promedio fue de 77.4 años (DE 7.1), el 31% tenían primaria incompleta, 37.5% eran independientes para las actividades básicas de la vida diaria (ABVD). Observamos que el desempeño cognitivo global se mantuvo estable a los 12 meses; al analizarlo por función únicamente la atención y juicio mostraron leve deterioro estadísticamente significativo, el resto de las funciones no presentaron cambios. Discusión y conclusiones: la demencia es un padecimiento que tiende a ser progresivo, afecta a quien la padece y a sus familiares. La evaluación mostró el impacto de la intervención en el funcionamiento cognitivo global de los asistentes al CDAMD con cambios discretos en atención y juicio, de funciones sobre las cuales se recomienda prestar especial atención en la elaboración de programas de estimulación.

Efficacy of the Diabetes Prevention Program Group Lifestyle Balance program modified for individuals with TBI (GLB-TBI)

Article

Jul 2022
ANN BEHAV MED

Background Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI. Purpose To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes. Methods Individuals with moderate to severe TBI, age 18–64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months. Results The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27). Conclusions Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.

Comparing emergency department use among individuals with varying levels of cognitive impairment

Article

Full-text available

May 2022
BMC Geriatr

Introduction As the population ages, Alzheimer’s disease and related dementias (ADRD) are becoming increasingly common in patients presenting to the emergency department (ED). This study compares the frequency of ED use among a cohort of individuals with well-defined cognitive performance (cognitively intact, mild cognitive impairment (MCI), and ADRD). Methods We performed a retrospective cohort study of English-speaking, community-dwelling individuals evaluated at four health system-based multidisciplinary memory clinics from 2014–2016. We obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. We characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches. Results Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as MCI, and 318 as ADRD. The proportion of subjects with any annual ED use did not increase significantly with greater cognitive impairment: cognitively intact (16.9%), MCI (26.1%), and ADRD (28.9%) ( p = 0.072). Average number of ED visits increased similarly: cognitively intact (0.27, SD 0.72), MCI (0.41, SD 0.91), and ADRD (0.55, SD 1.25) ( p = 0.059). Multivariate logistic regression results showed that patients with MCI (odds ratio (OR) 1.62; CI = 0.87–3.00) and ADRD (OR 1.84; CI = 0.98–3.46) did not significantly differ from cognitively intact adults in any ED use. Multivariate negative binomial regression found patients with MCI (incidence rate ratio (IRR) 1.38; CI = 0.79–2.41) and ADRD (IRR 1.76, CI = 1.00–3.10) had elevated but non-significant risk of an ED visit compared to cognitively intact individuals. Conclusion Though there was no significant difference in ED use in this small sample from one health system, our estimates are comparable to other published work. Results suggested a trend towards higher utilization among adults with MCI or ADRD compared to those who were cognitively intact. We must confirm our findings in other settings to better understand how to optimize systems of acute illness care for individuals with MCI and ADRD.

Montreal Cognitive Assessment: Normative Data for Cognitively Healthy Swedish 80- to 94-Year-Olds

Article

Full-text available

Apr 2022
J ALZHEIMERS DIS

Background: The Montreal Cognitive Assessment (MoCA) is sensitive to cognitive impairment; however, it is also sensitive to demographic and socio-cultural factors. This necessitates reliable sub-population norms, but these are often lacking for older adults. Objective: To present demographically adjusted regression-based MoCA norms for cognitively healthy Swedish older adults. Methods: A pseudo-random sample of community-dwelling 80- to 94-year-olds, stratified by age and gender, was invited to the study. Initial telephone interviews and medical records searches (n = 218) were conducted to screen for cognitive impairment. N = 181 eligible participants were administered a protocol including the Swedish version of the MoCA and assessment of global cognition (Mini-Mental State Examination, MMSE) and depression (Patient Health Questionnaire-9, PHQ-9). Individuals scoring in the range of possible cognitive impairment on the MMSE or more than mild depression on the PHQ-9 were excluded (n = 23); three discontinued the test-session. Results: Norms were derived from the remaining n = 158. They were evenly distributed by gender, on average 85 years old, and with a mean education of 11 years. MoCA scores were independently influenced by age and education, together explaining 17.2% of the total variance. Higher age and lower education were associated with lower performance and 46% performed below the original cut-off (< 26/30). Conclusion: The negative impact of increasing age on MoCA performance continues linearly into the nineties in normal aging. Demographic factors should be considered when interpreting MoCA performance and a tool for computing demographically corrected standard scores is provided.

The predictive value of a new brief cognitive test for long-term functional outcome in acute TBI

Article

Mar 2022
ARCH PHYS MED REHAB

Objective To determine how results on the EXACT (EXAmen Cognitif abrégé en Traumatologie), a new test specifically designed to briefly assess global cognitive functioning during the acute phase of traumatic brain injury (TBI), can predict long-term functional outcome compared to length of post-traumatic amnesia (PTA), a well-established predictor. Design Inception cohort. Settings Level 1 trauma center. Participants A total of 90 patients hospitalized for a moderate or severe TBI. Interventions Not applicable Main outcome measures Performance on the EXACT in the first three months after injury and results on the Disability Rating Scale (DRS) at follow-up one to two years later. Results EXACT scores were all correlated with length of PTA and DRS result. Compared to length of PTA, the EXACT added significantly to the regression and improved prediction of functional outcome. More specifically, a total score of ≤ 80 on the EXACT was associated with a higher rate of long-term disability due to more severe TBI consequences. Behavioral regulation and executive functions were the cognitive domain that showed the most impairment, followed by attention and working memory, and episodic memory. Except for length of PTA and hospital stay, the DRS score was not correlated with other demographic (age, education) or clinical variables (Glasgow Coma Scale and maximum score on the Therapy Intensity Level Scale). Conclusion The EXACT can be administered to most patients early in the acute phase of TBI and results could be used, along with other predictors like PTA, to estimate their long-term functional sequelae. The EXACT may be a promising brief cognitive instrument for future studies investigating recovery after TBI.

Methodology and feasibility of neurofeedback to improve visual attention to letters in mild Alzheimer's disease

Preprint

Full-text available

Nov 2021

Brain computer interfaces systems are controlled by users through neurophysiological input for a variety of applications including communication, environmental control, motor rehabilitation, and cognitive training. Although individuals with severe speech and physical impairment are the primary users of this technology, BCIs have emerged as a potential tool for broader populations, especially with regards to delivering cognitive training or interventions with neurofeedback. The goal of this study was to investigate the feasibility of using a BCI system with neurofeedback as an intervention for people with mild Alzheimer's disease. The study focused on visual attention and language since ad is often associated with functional impairments in language and reading. The study enrolled five adults with mild ad in a nine to thirteen week BCI EEG based neurofeedback intervention to improve attention and reading skills. Two participants completed intervention entirely. The remaining three participants could not complete the intervention phase because of restrictions related to covid. Pre and post assessment measures were used to assess reliability of outcome measures and generalization of treatment to functional reading, processing speed, attention, and working memory skills. Participants demonstrated steady improvement in most cognitive measures across experimental phases, although there was not a significant effect of NFB on most measures of attention. One subject demonstrated significantly significant improvement in letter cancellation during NFB. All participants with mild AD learned to operate a BCI system with training. Results have broad implications for the design and use of bci systems for participants with cognitive impairment. Preliminary evidence justifies implementing NFB-based cognitive measures in AD.

Whole-blood metabolomics of dementia patients reveal classes of disease-linked metabolites

Article

Full-text available

Sep 2021
P NATL ACAD SCI USA

Significance Dementia is a slowly progressing, chronic, and usually irreversible decline in cognitive function. Mechanistic causes and definitive treatments remain elusive. Using comprehensive metabolomics, we identified five groups of 33 metabolites (A to E), 13 of them previously reported, possibly useful for diagnosis and therapy of forms of dementia, such as Alzheimer’s disease. Seven A compounds may act as neurotoxins, whereas B to E compounds may protect the nervous system against oxidative stress, maintain energy reserves, supply nutrients and neuroprotective factors. Five metabolites, ergothioneine, S -methyl-ergothioneine, trimethyl-histidine, methionine, and tryptophan, overlap with those reported for frailty. Interventions for cognitive diseases involving these dementia metabolomic markers may be accomplished either by inhibiting A compounds or by supplementing B to E compounds in patients.

Impacto de los programas de estimulación en adultos mayores con demencia que asisten a un centro de día

Article

Full-text available

Dec 2014

Las demencias son un problema de salud pública a nivel mundial con serias implicaciones sociomédicas y económicas. El centro de día para adultos mayores con demencia (CDAMD) representa una opción a nivel comunitario para el apoyo de la población afectada y sus familias. Objetivo: describir los resultados a 6 y 12 meses de intervenciones realizadas en el CDAMD en pacientes con demencia. Material y métodos: se trata de un ensayo clínico abierto. La población de estudio fue una muestra por conveniencia, integrada por 16 adultos mayores (AM) con demencia en etapa de leve a moderada, usuarios de un CDAMD de la ciudad de México. A quienes se les realizó evaluaciones cognitivas de funcionalidad y severidad de la demencia. Se compararon las evaluaciones pre y posintervención (a los 12 meses). Resultados: el 63% fueron mujeres, la edad promedio fue de 77.4 años (DE 7.1), el 31% tenían primaria incompleta, 37.5% eran independientes para las actividades básicas de la vida diaria (ABVD). Observamos que el desempeño cognitivo global se mantuvo estable a los 12 meses; al analizarlo por función únicamente la atención y juicio mostraron leve deterioro estadísticamente significativo, el resto de las funciones no presentaron cambios. Discusión y conclusiones: la demencia es un padecimiento que tiende a ser progresivo, afecta a quien la padece y a sus familiares. La evaluación mostró el impacto de la intervención en el funcionamiento cognitivo global de los asistentes al CDAMD con cambios discretos en atención y juicio, de funciones sobre las cuales se recomienda prestar especial atención en la elaboración de programas de estimulación.

Automatic Assessment of Cognitive Tests for Differentiating Mild Cognitive Impairment: A Proof of Concept Study of the Digit Span Task

Article

Full-text available

Nov 2020

Background Current conventional cognitive assessments are limited in their efficiency and sensitivity, often relying on a single score such as the total correct items. Typically, multiple features of response go uncaptured. Objectives We aim to explore a new set of automatically derived features from the Digit Span (DS) task that address some of the drawbacks in the conventional scoring and are also useful for distinguishing subjects with Mild Cognitive Impairment (MCI) from those with intact cognition. Methods Audio-recordings of the DS tests administered to 85 subjects (22 MCI and 63 healthy controls, mean age 90.2 years) were transcribed using an Automatic Speech Recognition (ASR) system. Next, five correctness measures were generated from Levenshtein distance analysis of responses: number correct, incorrect, deleted, inserted, and substituted words compared to the test item. These per-item features were aggregated across all test items for both Forward Digit Span (FDS) and Backward Digit Span (BDS) tasks using summary statistical functions, constructing a global feature vector representing the detailed assessment of each subject’s response. A support vector machine classifier distinguished MCI from cognitively intact participants. Results Conventional DS scores did not differentiate MCI participants from controls. The automated multi-feature DS-derived metric achieved 73% on AUC-ROC of the SVM classifier, independent of additional clinical features (77% when combined with demographic features of subjects); well above chance, 50%. Conclusion Our analysis verifies the effectiveness of introduced measures, solely derived from the DS task, in the context of differentiating subjects with MCI from those with intact cognition.

Cognición, actividades de la vida diaria y variables psicológicas en mujeres adultas mayores practicantes de Tai Chi Chuan (Cognition, activities of daily living and psychological variables in elderly women practitioners of Tai Chi Chuan)

Article

Full-text available

May 2016

El tener actividad física se ha asociado con un funcionamiento cognitivo exitoso durante la etapa adulta o vejez. Una actividad física deportiva es el Tai Chi, que es un arte marcial suave, con efectos benéficos sobre la salud física, psicológica y cognitiva. El objetivo del presente es caracterizar una muestra de mujeres mayores de 60 años practicantes de Tai Chi Chuan Yuan de la Ciudad de México y compararlas con mujeres sedentarias. Ambos grupos fueron evaluados con la prueba neuropsicológica COGNISTAT, con las escalas de depresión y ansiedad de Beck y con la escala de actividades de la vida diaria para el adulto mayor INACVIDIAM. Los resultados obtenidos mostraron que el grupo de mujeres practicantes de Tai Chi tuvieron puntajes significativamente más altos que las mujeres sedentarias en las subpruebas de memoria, atención y construcción. Y una tendencia a tener mayor frecuencia y satisfacción al realizar actividades de la vida diaria, con niveles nulos y mínimos de depresión y ansiedad respectivamente. Se concluye que el conocer cuáles son las funciones cognitivas que pueden beneficiarse con la práctica de Tai Chi puede servir para promover este arte marcial suave como una terapia alternativa a la intervención neuropsicológica en pacientes con deterioro cognitivo propio del envejecimiento normal o patológico.Abstract. Having physical activity it has been associated with successful cognitive functioning in adulthood or old age. A sports physical activity is Tai Chi, a soft martial art that has come forth benefits effects on physical, psychological and cognitive health. The aim of this study is to characterize a sample of women over 60 practitioners of Tai Chi Chuan Yuan form Mexico City and compared with sedentary women. Both groups were evaluated with neuropsychological test COGNISTAT, with scales of depression and anxiety Beck and the activities of daily life for the elderly INACVIDIAM. The results showed that the group of women practicing Tai Chi had significantly higher than sedentary in subtests memory, care and construction women's scores. And a tendency to have more frequent and satisfaction to perform activities of daily living, with zero and low depression and anxiety levels respectively. It is concluded that knowing what cognitive functions that can benefit from Tai Chi practice can serve to promote this soft martial art as an alternative therapy to neuropsychological intervention in patients with cognitive impairment due to normal or pathological aging.

Cognistat: normes francophones pour les 60 ans et plus

Article

Jan 2020

Cognistat is a cognitive screening test that is widely used in English-speaking countries. Its French adaptation is now available. The present study aims to establish norms for a population aged 60 and over. One hundred and fifty-one participants aged between 60 and 84 years old with normal cognitive function were divided into 5 five-year age groups. The results on Cognistat are reported for each subtest and age group. Age has a significant effect in only two subtests (Attention and Language Comprehension), which suggests a reduced performance for older participants. However, these effects are very weak and irregular. For this reason and given data distribution, norms are proposed to define performance thresholds for the 15 th (lower limit of the normal range), 10 th (mild cognitive impairment) and 5 th (clinically significant) percentiles for each subtest for the clinical use of Cognistat with individuals 60 years of age and older.

Assessing method agreement for paired repeated binary measurements administered by multiple raters

Article

Dec 2019

Method comparison studies are essential for development in medical and clinical fields. These studies often compare a cheaper, faster, or less invasive measuring method with a widely used one to see if they have sufficient agreement for interchangeable use. Moreover, unlike simply reading measurements from devices, eg, reading body temperature from a thermometer, the response measurement in many clinical and medical assessments is impacted not only by the measuring device but also by the rater. For example, widespread inconsistencies are commonly observed among raters in psychological or cognitive assessment studies due to different characteristics such as rater training and experience, especially in large‐scale assessment studies when many raters are employed. This paper proposes a model‐based approach to assess agreement of two measuring methods for paired repeated binary measurements under the scenario where the agreement between two measuring methods and the agreement among raters are required to be studied simultaneously. Based upon the generalized linear mixed models (GLMMs), the decision on the adequacy of interchangeable use is made by testing the equality of fixed effects of methods. Approaches for assessing method agreement, such as the Bland‐Altman diagram and Cohen's kappa, are also developed for repeated binary measurements based upon the latent variables in GLMMs. We assess our novel model‐based approach by simulation studies and a real clinical application, in which patients are evaluated repeatedly for delirium with two validated screening methods. Both the simulation studies and the real data analyses demonstrate that our proposed approach can effectively assess method agreement.

eGFR and deep white matter hyperintensity as predictors of cognitive decline long after carotid endarterectomy

Article

Full-text available

Nov 2019

Chronic kidney disease and white matter hyperintensity (WMH) are associated with cognitive decline. The aim of this study was to assess the correlations between estimated glomerular filtration rate (eGFR) or WMH and cognitive function in patients who have undergone carotid endarterectomy (CEA). Cognitive functions were investigated using the Neurobehavioral Cognitive Status Examination (Cognistat) in 83 patients who had undergone CEA. The eGFR at 5 years prior to examination was significantly associated with severe cognitive impairment (odds ratio, 0.89 per 1-mL/min/1.73 m2 increase, 95% confidence interval 0.82–0.97, p = 0.0004). Receiver operating characteristic analysis revealed that a cutoff eGFR of 46.8 mL/min/1.73 m2 at 5 years prior to examination offered the most reliable predictor of severe cognitive impairment (sensitivity 88.9%, specificity 76.5%, area under the curve 0.848). The eGFR at 5 years prior to examination showed a significant linear association with total Cognistat score (r2 = 0.11035, p = 0.0032) compared to eGFR at 3 years prior to examination (r2 = 0.06455, p = 0.0230) or at examination (r2 = 0.0210, p = 0.0210). Spearman’s correlation coefficient revealed that orientation, comprehension, repetition, construction, memory, and similarity correlated with eGFR at 5 years prior to examination. Conversely, Fazekas grade for deep WMH at examination was associated with total Cognistat score (p = 0.0016), unlike that at 3 years (p = 0.0100) or 5 years prior to examination (p = 0.0172). While eGFR correlates with future cognitive function, deep WMH associates with present cognitive function in patients who have undergone CEA.

Proximity Bias Following Affective Metaphors in Patients With Depression—Psychoanalytic Considerations

Article

Full-text available

Nov 2019

Background: Many languages use spatial metaphors to describe affective states such as an upward bias to denote positive mood, a downward bias to denote negative mood, a body proximity bias to denote personal relatedness concern, and a right-left bias to denote negative or positive valence. These biases might be related to experiential traces related to these affective states. If this is the case, depressed subjects would show either a downward spatial bias, a body proximity bias, or a right-left shift in attention. We evaluated the occurrence of such biases in subjects with depression compared to healthy controls. Methods: Subjects: 10 subjects with depression (5F:5M; age = 47.2 ± 15.2) and 10 healthy controls (5F:5M; age = 45.8 ± 14.5). Experimental task: line bisection task. Lines were presented in three spatial orientations [vertical (up-down), horizontal (right-left), radial (proximal-distal)] and were either blank, composed with words (negative/positive/neutral), or with smileys (negative/positive/neutral). There were 21 line types, and each was presented eight times, reaching a total of 168 lines. Results: Compared with healthy controls, subjects with depression bisected radial lines significantly closer to their body. There were no significant differences for either horizontal or vertical lines. Conclusion: The proximity spatial bias observed in subjects with depression suggests that depression might activate neural spatial networks. We argue that these networks could be dynamically activated through narcissistic mechanisms as implied in “Mourning and Melancholia” where Freud postulates a narcissistic mediated bias in depression according to which the depressed subjects withdraw from the outside world.

The Effectiveness of Training Programs on the Fidelity of Neuropsychological Tests

Article

Full-text available

Oct 2019

Background There will probably be an exponential increase in the number of seniors suffering from dementia, as aging is the greatest risk factor for this disease. Therefore, neuropsychological tests to assessing dementia are likely to play an increasingly important role for medical services in Japan. This study developed and evaluated the usefulness of a training program on neuropsychological tests aimed at promoting the understanding of testers with regard to the cognitive functions and communication required in the neuropsychological testing process. Methods The subjects of this study comprised 20 individuals engaged in administrating neuropsychological tests at the Japan-Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes. A four-hour training session was held. The first part of the training program focused on “cognitive functions and communication;” the second addressed “neuropsychological tests.” As the main evaluation criteria, a fidelity checklist was created with 14 items designed to measure success or failure with regard to important and easily mistakable aspects of implementing each neuropsychological test. They were conducted three times: before, immediately after, and six months after the training. Results The main effect of time was significant for the “fidelity” score. The effect size was large at η² = 0.69. A simple main effect test using the Bonferroni method revealed significant differences between the pre-training and post-training values and between the pre-training and six-month point values. However, no significant differences were found in self-efficacy scores before, immediately after, and six months after the training. Conclusion This outcome indicates that the fidelity of the subjects to neuropsychological tests increased as a result of the training program, and that this improvement was maintained through the six-month period following the program. Moreover, the large effect size suggests that the training program may be effective in facilitating the mastery of neuropsychological tests in testers.

AUTOMATIC ASSESSMENT OF CONVENTIONAL COGNITIVE TESTS FOR DIFFERENTIATING MILD COGNITIVE IMPAIRMENT: A PROOF OF CONCEPT STUDY OF THE DIGIT SPAN TASK

Article

Full-text available

Jul 2019

Language Comprehension After Mild Traumatic Brain Injury: The Role of Speed

Article

Full-text available

Aug 2019
AM J SPEECH-LANG PAT

Purpose The aim of this study was to characterize language comprehension in mild traumatic brain injury (mTBI) by testing a speed-based hypothesis. We hypothesized that adults with mTBI would perform worse than a group of adults with orthopedic injuries (OIs) on an experimental language comprehension task. Method The study employed a prospective experimental design. Participants were 19 adults with mTBI and 19 adults with OI ages 18–55 years. Participants completed the Whatdunit task, a sentence agent selection task in speeded and unspeeded conditions. Results In the unspeeded condition, the mTBI group performed with a marginally significant higher accuracy than the OI group. In the speeded condition, the mTBI group performed with lower accuracy than the OI group; however, this difference did not reach statistical significance. There was a marginally significant interaction of Sentence Type × Group for reaction time in the speeded condition. Conclusions While our task might have been sensitive to cognitive processing abilities in both groups (as evidenced by the main effects of condition and sentence type), the task was not specific enough to capture mTBI-related deficits. The similarities in performance between both groups have clinical implications for the treatment of not just brain-related trauma but also trauma in general.

Effectiveness of using assistive technology for time orientation and memory, in older adults with or without dementia

Article

Full-text available

Aug 2019

Aims: The purposes of this study were to reveal the effectiveness of an electric calendar, showing the date and schedule automatically for older people, and to prove the characteristics of appropriate users. Material and Methods: The participants were 27 older adults with or without dementia (9 men and 18 women, mean age: 81.5 ± 6.9 years, range: 72–94 years). The study design was a cross-over randomized controlled trial, with 15 participants (55.6%) allocated to the first group to use the electric calendar, and 12 participants (44.4%) to the second intervention group. The outcome measures are daily behaviors and cognitive function assessed by the Mini-Mental State Examination and Neurobehavioral Cognitive Status Examination. Results: Participants showed significant increase in total Mini-Mental State Examination score (p = 0.020, a paired t-test) after intervention period, whereas there was no significant difference after no intervention. Daily activities related healthcare were improved. The participants with positive outcomes showed higher motivations, and around 18 points in Mini-Mental State Examination. Most healthy older adults mentioned that electric calendars were useful, but unnecessary. Conclusion and Significance: Using the electric calendar was effective in improving global cognitive function and daily activities. The target users are older people, who (1) might have mild dementia, (2) have difficulties in daily activities, (3) can be supported by caregivers, and (4) have positive motivation to new technologies. • IMPLICATIONS FOR REHABILITATION • An electric calendar is effective on grovel cognitive function, and activities of daily living related to healthcare in older adults, as well as reality orientation therapy. • The electric calendar can be useful for older people with mild dementia or mild cognitive impairment, having difficulties activities of daily living, supported by caregivers at regular intervals.

Accuracy of the Cognitive Assessment Battery in a Primary Care Population

Article

Full-text available

Aug 2019

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. Objective: To investigate the accuracy of the CAB in a primary care population. Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes ("no cognitive impairment" or "cognitive impairment"). Results: The "cognitive impairment" group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849. Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

Imagery Ability and Imagery Perspective Preference: A Study of Their Relationship and Age- and Gender-Related Changes

Article

Full-text available

Jul 2019
BEHAV NEUROL

This study examined if imagery ability (i.e., vividness and temporal congruence between imagined and executed knee extensions) and imagery perspective preference were affected by ageing and gender. Ninety-four participants, 31 young, 43 intermediate, and 20 older adults completed the Vividness of Movement Imagery Questionnaire-2 and a knee extension temporal congruence test to reflect on their imagery ability and an imagery perspective preference test. Male participants had a better imagery ability than the female participants ( F 4,85=2.84 , p=.029 , η2=.118 ). However, significant age-related changes in imagery ability were not found in the three age groups. Change in imagery perspective preference with a trend towards an external imagery perspective was observed with ageing ( F 3,89=3.16 , p=.028 , η2=.096 ) but not between male and female. The results suggest that imagery ability may be preserved with ageing. As individuals age, their preference for using an imagery perspective shifts from a more internal to a more external perspective. This understanding is important when designing future imagery research and real-life application or clinical intervention.

Article

Full-text available

Jun 2019
BMC NEUROL

Abstract Background and aim Toxic oligomeric α-synuclein (αS; O-αS) has been suggested to play a central role in the pathogenesis of Lewy body diseases such as Parkinson’s disease (PD). Cerebrospinal fluid (CSF) levels of αS, O-αS, total and phosphorylated tau, and amyloid β 1–42 (Aβ1–42) are thought to reflect the pathophysiology or clinical symptoms in PD. In this study, we examined correlations of the CSF levels of these proteins with the clinical symptoms, and with each other in drug-naïve patients with PD. Methods Twenty-seven drug-naïve patients with PD were included. Motor and cognitive functions were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), and Neurobehavioral Cognitive Status Examination (COGNISTAT). CSF levels of total αS, O-αS, Aβ1–42, total tau and tau phosphorylated at threonine 181 (P-tau181p) were measured. CSF levels of these proteins were compared with clinical assessments from the UPDRS, MoCA and COGNISTAT using Spearman correlation analysis. Spearman correlation coefficients among CSF protein levels were also evaluated. Results CSF levels of αS were negatively correlated with UPDRS part III (motor score) (p

Evaluation and Diagnosis of Neuronal Integrity in Diffuse Axonal injury : A 123I-Iomazenil SPECT and MRI Study頭部外傷による高次脳機能障害の診断・治療の最前線─123I-イオマゼニル SPECT および MRI による神経活性評価とびまん性軸索損傷の診断

Article

Mar 2024

Objective assessment of the neuronal abnormalities in cases of traumatic brain injury (TBI) with diffuse axonal injury (DAI) is crucial to understanding the underlying pathology, as well as from the point of view of facilitating socioeconomic support for these patients. Neuronal integrity can be evaluated by benzodiazepine binding using ¹²³I-iomazenil (IMZ) SPECT. We aimed to investigate the extent of neuronal damage in cases of TBI with DAI using ¹²³I-IMZ SPECT and MRI. The findings in 31 patients with TBI without any major focal brain lesions were compared with those of 25 age-matched normal controls. Subjects underwent ¹²³I-IMZ SPECT and MRI, and also assessment by cognitive function tests. The partial volume effect of ¹²³I-IMZ SPECT was corrected using MRI. Regional benzodiazepine binding and brain atrophy in TBI were assessed based on the volume of interest and voxel-based analysis. In the patients with TBI, decreased binding of ¹²³I-IMZ was detected in the medial frontal/orbitofrontal cortex, posterior cingulate gyrus, cuneus, precuneus, and superior region of the cerebellum. The decreased ¹²³I-IMZ binding in the cuneus and precuneus was associated with cognitive decline after the injury. In the patients with TBI, brain atrophy was detected in the frontal lobe, anterior temporal and parietal cortex, corpus callosum, and posterior part of the cerebellum. ROC analysis of ¹²³I-IMZ SPECT for the detection of neuronal injury showed a high diagnostic ability of ¹²³I-IMZ binding for TBI in the cingulate gyrus, medial regions of the frontal, parietal, and occipital lobes, and superior region of the cerebellum. Evaluation of the neuronal integrity by ¹²³I-IMZ SPECT provides important information for the diagnosis and pathological interpretation in cases of TBI with DAI.

The oscillatory features of visual processing are altered in healthy aging

Article

Full-text available

Feb 2024

The temporal features of visual processing were compared between young and elderly healthy participants in visual object and word recognition tasks using the technique of random temporal sampling. The target stimuli were additively combined with a white noise field and were exposed very briefly (200 ms). Target visibility oscillated randomly throughout exposure duration by manipulating the signal-to-noise ratio (SNR). Classification images (CIs) based on response accuracy were calculated to reflect processing efficiency according to the time elapsed since target onset and the power of SNR oscillations in the 5–55 Hz range. CIs differed substantially across groups whereas individuals of the same group largely shared crucial features such that a machine learning algorithm reached 100% accuracy in classifying the data patterns of individual participants into their proper group. These findings demonstrate altered perceptual oscillations in healthy aging and are consistent with previous investigations showing brain oscillation anomalies in the elderly.

The Effect of Jittered Stimulus Onset Interval on Electrophysiological Markers of Attention in a Brain-Computer Interface Rapid Serial Visual Presentation Paradigm

Article

Full-text available

Jan 2024

Brain responses to discrete stimuli are modulated when multiple stimuli are presented in sequence. These alterations are especially pronounced when the time course of an evoked response overlaps with responses to subsequent stimuli, such as in a rapid serial visual presentation (RSVP) paradigm used to control a brain-computer interface (BCI). The present study explored whether the measurement or classification of select brain responses during RSVP would improve through application of an established technique for dealing with overlapping stimulus presentations, known as irregular or "jittered" stimulus onset interval (SOI). EEG data were collected from 24 healthy adult participants across multiple rounds of RSVP calibration and copy phrase tasks with varying degrees of SOI jitter. Analyses measured three separate brain signals sensitive to attention: N200, P300, and occipitoparietal alpha attenuation. Presentation jitter visibly reduced intrusion of the SSVEP, but in general, it did not positively or negatively affect attention effects, classification, or system performance. Though it remains unclear whether stimulus overlap is detrimental to BCI performance overall, the present study demonstrates that single-trial classification approaches may be resilient to rhythmic intrusions like SSVEP that appear in the averaged EEG.

Preliminary Study on the Effects of Virtual Reality-based Cognitive Rehabilitation and Computer-based Cognitive Rehabilitation on Function and Prefrontal Cortex in Convalescent Stroke Patients

Article

May 2023

Autonomous Virtual Cognitive Assessment via NLP and Hand Gesture Recognition

Conference Paper

Oct 2022

Impaired neuronal integrity in traumatic brain injury detected by 123 I-iomazenil single photon emission computed tomography and MRI

Article

Jul 2022

This study was aiming at investigating the extent of neuronal damage in cases of traumatic brain injury (TBI) with diffuse axonal injury (DAI) using ¹²³ I-iomazenil(IMZ) SPECT and MRI. We compared the findings in 31 patients with TBI without any major focal brain lesions and 25 age-matched normal controls. Subjects underwent ¹²³ I-IMZ SPECT and MRI, and also assessment by cognitive function tests. The partial volume effect of ¹²³ I-IMZ SPECT was corrected using MRI. In the patients with TBI, decreased spatial concentration of ¹²³ I-IMZ binding was detected in the medial frontal/orbitofrontal cortex, posterior cingulate gyrus, cuneus, precuneus, and superior region of the cerebellum. ROC analysis of ¹²³ I-IMZ SPECT for the detection of neuronal injury showed a high diagnostic ability of ¹²³ I-IMZ binding density for TBI in these areas. The decreased ¹²³ I-IMZ uptake density in the cuneus and precuneus was associated with cognitive decline after the injury. In the patients with TBI, brain atrophy was detected in the frontal lobe, anterior temporal and parietal cortex, corpus callosum, and posterior part of the cerebellum. Evaluation of the neuronal integrity by ¹²³ I-IMZ SPECT and MRI provides important information for the diagnosis and pathological interpretation in cases of TBI with DAI.

Ankle-Brachial Index and Cardio-Ankle Vascular Index as Predictors of Cognitive Decline Over Time After Carotid Endarterectomy

Article

Full-text available

Jul 2022

Objective: Patients with carotid stenosis risk cognitive impairment even after carotid endarterectomy (CEA) because of the long-term presence of vascular risk factors. Early prediction of cognitive decline is useful because early appropriate training for impaired cognitive domains can improve their functions. Ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) are frequently used as general indicators of systemic atherosclerosis and are associated with cognitive function in the general population. This study aimed to evaluate the utility of those vascular biomarkers for predicting cognitive decline in patients after CEA. Methods: Patients who had undergone both CEA at our institute and cognitive evaluations between March 2016 and January 2022 were invited to participate in this study. Associations between ABI or CAVI three years before baseline and cognitive function at baseline were assessed retrospectively in 94 patients, and associations between ABI or CAVI at baseline and three-year changes in cognitive functions were assessed prospectively in 24 patients. Cognitive functions were assessed using the Frontal Assessment Battery (FAB) and Neurobehavioral Cognitive Status Examination (Cognistat). Results: Low ABI three years before baseline was associated with poor performances on Cognistat and FAB at baseline. ABI, as a continuous measure, three years before baseline, showed positive linear associations with total Cognistat score and subscores for naming, construction, and judgment at baseline. The Wilcoxon signed-rank test showed that the total Cognistat score, total FAB score, and subscores for attention and inhibitory control declined after three years. CAVI at baseline was negatively associated with three-year changes in total Cognistat score and subscores for naming, construction, and memory. Conclusion: Cognitive function can decline over time in patients with carotid stenosis even after CEA. ABI and CAVI might be useful to predict cognitive function and its decline among patients who have undergone CEA.

Methodology and preliminary data on feasibility of a neurofeedback protocol to improve visual attention to letters in mild Alzheimer's disease

Article

Full-text available

Jun 2022

Background Brain-computer interface (BCI) systems are controlled by users through neurophysiological input for a variety of applications, including communication, environmental control, and motor rehabilitation. Although individuals with severe speech and physical impairment are the primary users of this technology, BCIs have emerged as a potential tool for broader populations, including delivering cognitive training/interventions with neurofeedback (NFB). Methods This paper describes the development and preliminary testing of a protocol for use of a BCI system with NFB as an intervention for people with mild Alzheimer's disease (AD). The intervention focused on training visual attention and language skills, as AD is often associated with functional impairments in both. This funded pilot study called for enrolling five participants with mild AD in a six-week BCI EEG-based NFB intervention that followed a four-to-seven-week baseline phase. While two participants completed the study, the remaining three participants could not complete the intervention phase because of COVID-19 restrictions. Results Preliminary pilot results suggested: (1) participants with mild AD were able to participate in a study with multiple assessments per week and complete all outcome measures, (2) most outcome measures were reliable during the baseline phase, and (3) all participants with mild AD learned to operate a BCI spelling system with training. Conclusions Although preliminary results demonstrate practical feasibility to deliver NFB intervention using a BCI to adults with AD, completion of the protocol in its entirety with more participants is needed to further assess whether implementing NFB-based cognitive intervention is justified for functional treatment outcomes. Trial registration This study was registered with ClinicalTrials.gov (NCT03790774).

Feasibility and Pilot Testing of Mobile Health Apps to Supplement 2 Healthy Lifestyle Interventions in Chronic Traumatic Brain Injury

Article

Mar 2022
J HEAD TRAUMA REHAB

Objectives: To determine the feasibility of mobile health (mHealth) apps for enhancing participation of people with chronic traumatic brain injury (TBI) in the Group Lifestyle Balance (GLB-TBI) weight loss intervention and Brain Health Group (BHG-TBI) active control intervention. Setting: Community. Participants: n = 56 overweight/obese adults with moderate-severe TBI. Design: The GLB-TBI is a 12-month group- and community-based program to promote healthy eating and physical activity. The BHG-TBI is a 12-month group- and community-based program to promote general brain health, designed as an active control condition matched on time, structure, and perceived benefit to the GLB-TBI. In a randomized controlled trial testing the efficacy of the GLB-TBI for weight loss, participants used a group-specific mHealth app providing daily tips customized according to their intervention allocation. Main measures: Compliance (percentage of daily prompts read and completed) and participant-reported satisfaction and usability. Results: In conjunction with relevant stakeholders, we developed the content and structure of the GLB-TBI and BHG-TBI apps based on core curriculum components. We incorporated cognitive strategies (app notifications) to address potential cognitive impairment common after TBI. Both apps delivered brief daily educational and motivational "tips" derived directly from their respective curricula. Daily use of the apps varied greatly across participants, with most participants who used the apps completing 10% to 50% of daily content. Participants found the apps to be easy to use, but only some found them helpful. App use was substantially different for those who participated in the intervention during (2020) versus before (2019) the COVID-19 pandemic. Conclusions: Although enhancing an intensive lifestyle intervention with mHealth technology may be helpful, further refinement is needed to optimize the frequency and delivery methods of mHealth content. Although one might expect remote app use to have been higher during the pandemic, we observed the opposite, potentially due to less hands-on training and ongoing support to use the app and/or general technology fatigue with social distancing.

The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients

Article

Full-text available

Mar 2022
PLOS ONE

Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function. Trial registration NCT03162081, 22 May 2017.

Whole blood metabolomics of dementia patients reveal classes of disease-linked metabolites

Preprint

Full-text available

Jun 2021

Dementia is caused by factors that damage neurons. We quantified small molecular markers in whole blood of dementia patients, using non-targeted liquid chromatography-mass spectroscopy (LC-MS). Thirty-three metabolites, classified into 5 groups (A-E), differed significantly in dementia patients, compared with healthy elderly subjects. Seven Group A metabolites present in plasma, including quinolinic acid, kynurenine, and indoxyl-sulfate, increased. Possibly they act as neurotoxins in the central nervous system (CNS). The remaining 26 compounds (Groups B-E) decreased, possibly causing a loss of support or protection of the brain in dementia. Six Group B metabolites, normally enriched in red blood cells (RBCs) of healthy subjects, all contain trimethylated ammonium moieties. These metabolites include ergothioneine and structurally related compounds have scarcely been investigated as dementia markers, validating the examination of RBC metabolites. Ergothioneine, a potent anti-oxidant, is significantly decreased in various cognition-related disorders, such as mild cognitive impairment and frailty. Group C compounds, also include some oxidoreductants and are normally abundant in RBCs (NADP ⁺ , glutathione, ATP, pantothenate, S-adenosyl-methionine, and gluconate). Their decreased levels in dementia patients may also contribute to depressed brain function. Groups D (12) contains plasma compounds, such as amino acids, glycerophosphocholine, dodecanoyl-carnitine, 2-hydroxybutyrate, which normally protect the brain, but their diminution in dementia may reduce that protection. Seven Group D compounds have been identified previously as dementia markers. Group B-E compounds may be critical to maintain the CNS by acting directly or indirectly. How RBC metabolites act in the CNS and why they diminish so significantly in dementia remain to be determined. Significance Statement Dementia is a slowly progressing, chronic, and usually irreversible decline in cognitive function. Mechanistic causes and definitive treatments remain elusive. Using comprehensive metabolomics, we identified 5 groups of metabolites (A-E), 21 of which are novel, possibly useful for diagnosis and therapy of forms of dementia, such as Alzheimer’s disease. Seven Group A compounds may act as neurotoxins, whereas Group B-E compounds may protect the CNS against oxidative stress, maintain energy reserves, supply nutrients and neuroprotective factors. Five metabolites, ergothioneine, S -methyl-ergothioneine, trimethyl-histidine, methionine, and tryptophan identified in this study overlap with those reported for frailty. Interventions for cognitive diseases involving these dementia metabolomic markers may be accomplished either by inhibiting Group A compounds or by supplementing Group B-E compounds in patients.

Dysphagia Management in Military Service Members With Polytrauma: Overview and Case Report

Article

Full-text available

Oct 2020

Purpose At Walter Reed National Military Medical Center, service members (SMs) with polytraumatic injuries, usually resulting from blast explosions, are routinely referred to the Speech Pathology Clinic for evaluation of swallowing function. The purpose of this clinical focus article is to advance the speech-language pathologist's (SLP) knowledge of polytrauma and to improve the care of individuals with traumatic injuries, especially related to nutrition and swallowing within a larger multidisciplinary team approach. Case Report Previous research within our center identified common demographic and injury characteristics of SMs with combat-related injuries that led to referrals for swallowing evaluation. An SM with polytraumatic injuries was selected for this case report to illustrate the relevance of the research findings and also the importance of multidisciplinary team support to appropriately manage such complex cases. Evaluations and relevant treatments are described across a 3-month acute care hospitalization, including swallowing and nutritional recommendations at the time of each swallowing evaluation. Discussion Comparisons of polytrauma cases at Walter Reed National Military Medical Center with literature from civilian trauma centers revealed somewhat longer hospitalizations and the particular influence of maxillofacial trauma on dysphagia outcomes. The complex case reported in this article illustrates the importance of multidisciplinary care and coordination, with particular emphasis on the intersecting roles of the SLP and registered dietitian. This report can serve as a guide for SLPs working in trauma settings for developing prognostic statements, treatment plans, and multidisciplinary interaction.

Blast in Context: The Neuropsychological and Neurocognitive Effects of Long-Term Occupational Exposure to Repeated Low-Level Explosives on Canadian Armed Forces' Breaching Instructors and Range Staff

Article

Full-text available

Dec 2020

Currently, there is strong interest within the military to better understand the effects of long-term occupational exposure to repeated low-level blast on health and performance. To gain traction on the chronic sequelae of blast, we focused on breaching—a tactical technique for gaining entry into closed/blocked spaces by placing explosives and maintaining a calculated safe distance from the detonation. Using a cross-sectional design, we compared the neuropsychological and neurocognitive profiles of breaching instructors and range staff to sex- and age-matched Canadian Armed Forces (CAF) controls. Univariate tests demonstrated that breaching was associated with greater post-concussive symptoms (Rivermead Post Concussion Symptoms Questionnaire) and lower levels of energy (RAND SF-36). In addition, breaching instructors and range staff were slower on a test that requires moving and thinking simultaneously (i.e., cognitive-motor integration). Next, using a multivariate approach, we explored the impact of other possible sources of injury, including concussion and prior war-zone deployment on the same outcomes. Concussion history was associated with higher post-concussive scores and musculoskeletal problems, whereas deployment was associated with higher post-concussive scores, but lower energy and greater PTSD symptomatology (using PCL-5). Our results indicate that although breaching, concussion, and deployment were similarly correlated with greater post-concussive symptoms, concussion history appears to be uniquely associated with altered musculoskeletal function, whereas deployment history appears to be uniquely associated with lower energy and risk of PTSD. We argue that the broader injury context must, therefore, be considered when studying the impact of repetitive low-level explosives on health and performance in military members.

Reliability and Validity of the Severe Impairment in Taiwanese Patients with Moderate to Severe Alzheimer’s Disease

Article

Full-text available

Aug 2020

Background: The Severe Impairment Battery (SIB) was developed to evaluate cognitive functions in moderate to severe dementia patients. We aimed to examine the reliability and validity of the Taiwanese version of the SIB (T-SIB) in patients with moderate to severe Alzheimer's disease (AD). Methods: AD patients with clinical dementia rating (CDR) stage 2 (n=79) or 3 (n=21) and scores < 15 on the Taiwanese version of mini mental state examination (T-MMSE) were recruited from six hospitals in Taiwan. Cronbach's alpha was used to evaluate the internal consistency of the T-SIB. The CDR and functional assessment staging (FAST) scores were used to assess dementia severity. Results: We recruited 100 AD patients (73 women and 27 men; mean T-SIB score, 56.4 ± 24.8). The mean T-SIB total score for patients with CDR 2 and 3 were 60.3 ± 23.3 and 41.2 ± 24.9, respectively. The internal consistency of the T-SIB was 0.96. The T-SIB was moderately correlated with the T-MMSE (Pearson's correlation coefficient=0.76). The areas under the curve for discriminating between CDR 2 and CDR 3 were 0.81 (95% C=0.91-0.71) and 0.72 (95% CI=0.84-0.61), respectively. Using a cut-off score of 59, the T-SIB had a sensitivity of 80% and specificity of 61% for discriminating between CDR 2 and CDR 3. Using a cut-off score of 45, the T-SIB had a sensitivity of 83.3% and specificity of 73.1% for discriminating between the FAST stage 7c. Conclusion: T-SIB is a reliable and valid instrument for measuring cognition of severely demented Taiwanese AD patients.

Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: A cross-sectional study

Article

Full-text available

Jul 2020

Objectives: Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression. Design: Cross-sectional hospital-based study. Settings: Data was collected consecutively from inpatients at somatic wards of a general university hospital. Participants: Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks. Outcome measures: The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores. Results: The main result indicated that CNSD users (n=100) had (β=-3.4, 95% CI 6.27 to -0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= -2.50 - 5.45; -0.46, p=0.097). Comorbidity was associated with cognitive function (β=-0.77, 95% CI -1.22 to -0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=-0.80, 95% CI 1.24 to -0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function. Conclusion: Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity. Trial registration number: NCT03162081, 22 May 2017.

Pharmacogenetic studies in Alzheimer disease

Article

Full-text available

Jun 2020

Introduction Alzheimer disease (AD) is the most common cause of dementia and is considered one of the main causes of disability and dependence affecting quality of life in elderly people and their families. Current pharmacological treatment includes acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine; however, only one-third of patients respond to treatment. Genetic factors have been shown to play a role in this inter-individual variability in drug response. Development We review pharmacogenetic reports of AD-modifying drugs, the pharmacogenetic biomarkers included, and the phenotypes evaluated. We also discuss relevant methodological considerations for the design of pharmacogenetic studies into AD. A total of 33 pharmacogenetic reports were found; the majority of these focused on the variability in response to and metabolism of donepezil. Most of the patients included were from Caucasian populations, although some studies also include Korean, Indian, and Brazilian patients. CYP2D6 and APOE are the most frequently studied biomarkers. The associations proposed are controversial. Conclusions Potential pharmacogenetic biomarkers for AD have been identified; however, it is still necessary to conduct further research into other populations and to identify new biomarkers. This information could assist in predicting patient response to these drugs and contribute to better treatment decision-making in a context as complex as ageing.

Common carotid flow velocity is associated with cognitive function after carotid endarterectomy

Article

Apr 2020
J CLIN NEUROSCI

The relationship between ultrasonographic flow parameters and cognitive function has not been well studied. This study aimed to clarify associations between carotid flow velocity (FV) and cognitive function in patients with a history of carotid endarterectomy (CEA). Ninety-four patients who previously underwent CEA participated in this study. The Neurobehavioral Cognitive Status Examination (Cognistat) and Frontal Assessment Battery (FAB) were adopted to assess cognitive functions at a mean of 6.5 ± 3.2 years after CEA. End-diastolic flow velocity (EDV) of the left and right common carotid artery (CCA) was significantly associated with total Cognistat score (p < 0.001) and total FAB score (p < 0.05). Pulsatility index (PI) of the left CCA was significantly associated with total Cognistat score and total FAB score (p < 0.01). A cut-off right CCA EDV of 14.5 cm/s offered the most reliable predictor of the bottom 25th percentile of total Cognistat score (sensitivity 83.3%, specificity 61.0%, area under the curve (AUC) 0.731, p = 0.0060), while a cut-off left CCA PI of 1.83 was the most reliable predictor of the bottom 25th percentile of total FAB score (sensitivity 73.3%, specificity 60.0%, AUC 0.679, p = 0.0179). Left and right CCA EDV correlated with sub-components of comprehension, construction, judgment, programming (p < 0.01), and conceptualization (p < 0.05). Right CCA EDV correlated with similarity (p < 0.01), repetition, naming, and memory (p < 0.05). Left CCA PI correlated with attention, conceptualization (p < 0.01), repetition, construction, similarity, and mental flexibility (p < 0.05), while right CCA PI correlated with construction (p < 0.05). CCA FV may offer useful markers of cognitive functions in patients with a history of CEA.

EVALUATE-AD: Ecologically Valid, Longitudinal, and Unbiased Assessment of Treatment Efficacy in Alzheimer’s Disease (Preprint)

Article

Full-text available

Dec 2019

Background: The current clinical trial assessment methodology relies on a combination of self-report measures, cognitive and physical function tests, and biomarkers. This methodology is limited by recall bias and recency effects in self-reporting and by assessments that are brief, episodic, and clinic based. Continuous monitoring of ecologically valid measures of cognition and daily functioning in the community may provide a more sensitive method to detect subtle, progressive changes in patients with cognitive impairment and dementia. Objective: This study aimed to present an alternative trial approach using a home-based sensing and computing system to detect changes related to common treatments employed in Alzheimer disease (AD). This paper introduces an ongoing study that aims to determine the feasibility of capturing sensor-based data at home and to compare the sensor-based outcomes with conventional outcomes. We describe the methodology used in the assessment protocol and present preliminary results of feasibility measures and examples of data related to medication-taking behavior, activity levels, and sleep. Methods: The EVALUATE-AD (Ecologically Valid, Ambient, Longitudinal and Unbiased Assessment of Treatment Efficacy in Alzheimer's Disease) trial is a longitudinal naturalistic observational cohort study recruiting 30 patients and 30 spouse coresident care partners. Participants are monitored continuously using a home-based sensing and computing system for up to 24 months. Outcome measures of the automated system are compared with conventional clinical outcome measures in AD. Acceptance of the home system and protocol are assessed by rates of dropout and protocol adherence. After completion of the study monitoring period, a composite model using multiple functional outcome measures will be created that represents a behavioral-activity signature of initiating or discontinuing AD-related medications, such as cholinesterase inhibitors, memantine, or antidepressants. Results: The home-based sensing and computing system has been well accepted by individuals with cognitive impairment and their care partners. Participants showed good adherence to the completion of a weekly web-based health survey. Daily activity, medication adherence, and total time in bed could be derived from algorithms using data from the sensing and computing system. The mean monitoring time for current participants was 14.6 months. Medication adherence, as measured with an electronic pillbox, was 77% for participants taking AD-related medications. Conclusions: Continuous, home-based assessment provides a novel approach to test the impact of new or existing dementia treatments generating objective, clinically meaningful measures related to cognition and everyday functioning. Combining this approach with the current clinical trial methodology may ultimately reduce trial durations, sample size needs, and reliance on a clinic-based assessment. International registered report identifier (irrid): DERR1-10.2196/17603.

Skeletal muscle function and need for long-term care of urban elderly people in Japan (the Bunkyo Health Study): a prospective cohort study

Article

Full-text available

Sep 2019

Purpose The proportion of elderly individuals (age ≥65 years) in Japan reached 27.7% in 2017, the highest in the world. A serious social problem in a super-aged society is the rise in the number of elderly people who need long-term care (LTC), which is mainly due to cerebrovascular disease, dementia, age-related frailty, falls and fractures, and joint disease. We hypothesised that decreased muscle mass, muscle strength and insulin sensitivity are the common risk factors for these diseases related to needing LTC. We developed a prospective cohort study of elderly subjects in an urban community to test this hypothesis. The primary objective is to prospectively investigate associations between muscle mass, muscle strength, and insulin sensitivity and incidence of main disease and risk factors of needing LTC. The primary outcomes are the incidence of cerebrovascular disease and cognitive decline. Participants Participants were 1629 people aged 65–84 years living in 13 communities in an urban area (Bunkyo-ku, Tokyo, Japan). Average age was 73.1±5.4 years. Findings to date We obtained baseline data on cognitive function, cerebral small vessel disease (SVD) determined by brain MRI, body composition, bone mineral density, arteriosclerosis, physical function, muscle mass, muscle strength and insulin sensitivity. Mild cognitive impairment and dementia were observed in 18.1% and 3.3% of participants, respectively. The prevalence of cerebral SVD was 24.8%. These characteristics are similar to those previously reported in elderly Japanese subjects. Future plans We will ask participants about their health status, including incidence of cerebrovascular disease, falls, fractures and other diseases every year by mail. We plan to re-evaluate cognitive function, brain MRI parameters and other parameters at 5 and 10 years after the baseline evaluation. We will evaluate whether low muscle function (muscle mass, muscle strength or insulin sensitivity) is a risk factor for cognitive decline or cerebrovascular disease.

A Swedish survey of occupational therapists' involvement and performance in driving assessments

Article

Jul 2009
Scand J Occup Ther

The purpose of this study was to examine the extent to which occupational therapists (OTs) are involved in driving assessments in Sweden and how these assessments are performed. A questionnaire was sent to 154 geriatric, rehabilitation, and neurological clinics, and additionally directly to 19 OTs who had purchased a test battery specifically used for driving assessments. The response rate was 60%. Of those responding, 57% reported being involved in fitness-to-drive assessments. However, such assessments were carried out in various manners and diverse methods were used, ranging from unstandardized activity assessments to a test developed specifically for driving assessments. Only 19% used on-road driving tests as a complement to the clinical assessments. Apart from the lack of appropriate methods, the respondents said that they did not have sufficient knowledge to perform driving assessments and expressed a need for further education. In the future it seems necessary for OTs in Sweden to undergo specialized training and perform the assessments on a regular basis to maintain a high level of competence as driving assessors.

The Neurobehavioral Cognitive Status Examination: A Brief But Differentiated Approach to Cognitive Assessment

Abstract

No full-text available

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