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Mini-mental state-practical method for grading cognitive state of patients for clinicians

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... Four participants had comparable functional independence to older adults with advanced PD (Hoehn & Yahr stage IV, mean Functional Independence Measure (FIM) total score 45.5 ± 13.7) [31] while five were more independent. Four participants had scores on the Minimental State Examination (MMSE) [26] that were above the suggested cut off for dementia of ≤ 24/30, [26]. However, all but one participant had cognitive scores consistent with dementia (scored ≤ 80/134) in the Parkinson's Disease Cognitive Rating Scale (PD-CRS) [27]. ...
... Four participants had comparable functional independence to older adults with advanced PD (Hoehn & Yahr stage IV, mean Functional Independence Measure (FIM) total score 45.5 ± 13.7) [31] while five were more independent. Four participants had scores on the Minimental State Examination (MMSE) [26] that were above the suggested cut off for dementia of ≤ 24/30, [26]. However, all but one participant had cognitive scores consistent with dementia (scored ≤ 80/134) in the Parkinson's Disease Cognitive Rating Scale (PD-CRS) [27]. ...
... PDD Parkinson's disease dementia, DLB Dementia with Lewy bodies, MDS-UPDRS Movement Disorder Society Unified Parkinson's Disease Rating Scale. (21) Total score includes parts I-IV, Part III is the assessor rated motor score, FIM Functional independence measure [25], MMSE Mini-mental state exam [26], PD-CRS Parkinson's disease Cognitive rating scale [27], GDS-15 Geriatric Depression Scale -15 item [28], AChEI/NMDA Acetyl-cholinesterase Inhibitor/ N-methyl-D-aspartate, PPI Proton Pump Inhibitor. a denotes the months since the participants received a formal diagnosis of LBD. ...
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Background: Lewy body dementia (LBD) is an aggressive type of dementia of rapid, fluctuating disease trajec-tory, higher incidence of adverse events, and poorer functional independence than observed in Alzheimer's disease dementia. Non-pharmacological treatments such as progressive, high-intensity exercise are effective in other neuro-logical cohorts but have been scarcely evaluated in LBD. Methods: The Promoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial was a non-ran-domised, non-blinded, crossover pilot trial involving older adults with LBD consisting of a baseline assessment, an 8-week wait-list, and an 8-week exercise intervention. The aims of this study were to evaluate the determinants of the primary outcome functional independence, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale, and the feasibility and preliminary efficacy of an exercise intervention on this outcome. Additionally , important clinical characteristics were evaluated to explore associations and treatment targets. The exercise intervention was supervised, clinic-based, high-intensity progressive resistance training (PRT), challenging balance, and functional exercises, 3 days/week. Results: Nine participants completed the baseline cross-sectional study, of which five had a diagnosis of Parkinson's disease dementia (PDD), and four dementia with Lewy Bodies (DLB). Six completed the exercise intervention (three PDD, three DLB). The cohort was diverse, ranging from mild to severe dementia and living in various residential settings. Greater functional independence at baseline was significantly associated with better physical function, balance, cognition, quality of life, muscle mass ratio, walking endurance, faster walking speed and cadence, and lower demen-tia severity (p < 0.05). Participants declined by clinically meaningful amounts in functional independence, cogni-tion, physical function, muscle mass, and weight over the wait-list period (p < 0.05). Following exercise, participants improved by clinically meaningful amounts in functional independence, cognition, physical function, and strength (p < 0.05). Progressive, high intensity exercise was well-tolerated (> 80% adherence), and only one minor exercise-related adverse event occurred. Conclusions: PRIDE is the first exercise trial conducted specifically within individuals diagnosed with LBD, and provides important insight for the design of larger, randomized trials for further evaluation of progressive, high-intensity exercise as a valuable treatment in LBD. Accessible at: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03347-2
... All the participants were right-handed. Exclusion criteria were: (1) previous history of brain disease, including stroke, epilepsy, trauma, or hemorrhage; (2) Mini-Mental State Examination (MMSE) (Folstein et al., 1975) score < 27; (3) psychiatric or neurologic disorders that may affect cognition; (4) alcohol or drug abuse; and (5) contraindications for MRI scan. All subjects underwent a series of standardized clinical evaluations. ...
... A battery of cognitive assessments was performed before MRI. General cognition was assessed with the MMSE (Folstein et al., 1975). Anxiety and depression were evaluated with the Self-Rating Anxiety Scale (Zung, 1971) and the Self-Rating Depressive Scale (Zung, 1965), respectively. ...
Article
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Type 2 diabetes is associated with a higher risk of dementia. The pathogenesis is complex and partly influenced by genetic factors. The hippocampus is the most vulnerable brain region in individuals with type 2 diabetes. However, whether the genetic risk of type 2 diabetes is associated with the hippocampus and episodic memory remains unclear. This study explored the influence of polygenic risk score (PRS) of type 2 diabetes on the white matter topological properties of the hippocampus among individuals with and without type 2 diabetes and its associations with episodic memory. This study included 103 individuals with type 2 diabetes and 114 well-matched individuals without type 2 diabetes. All the participants were genotyped, and a diffusion tensor imaging-based structural network was constructed. PRS was calculated based on a genome-wide association study of type 2 diabetes. The PRS-by-disease interactions on the bilateral hippocampal topological network properties were evaluated by analysis of covariance (ANCOVA). There were significant PRS-by-disease interaction effects on the nodal topological properties of the right hippocampus node. In the individuals with type 2 diabetes, the PRS was correlated with the right hippocampal nodal properties, and the nodal properties were correlated with the episodic memory. In addition, the right hippocampal nodal properties mediated the effect of PRS on episodic memory in individuals with type 2 diabetes. Our results suggested a gene-brain-cognition biological pathway, which might help understand the neural mechanism of the genetic risk of type 2 diabetes affects episodic memory in type 2 diabetes.
... Voor het in kaart brengen van cognitieve problemen en depressieve symptomen kun je ook screeningsinstrumenten als de Mini-Mental State Examination (MMSE) en de geriatrische depressieschaal (GDS) gebruiken (Folstein et al. 1975;Yesavage et al. 1983 ...
... Het geeft ook de mogelijkheid functioneren te vervolgen over de tijd.Er zijn veel psychologische testschalen voor de screening van het psychisch functioneren. Bij de diagnostiek van het dementiesyndroom wordt vaak de Mini-Mental State Examination (MMSE) gebruikt(Folstein et al. 1975). Een score lager dan 24 uit 30 kan duiden op cognitief functieverval, maar bij de interpretatie is enige voorzichtigheid geboden omdat de resultaten mede worden bepaald door leeftijd, opleidingsniveau, aandacht en concentratie.Een ander cognitief screeningsinstrument is de Montreal Cognitive Assessment (MoCa). ...
Book
Na vijf jaar is dit veelgebruikte Leerboek geriatrie herzien: bestaande hoofdstukken zijn up-to-date gemaakt en nieuwe (online) hoofdstukken over complexe besluitvorming, interprofessioneel leren, preventieve geneeskunde en COVID-19 bij ouderen zijn toegevoegd. Hiermee past het boek goed in dit tijdperk van veel aandacht bij arts en maatschappij voor samen beslissen, interprofessioneel werken en persoonsgerichte zorg. Het sluit ook aan bij de onderwijsdoelen over ouderenzorg in het raamplan artsopleiding 2020. Ook in deze vierde druk beginnen we met een sectie over veroudering en de geriatrische werkwijze met in de twee secties daarna aandacht voor specifieke geriatrische syndromen en ouderenpsychiatrie. Per hoofdstuk komen de belangrijkste aspecten aan bod, die uniek zijn voor de geriatrische patiënt en passen bij de probleemgeoriënteerde geneeskunde met ouderen. Binnen de geriatrie staat het samen met patiënt en eventuele mantelzorger bepalen en prioriteren van behandeldoelen centraal, wat zowel de geriatrische werkwijze richting geeft, als de meerwaarde daarvan bepaalt. Interdisciplinair werken omvat deze werkwijze beter dan ‘multidisciplinair’ en interdisciplinair werken en leren wordt landelijk sterk gestimuleerd. Daarom gebruiken we deze termen in dit boek, ondanks dat ‘interdisciplinair’ nog niet overal in de praktijk in gebruik is. Het beoogde kennisniveau is dat van de basisarts, maar omdat het boek vraaggestuurd is, wordt rekening gehouden met enige variatie in het kennisniveau en de interesse van de student. Voor zowel de student geneeskunde, physician assistant en verpleegkundig specialist als voor de geriater in spé biedt het boek een schat aan nuttige en prikkelende kennis. De hiervoor noodzakelijke variatie in de stof maakt dat ook beginnende artsen in opleiding tot geriater, internist, huisarts of specialist ouderengeneeskunde het boek goed kunnen gebruiken. Het is een leerboek voor Nederlandse en Vlaamse studenten, wat zich weerspiegelt in de selectie van auteurs en redacteuren uit beide windstreken. Graag bedanken wij de collega-auteurs en studenten die enthousiast hebben meegewerkt aan de eerste drie drukken van het boek en verwelkomen we de nieuwe auteurs. Rest ons alleen de gebruiker heel veel succes en studieplezier te wensen. Suggesties voortkomend uit jullie praktijkervaring ontvangen we graag en kunnen direct via de link in de digitale leeromgeving naar ons worden opgestuurd
... As part of routine care, baseline characteristics are recorded within the geriatric assessment, which is carried out by a nursing and medical staff member of the LVR-Hospital Cologne. The geriatric assessment includes sex, age, weight and height, clinical diagnosis, MMSE [29], and Timed Up and Go Test (TUG) [30]. ...
... Study randomization was done through Study Randomizer (2017), a web-based randomization service [33]. In order to achieve the best possible balance between the two study groups, the factors, sex, age, and MMSE score [29] will be weighted 1:1 in the program. Patients are sequentially numbered, no conclusion can be drawn about the patients, with the exception of the study director who takes the patient's informed consent. ...
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Background Major depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms. Methods A single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients’ depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes. Discussion This short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians. Trial registration German Clinical Trial Register ID: DRKS00026117 Trial status Protocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.
... Education was reported as years of study undertaken, including those towards an incomplete or pending qualification. Folstein et al., 1975). The MMSE is a brief multidomain cognitive assessment that uses 11 tasks to test orientation, memory, attention, concentration, repetition, visuospatial skills, comprehension and calculation. ...
... Scores range from 0 to 30, with a score of 24 or higher indicating intact cognition, while scores of 23 or below identify cognitive impairment. Psychometrically, the MMSE shows moderate sensitivity and specificity, as well as high test-retest reliability (.89) and interrater reliability (.82) in elderly samples with dementia (Lewis & Trempe, 2017;Folstein et al., 1975). The MMSE also shows good internal consistency (α = .77), ...
Poster
Globally, more than 50 million people live with dementia, with this number expected to rise to 82 million by 2030. This growth has increased the divide between elders from culturally and linguistically diverse (CALD) and non-CALD backgrounds. In the current literature, there is evidence for cognitive differences between CALD and non-CALD elders with Alzheimer’s disease (AD), which are thought to be influenced by education. However, this discrepancy has not been examined within diverse large-scale community data like the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The current between-subjects quasi-experimental study investigated whether CALD status and CALD-education interaction influences MMSE performance in cognitively normal (CN), Mild Cognitive Impairment (MCI) and AD ADNI elders. Data from 246 participants aged between 56 and 89 (M = 73.3, SD = 7.0) was sampled from ADNI at baseline. A 3-way ANOVA was conducted with bootstrapping; the results did not find a significant effect of CALD status, education or CALD-education interaction on MMSE performance in any cognitive group. These outcomes are inconsistent with prior findings as well as cognitive reserve theory literature linking low education attainment and cognitive frailty. Although nonsignificant, boxplots of scores reveal that minor differences were evident between CALD and non-CALD by educational group in CN, MCI and AD. Despite limitations such as poor specificity into individual CALD groups, this research is promising as it provides insight into cognitive decline in culturally diverse elders and can guide replication in an Australian context.
... The Mini-Mental State Examination (MMSE) [33], is a practical method for rating global cognition. MMSE demonstrates moderately high levels of reliability, and has been reported to be internally consistent [34]. ...
... Vision was measured with the KM chart [41], impaired vision defined as having a visual acuity of 0.5 or less. Impaired cognition defined as a score below 25 on the Mini-mental state examination (MMSE) [33,35] Missing: MADRS 10 men and 10 women, nervous 5 women, easily irritated 5 women, difficulty concentrating 2 men, 6 women, anxious 1 man, 5 women, feeling down 1 man, 5 women, cries easily 5 women, difficulty relaxing 5 women, poor appetite 5 women, weight loss 1 woman, sleep disturbances 5women c Cumulative Illness Rating Scale-Geriatrics (CIRS-G), (psychiatric illness also includes dementia). No problem affecting that system, Current mild problem or past significant problem, Moderate disability or morbidity and/or requires first-line therapy, Severe problem and/or constant and significant disability and/or hard-tocontrol chronic problems or Extremely severe problem and/or immediate treatment required and/or organ failure and/or severe functional impairment [43]. ...
Article
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Background Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. Aims The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). Methods This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above . Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people ( ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. Results The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50–12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15–4.71, p = 0.019) compared to patients in the control group who received regular medical care. Conclusion Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people. Trial registration ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
... The MMSE is widely used to assess cognitive function worldwide [21,22]. The total cognition score ranges from 0 to 21, which includes the following items: the Telephone Interview of Cognitive Status (TICS-10) (orientation and attention, 5), word recall (episodic memory, 10), serial subtraction of 7 from 100(up to 5 times, 5), and figure drawing (visual spatial abilities, 1) [23]. ...
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This study aims to investigate the association between trajectories of the cognition and body mass index (BMI) among Chinese middle and old-aged adults. A total of 5693 adults (age 45 +) whose cognitive score is higher than average at the baseline were included from China Health and Retirement Longitudinal Study (CHARLS:2011–2015). Cognitive function was measured by Mini-mental state examination (MMSE) in Chinese version. The Group-based trajectory modeling (GBTM) was adopted to identify the potential heterogeneity of longitudinal changes over the past 5 years and to investigate the relationship between baseline BMI and trajectories of cognitive function. Three trajectories were identified in results: the slow decline (37.92%), the rapid decline (6.71%) and the stable function (55.37%). After controlling for other variables, underweight (BMI < 18.5 kg/m ² ) was associated with the rapid and slow decline trajectories. Obesity (BMI > 28 kg/m ² ) was associated with the slow decline trajectory. High-risk people of cognitive decline can be screened by measuring BMI.
... The cognitive tests performed, validated in Portuguese, were the Trail Making Test A and B to assess sustained attention, mental flexibility, executive function, spatial/visual organization, and processing speed [29][30][31][32], and the semantic Verbal Fluency test to assess semantic memory storage capacity, ability, ability to retrieve information from memory, and processing of executive functions [31][32][33][34]; the CERAD (The Consortium to Establish a Registry for Alzheimer's Disease) Word List Test to assess memory [32][33][34]; and the MMSE, to screen patients at risk of being diagnosed with dementia and make a global assessment of cognition, covering aspects of orientation, memory, attention, calculation, language, and comprehension [32,[35][36][37][38][39][40][41]. The cutoff value of MMSE varies according to education level, and scores with values below the cutoff corrected by the education level in the Brazilian population were used to indicate dementia risk [39]. ...
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Background: Type 2 Diabetes Mellitus (T2DM) patients are twice as likely to develop dementia. The study's goal was to evaluate cognitive performance and risk factors for cognitive decline in this population. Methods: Prospective observational study was conducted with 400 T2DM adults, of whom, during routine baseline and follow-up appointments, had socio-demographic, clinical, and laboratory data collected, and underwent physical examination, screening for depression symptoms (Patient Health Questionaire-9-PHQ-9), and cognitive tests: Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A/B, and Word Memory Tests. Each cognitive test score was converted to a z-score and its average resulted in a new variable called Global Cognitive z-Score [GCS(z)]. Averages of the cognitive test scores and GCS(z) at both moments were compared by the Student's T-Test for paired samples. Multivariate binary logistic regression models were built to assess the association of GCS(z) < zero with risk factors for cognitive decline at the baseline and follow-up. Results: After exclusions, 251 patients were eligible, being 56.6% female, mean age of 61.1 (± 9.8) years, 12.6 (± 8.9) years of DM duration, and 7.6 (± 4.2) years of school education. Follow-up had 134 patients reevaluated and took place after a mean of 18.4(± 5.0) months. Eleven (14%) patients with a GCS(z) ≥ 0 at baseline turned into a GCS(z) < 0 at follow-up. There were no significant differences between the means of cognitive test scores and GCS(z) at the two evaluation moments. At the baseline, the multivariate logistic regression model identified five risk factors associated with GCS(z) < zero: age ≥ 65 years, schooling ≤ 6 years, arterial hypertension, depression symptoms, and diabetic retinopathy (DR), with odds ratio (OR) and 95% confidence interval (CI95%) respectively: 5.46 (2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07) e 2.50 (1.18-5.34). At follow-up, the risk factors for GCS(z) < zero were: schooling ≤ 6 years, DM duration ≥ 10 years, depression symptoms, arterial hypertension, and cardiovascular disease (CVD), OR and CI95% respectively: 10.15 (3.68-28.01); 2.68 (0.96-7.48); 4.92 (1.77-13.70); 7.21 (1.38-35.71) e 5.76 (1.93-17.18). Conclusions: Based on our results, cognitive evaluation and follow-up should be incorporated on the routine of T2DM patients, especially for those with advanced age, low education level, prolonged DM duration, arterial hypertension, depression symptoms, CVD, and DR.
... In particular, cognitive impairment has long been recognized as an important symptom in SPG11 [9,10]. Most small case series, however, employed measures of intelligence like the Wechsler Intelligence Scale (WAIS) or global cognitive tests like the Mini-Mental State Examination (MMSE [11]), Montral Cognitive Assessment (MoCA [12]) or Addenbrooke's Cogntitive Examination (ACE [13]). However, a more detailed neuropsychological evaluation in a larger patient cohort is missing in order to comprehensively characterize the complex and multidimensional phenotype of this devastating motor neuron disease. ...
Article
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Background SPG11 -linked hereditary spastic paraplegia is characterized by multisystem neurodegeneration leading to a complex clinical and yet incurable phenotype of progressive spasticity and weakness. Severe cognitive symptoms are present in the majority of SPG11 patients, but a systematic and multidimensional analysis of the neuropsychological phenotype in a larger cohort is lacking. While thinning of the corpus callosum is a well-known structural hallmark observed in SPG11 patients, the neuroanatomical pattern of cortical degeneration is less understood. We here aimed to integrate neuropsychological and brain morphometric measures in SPG11. Methods We examined the neuropsychological profile in 16 SPG11 patients using a defined neuropsychological testing battery. Long-term follow up testing was performed in 7 patients. Cortical and subcortical degeneration was analyzed using an approved, artificial intelligence based magnetic resonance imaging brain morphometry, comparing patients to established reference values and to matched controls. Results In SPG11 patients, verbal fluency and memory as well as frontal-executive functions were severely impaired. Later disease stages were associated with a global pattern of impairments. Interestingly, reaction times correlated significantly with disease progression. Brain morphometry showed a significant reduction of cortical and subcortical parenchymal volume following a rostro-caudal gradient in SPG11. Whereas performance in memory tasks correlated with white matter damage, verbal fluency measures showed strong associations with frontal and parietal cortical volumes. Conclusions The present data will help define neuropsychological and imaging read out parameters in early as well as in advanced clinical stages for future interventional trials in SPG11.
... Scores for MMSE range from 0 to 30; lower scores indicate greater cognitive dysfunction. [48] MOCA The Montreal cognitive assessment comprises 12 individual tasks (grouped into cognitive domains, including visuospatial and executive functioning, attention, language, abstraction, naming, delayed memory recall and orientation), which are mostly binary, and are assessed and summed with a 6-item orientation screening and an educational correction to determine a total score reflecting global cognitive functioning. [49] FAQ The Functional Activities Questionnaire evaluates the instrumental activities of daily living (IADLs), such as preparing meals and managing personal finances. ...
Article
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In clinical practice, several standardized neuropsychological tests have been designed to assess and monitor the neurocognitive status of patients with neurodegenerative diseases such as Alzheimer’s disease. Important research efforts have been devoted so far to the development of multivariate machine learning models that combine the different test indexes to predict the diagnosis and prognosis of cognitive decline with remarkable results. However, less attention has been devoted to the explainability of these models. In this work, we present a robust framework to (i) perform a threefold classification between healthy control subjects, individuals with cognitive impairment, and subjects with dementia using different cognitive indexes and (ii) analyze the variability of the explainability SHAP values associated with the decisions taken by the predictive models. We demonstrate that the SHAP values can accurately characterize how each index affects a patient’s cognitive status. Furthermore, we show that a longitudinal analysis of SHAP values can provide effective information on Alzheimer’s disease progression.
... ranging from 1 to 7 15 ; the Mac Nair scale; the French cognitive complaint questionnaires (QPC) 16 ; Mini-mental state (MMSE) 17 ; the French version of the Free and Cued Reminding Selective Test (FCRST) 18 ; digit span; Digit Symbol Substitution Test (DSST) (subpart of Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV) 19 ; Trail making test (TMT) 20 ; Rey-Osterrieth complex figure test 21 ; Verbal Fluency Test (VFT); Categorical Naming Test (CNT) 22 ; the Stroop Color and Word and Interference Test 23 ; Visual Object and Space Perception (VOSP) 24 ; the picture naming test (D080) 25 ; and the praxis' tests 26 . A list of all tests is available in Supplementary Table 1. ...
Article
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Primary Sjögren’s syndrome (pSS) is an autoimmune disease with frequent neurological involvement. Memory complaints are common, but their precise patterns remain unclear. We wanted to characterize patterns of neurocognitive profiles in pSS patients with cognitive complaints. Only pSS patients with memory complaints were included, prospectively. Cognitive profiles were compiled through a comprehensive cognitive evaluation by neuropsychologists. Evaluations of anxiety, depression, fatigue, sleep disorders and quality of life were performed for testing their interactions with cognitive profiles. All 32 pSS patients showed at least borderline cognitive impairment, and 17 (53%) exhibited a pathological cognitive profile: a hippocampal profile (37%), a dysexecutive profile (22%), and an instrumental profile (16%) (possible overlap). Regarding the secondary objectives: 37% of patients were depressed, and 48% exhibited a mild-to-severe anxiety trait. Sleep disorders were frequent (excessive daytime sleepiness (55%), high risk for sleep apnea (45%), and insomnia (77%)). Cognitive impairments could not be explained alone by anxiety, depression or sleep disorders. Fatigue level was strongly associated with sleep disorders. Our study highlights that cognitive complaints in pSS patients are supported by measurable cognitive impairments, apart from frequently associated disorders such as depression, anxiety or sleep troubles. Sleep disorders should be screened.
... The CDR, CERAD-NB 26 and Mini-Mental State Examination (MMSE) 27 were conducted by trained psychologists at the LMU hospital memory clinic. Using the CERAD-NB battery a total score was created as shown previously, comprising the six sub-tests semantic fluency (animals/60 seconds), modified Boston Naming Test, Word List Learning, Constructional Praxis, Word List Recall and Word List Recognition Discriminability, with higher scores indicating better performance (maximum total score 100) 25 . ...
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Alzheimer's disease (AD) is characterized by amyloid‐β (Aβ) plaques and neurofibrillary tau tangles, but increasing evidence suggests that neuroinflammation also plays a key role, driven by the activation of microglia. Aβ and tau pathology appear to spread along pathways of highly connected brain regions, but it remains elusive if microglial activation follows a similar distribution pattern. Here we assess if connectivity is associated with microglia activation patterns. We included thirty‐two Aβ positive early AD subjects (18 women, 14 men) and 18 Aβ negative age‐matched healthy controls (10 women, 8 men) from the prospective ActiGliA study. All participants underwent microglial activation positron emission tomography (PET) with the third‐generation translocator protein (TSPO) ligand [18F]GE‐180 and magnetic resonance imaging (MRI) to measure resting‐state functional and structural connectivity. We found that inter‐regional covariance in TSPO‐PET and standardized uptake value ratio was preferentially distributed along functionally highly connected brain regions, with MRI structural connectivity showing a weaker association with microglial activation. AD patients showed increased TSPO‐PET tracer uptake bilaterally in the anterior medial temporal lobe compared to controls, and higher TSPO‐PET uptake was associated with cognitive impairment and dementia severity in a disease stage dependent manner. Microglial activation distributes preferentially along highly connected brain regions, similar to tau pathology. These findings support the important role of microglia in neurodegeneration and we speculate that pathology spreads throughout the brain along vulnerable connectivity pathways. This article is protected by copyright. All rights reserved.
... The ADAS-Cog, MMSE, and Clinical Dementia Rating scale Sum of Boxes (CDR-SOB) were the most commonly reported cognitive assessments in our included studies. The MMSE [23,24] is a 30-point quick and easy-to-perform questionnaire for assessing cognitive function, with higher scores indicating better function. ADAS-Cog is another cognitive test that assesses the level of cognitive dysfunction in AD patients, where a higher score means worse cognitive function and greater dysfunction [25,26]. ...
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Background Alzheimer’s disease (AD) is a neurodegenerative disease and the most common cause of dementia. In this umbrella systematic review (SR), we summarized the efficacy of different pharmacological interventions in improving cognitive function in patients with AD. Methods A systematic search was performed through the PubMed, Scopus, Embase, and Cochrane databases for SRs of studies assessing the efficacy of pharmacological interventions versus placebo in improving cognitive function in AD or mild cognitive impairment due to AD. The risk of bias (RoB) was assessed using the Risk of Bias in SRs (ROBIS) tool. Results Out of 1748 articles found through the database survey, 33 SR articles were included. These studies assessed effects of immunotherapy, cholinesterase inhibitors (ChEIs), memantine, statins, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs), antidiabetic agents, Cerebrolysin, RAS-targeting antihypertensive drugs (ARBs and ACEIs), psychostimulants, glycogen synthase kinase 3 (GSK-3) inhibitors, melatonin, and herbal medications on cognitive function in AD patients. There was no notable overall RoB in 18 studies (54.5%), the RoB in 14 studies (42.4%) was high, and in one study (3.0%) it was unclear. Conclusions The use of ChEIs, including rivastigmine, galantamine, and donepezil, as well as memantine has demonstrated a positive impact on improving cognitive outcomes of AD patients, but no considerable effects were found for immunotherapies. Melatonin, statins, antihypertensive drugs, antidiabetic agents, Cerebrolysin, psychostimulants, and some herbal drugs such as Danggui-Shaoyao-San and Ginkgo biloba seem to be effective in improving cognitive function of AD patients, but the evidence in this regard is limited.
... Cognitive function was assessed using the Mini Mental State Exam (MMSE) administered by trained research assistants [24]. We adopted age and education-specific cut-off points for the definition of cognitive impairment [25]. ...
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Objectives To evaluate dentition status amongst community-dwelling older adults and its association with frailty and cognitive impairment. Methodology One thousand forty-seven community-dwelling older adults aged ≥65 years were surveyed in an epidemiologic population-based cohort study in Singapore between April 2015 and August 2016. Data on demographics, dentition status, chronic diseases, activities and instrumental activities on daily-living, cognition (age- and education-specific MMSE cut-offs), frailty (FRAIL scale), perceived health and functional status were collected. Multiple logistic regression was performed to examine the association between dentition, frailty and cognition. Results Mean age of participants was 71.2 ± 5.5 years. The prevalence of denture use was 70.7% and edentulism 7.9%. Compared to edentulousness, having teeth was associated with lower odds of cognitive impairment and higher odds of being robust or pre-frail. Denture-wearers compared with edentulous persons were less likely to be male, had higher education level and more likely be robust or pre-frail. Conclusion and implications There were significant associations between dentition status, frailty and cognition in our study where those with remining teeth and / or dentures had better overall outcomes. As oral health, frailty and cognitive impairments are all modifiable risk factors for healthy ageing, countries should consider population level screening for oral health, frailty and cognitive impairment.
... All patients were clinically evaluated by neurology specialists. Cognitive function in the HC group was evaluated using the Mini-Mental State Examination (MMSE) (21). For PD patients, cognitive function was evaluated using the MMSE, the Montreal Cognitive Assessment (MoCA)-Changsha version (22), whereas motor symptoms were evaluated using Hoehn-Yahr scale (H-Y) and the Parkinson's Disease Unified Rating Scale Part III (UPDRS-III) (23). ...
Article
Background: Genetic susceptibility plays an important role in the pathogenesis of Parkinson's disease (PD). parkin S/N167 mutations may increase the risk of PD and affect white matter fibers in the brain. This cross-sectional study explored the effects of gene polymorphisms on white matter fiber damage in PD. Methods: In all, 54 cases were enrolled in the study, including PD patients carrying parkin gene S/N167 mutations (G/A), PD patients without gene S/N167 mutations (G/G), and healthy controls (HC). The whole-brain white matter fiber skeleton was analyzed using the tract-based spatial statistics (TBSS) method. Two-way analysis of variance (ANOVA) and post hoc tests were used for data analyses. Results: Two classification methods were used; one was based on disease classification, with 26 patients in the PD group (n=12 G/G, n=14 G/A) and 28 in the HC group (n=15 G/G, n=13 G/A), and the other was based on genetic classification, with 27 patients in the G/G group and 27 in the G/A group. In the G/A group, there was a wide range of significant changes in fractional anisotropy (FA), radial diffusivity (RD), and mean diffusivity (MD) values (P<0.05). There was also a significant decrease in FA in the PD-G/A group compared with the PD-G/G and HC-G/A groups (P<0.05). Conclusions: There were more extensive brain white matter fiber damage and changes in PD patients; the G/A polymorphism may cause more extensive brain white matter damage.
... Disability was assessed by Katz Index [20], and dependency in one or more BADL was considered as a risk factor in the analysis. Cognitive impairment was defined as age-and education-adjusted Mini Mental State Examination (MMSE) score <24 [21]. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire [22]. ...
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Background age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results overall, mortality was found to increase starting from eGFR = 30–44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81–5.95) to ACR = 30–300 mg/g (HR = 1.96, 95%CI = 1.23–3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45–59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78–0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71–0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function. Conclusions physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild–moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.
... 15 The UDS included standard diagnostic criteria for dementia and its differential diagnoses and used the global Clinical Dementia Rating™ (CDR™ 17,18 ) to operationalize the presence or absence of dementia and, when present, its severity. Cognitive normality at baseline was defined by a CDR global score of 0. Five cognitive tests were shared by all the studies: the Mini-Mental State Examination, 19 Animal Fluency (60 s), 20 Wechsler Adult Intelligence Scale (WAIS-R) Digit Symbol, 21 Boston Naming Test 22 and Logical Memory Delayed Recall. 21 For each, a Z-score was calculated by subtracting the mean from the raw score and dividing the difference by the SD of all test scores at baseline. ...
Article
The temporal evolutions and relative orderings of Alzheimer disease biomarkers, including CSF amyloid-β42 (Aβ42), Aβ40, total tau (Tau) and phosphorylated tau181 (pTau181), standardized uptake value ratio (SUVR) from the molecular imaging of cerebral fibrillar amyloid-β with PET using the 11C-Pittsburgh Compound-B (PiB), MRI-based hippocampal volume and cortical thickness and cognition have been hypothesized but not yet fully tested with longitudinal data for all major biomarker modalities among cognitively normal individuals across the adult lifespan starting from 18 years. By leveraging a large harmonized database from 8 biomarker studies with longitudinal data from 2609 participants in cognition, 873 in MRI biomarkers, 519 in PET PiB imaging and 475 in CSF biomarkers for a median follow-up of 5–6 years, we estimated the longitudinal trajectories of all major Alzheimer disease biomarkers as functions of baseline age that spanned from 18 to 103 years, located the baseline age window at which the longitudinal rates of change accelerated and further examined possible modifying effects of apolipoprotein E (APOE) genotype. We observed that participants 18–45 years at baseline exhibited learning effects on cognition and unexpected directions of change on CSF and PiB biomarkers. The earliest acceleration of longitudinal change occurred for CSF Aβ42 and Aβ42/Aβ40 ratio (with an increase) and for Tau, and pTau181 (with a decrease) at the next baseline age interval of 45–50 years, followed by an accelerated increase for PiB SUVR at the baseline age of 50–55 years and an accelerated decrease for hippocampal volume at the baseline age of 55–60 years and finally by an accelerated decline for cortical thickness and cognition at the baseline age of 65–70 years. Another acceleration in the rate of change occurred at the baseline age of 65–70 years for Aβ42/Aβ40 ratio, Tau, pTau181, PiB SUVR and hippocampal volume. Accelerated declines in hippocampal volume and cognition continued after 70 years. For participants 18–45 years at baseline, significant increases in Aβ42 and Aβ42/Aβ40 ratio and decreases in PiB SUVR occurred in APOE ɛ4 non-carriers but not carriers. After age 45 years, APOE ɛ4 carriers had greater magnitudes than non-carriers in the rates of change for all CSF biomarkers, PiB SUVR and cognition. Our results characterize the temporal evolutions and relative orderings of Alzheimer disease biomarkers across the adult lifespan and the modification effect of APOE ɛ4. These findings may better inform the design of prevention trials on Alzheimer disease.
...  El Minimental State Examination (Folstein, 1975) es una prueba con adaptación a la población española, que no suele exceder los 15 minutos de aplicación y que permite evaluar la orientación, atención, memoria, cálculo, razonamiento, lenguaje y praxias. ...
... Stage of Alzheimer's disease Clinical Dementia Rating (Morris, 1993) Cognitive screening Mini-mental State examination (Folstein et al., 1975) Comorbidity Self-report in face-to-face interviews and interventions, medical records and drug therapy in use Drug therapy in use (pharmaceutical active ingredient, pharmaceutical form, dose, dosage and route of administration) ...
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Abstract To assess the therapy relative to indication, effectiveness, safety and adherence in patients with Alzheimer’s disease (AD). An interventional, prospective, non-randomized study was conducted in a single secondary care center in Brazil. The pharmacist-led medication therapy management (MTM) was conducted to detect drug-related problems (DRPs) at baseline and after six months of intervention. The health status outcomes (i.e. cognitive screening tests; levels of glucose; total cholesterol; triglycerides; thyroid stimulating hormone; serum free thyroxine and blood pressure) were measured. 66 patients with AD were included, of whom 55 patients completed the follow-up of six months. 36 patients (36/55) were non-adherent to AD drug therapy. Out of detected 166 DRPs, 116 were solved. Four patients were withdrawn from the AD protocol due to resolution of prodromal symptoms. On the conclusion of the study, the MTM improved and controlled blood pressure, glucose, total cholesterol, triglycerides levels (p
... Such assessments employ cognitive tests which do not focus upon these broad aspects of cognitive functionality, but are either domain-specific, or assess multiple domains or 'global' cognition. Much of the research field is focused on perfusion of the GM or specific regions, with the assessment of cognition commonly occurring through the use of the MMSE (Folstein, Folstein and McHugh, 1975;Folstein, Robins and Helzer, 1983), one of three oft-used tests of multiple cognitive domains -the MMSE, ADAS-Cog (Rosen, Mohs and Davis, 1984), and the MoCA (Nasreddine et al., 2005). The MMSE has been used extensively in both large clinical trials and day-to-day within the clinic, due to the ease and speed of its administration. ...
Article
Changes in cerebral perfusion or metabolism can occur as a result of healthy ageing, and in conditions of impaired ageing such as mild cognitive impairment (MCI) or Alzheimer’s disease (AD). Overarchingly, this thesis aimed to explore physiological magnetic resonance imaging (MRI) measures to study both cerebral perfusion and metabolism in the healthy ageing brain. Specifically, arterial spin labelling (ASL) and functional magnetic resonance spectroscopy (1H-fMRS) were employed in the elucidation of healthy ageing. Investigation of cerebral functionality is clinically important, enabling understanding of healthy ageing and disease pathology beyond that provided by structural measures. Given the necessity for tightly-regulated tissue perfusion in the delivery of oxygen to the brain, assessment of brain perfusion can enable elucidation of related brain health. Firstly, this thesis focused on changes in brain perfusion within a cross-sectional retrospective cohort of healthy subjects. This study aimed to assess the utility of univariate and multivariate pattern analysis (MVPA) techniques, and determine whether spatial coefficient of variation (sCoV) measures – which provide a method for inferring spatial heterogeneity of blood flow from single post-label delay (PLD) ASL data – are more significantly associated with age than standard perfusion metrics (ml/100g/min values). The impact of data processing steps on quantification of perfusion was initially assessed. Particularly, the influence of partial volume effect (PVE) correction and how this affected quantification of cerebral perfusion was of interest. The relationship between measures of cerebral perfusion – in regions of interest, vascular territories, and grey matter – and age were assessed, before grey matter (GM) spatial covariance patterns were identified, with MVPA hypothesised to elucidate more subtle age-related change than univariate, voxel-wise methodology. The executive control network (ECN) was the only network exhibiting a significant decline in perfusion with age, after controlling for relevant covariates. Interestingly, whilst the PCA approach resulted in a pattern of both positive and negative associations with age across cerebral GM, the surviving clusters in voxel-wise approaches were deemed spurious. Five-fold cross validation of PCA findings was used to assess whether the resultant spatial covariance patterns were able to predict subject age. This prediction was successful, with related r2 values of between 0.5316 and 0.7297 (p < 0.001 for all), however validation of these findings in an unseen dataset is required. The utility of the sCoV metric was also compared with standard tissue perfusion values, finding that sCoV may be more closely associated with ageing than ml/100g/min in certain regions. Particularly, a significant increase in whole GM sCoV with age was notable, given the absence of significant changes in perfusion with age in the same region. Additionally, a MVPA approach was used to establish the complex unknown relationship between cerebral perfusion and the Montreal Cognitive Assessment (MoCA), before graph visualisation was used to further understand the regional relatedness of the spatial covariance pattern. PCA resulted in a model which provided a moderate explanation of the aforementioned relationship, but this may be improved by inclusion of additional covariates in subsequent work, such as those pertaining to genetic status, such as apolipoprotein E (APOE). This study also replicates an FDG PET cognitive resilience signature in an ASL cohort for the first time, with a trend towards declining perfusion with age found (p = .08). Lastly, as ageing is associated with metabolic failure in the brain, which is often investigated using methodology which employs ionising radiation, the final study was motivated to investigate possible metabolic markers of brain ageing which can be measured using MRI. Metabolic-functional coupling can be studied using functional stimulation, and functional magnetic resonance spectroscopy (fMRS) is perfectly poised to elucidate certain metabolic behaviour. Given the close relationship between glucose (Glc) – the key fuel for cerebral functionality – and lactate (Lac) metabolism, an optimised long echo time (TE) semi-localized by adiabatic selective refocusing (semi-LASER) sequence (TE=144ms) with optimised J-modulation selection at 7T was employed to assess the effects of age on the dynamic behaviour of Lac, and determine its absolute concentrations throughout the time course, whilst a visual stimulation paradigm was viewed. Successful quantification of metabolite concentrations – including Lac, tCr and tNAA – was achieved in both the young and old cohorts, and their Lac peaks clearly visually identifiable throughout the time course. A significant increase in Lac concentration was observed between rest and stimulation, but not stimulation and recovery, in the young cohort. No significant Lac time course changes were identified in the full old cohort. This thesis concluded by summarising and contextualising the key findings herein, and discussion of possible directions for further associated research. The findings of this thesis broaden the field of knowledge around healthy ageing, and therefore may contribute to subsequent translation efforts for both clinical diagnostics and treatment approaches.
... Global cognitive performance was assessed in each patient using the Mini-Mental State Examination (MMSE; Folstein et al., 1975). Cognitive domain-specific tests were performed on all patients. ...
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Introduction : Two common variants of sortilin-related receptor 1 gene ( SORL1 ), rs2298813 and rs1784933, have been associated with late-onset Alzheimer’s disease (AD) in the Han Chinese population in Taiwan. However, neuroimaging correlates of these two SORL1 variants remain unknown. We aimed to determine whether the two SORL1 polymorphisms were associated with any volumetric differences in brain regions in late-onset AD patients. Methods : We recruited 200 patients with late-onset AD from Taipei Veterans General Hospital. All patients received a structural magnetic resonance (MR) imaging brain scan and completed a battery of neurocognitive tests at enrollment. We followed up to assess changes in Mini-Mental State Examination (MMSE) scores in 155 patients (77.5%) at an interval of 2 years. Volumetric measures and cortical thickness of various brain regions were performed using FreeSurfer. Regression analysis controlled for apolipoprotein E status. Multiple comparisons were corrected for using the false discovery rate. Results : The homozygous major allele of rs2298813 was associated with larger volumes in the right putamen ( p = 0.0442) and right pallidum ( p = 0.0346). There was no link between the rs1784933 genotypes with any regional volume or thickness of the brain. In the rs2298813 homozygous major allele carriers, the right putaminal volume was associated with verbal fluency ( p = 0.008), and both the right putaminal and pallidal volumes were predictive of clinical progression at follow-up ( p = 0.020). In the minor allele carriers, neither of the nuclei was related to cognitive test performance or clinical progression. Conclusion : The major and minor alleles of rs2298813 had differential effects on the right lentiform nucleus volume and distinctively modulated the association between the regional volume and cognitive function in patients with AD.
... However, current FAB Italian normative data date back to more than 15 years ago and sociodemographic changes require norms updating [9]. Moreover, to the best of the authors' knowledge, the FAB has been only validated against "non-executive" screeners in Italy [6]-e.g., the Mini-Mental State Examination (MMSE) [10]-whereas its association with "EF-loaded" screening measures, e.g., the Montreal Cognitive Assessment (MoCA) [11], has yet to be explored. In addition, FAB normative studies do not provide with norms for its subtests, despite this being an increasingly widespread approach for cognitive screeners in Italy [12,13], as it allows greater flexibility for clinicians when using these instruments. ...
... Symptomatic family members were identified and assessed by local clinicians and referred for genetic counseling and testing. At least one member per family (proband/index case) underwent medical, neurological, and neuropsychological evaluations, including the Mini-Mental State Examination (MMSE) [15] or Montreal Cognitive Assessment (MoCA) [16] with additional neuropsychological tests (e.g., verbal fluency, logical memory) and dementia functional scales (e.g., Clinical Dementia Rating (CDR ® ) [17], Functional Activities Questionnaire). Clinical diagnosis of symptomatic AD or cognitive status (cognitive healthy vs. cognitive impaired) was done without knowledge of mutation status and according to DSM-IV criteria. ...
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Background In fewer than 1% of patients, AD is caused by autosomal dominant mutations in either the presenilin 1 ( PSEN1 ), presenilin 2 ( PSEN2 ), or amyloid precursor protein ( APP ) genes. The full extent of familial AD and frequency of these variants remains understudied in Latin American (LatAm) countries. Due to the rare nature of these variants, determining the pathogenicity of a novel variant in these genes can be challenging. Here, we use a systematic approach to assign the likelihood of pathogenicity in variants from densely affected families in Latin American populations. Methods Clinical data was collected from LatAm families at risk for DIAD. Symptomatic family members were identified and assessed by local clinicians and referred for genetic counseling and testing. To determine the likelihood of pathogenicity among variants of unknown significance from LatAm populations, we report pedigree information, frequency in control populations, in silico predictions, and cell-based models of amyloid-beta ratios. Results We identified five novel variants in the presenilin1 ( PSEN1 ) gene from Brazilian and Mexican families. The mean age at onset in newly identified families was 43.5 years (range 36–54). PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, p.Ala275Thr, and p.Ile414Thr variants have not been reported in PubMed, ClinVar, and have not been reported in dominantly inherited AD (DIAD) families. We found that PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, and p.Ala275Thr produce Aβ profiles consistent with known AD pathogenic mutations. PSEN1 p.Ile414Thr did not alter Aβ in a manner consistent with a known pathogenic mutation. Conclusions Our study provides further insights into the genetics of AD in LatAm. Based on our findings, including clinical presentation, imaging, genetic, segregations studies, and cell-based analysis, we propose that PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, and p.Ala275Thr are likely pathogenic variants resulting in DIAD, whereas PSEN1 p.Ile414Thr is likely a risk factor. This report is a step forward to improving the inclusion/engagement of LatAm families in research. Family discovery is of great relevance for the region, as new initiatives are underway to extend clinical trials and observational studies to families living with DIAD.
... Variables considered for the model were age, sex, Mini-Mental State Examination (MMSE) [28], Charlson Comorbidity Index (CCI), Neuropsychiatric Inventory (NPI) [29], APOE e4 status, MRI medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), white matter hyperintensities (WMH), CSF Aβ42 and CSF p-tau. All candidate predictors were measured at the first recorded diagnosis in the memory clinic. ...
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Background: Patients and caregivers express a desire for accurate prognostic information about time to institutionalization and mortality. Previous studies predicting institutionalization and mortality focused on the dementia stage. However, Alzheimer's disease (AD) is characterized by a long pre-dementia stage. Therefore, we developed prediction models to predict institutionalization and mortality along the AD continuum of cognitively normal to dementia. Methods: This study included SCD/MCI patients (subjective cognitive decline (SCD) or mild cognitive impairment (MCI)) and patients with AD dementia from the Amsterdam Dementia Cohort. We developed internally and externally validated prediction models with biomarkers and without biomarkers, stratified by dementia status. Determinants were selected using backward selection (p<0.10). All models included age and sex. Discriminative performance of the models was assessed with Harrell's C statistics. Results: We included n=1418 SCD/MCI patients (n=123 died, n=74 were institutionalized) and n=1179 patients with AD dementia (n=413 died, n=453 were institutionalized). For both SCD/MCI and dementia stages, the models for institutionalization and mortality included after backward selection clinical characteristics, imaging, and cerebrospinal fluid (CSF) biomarkers. In SCD/MCI, the Harrell's C-statistics of the models were 0.81 (model without biomarkers: 0.76) for institutionalization and 0.79 (model without biomarker: 0.76) for mortality. In AD-dementia, the Harrell's C-statistics of the models were 0.68 (model without biomarkers: 0.67) for institutionalization and 0.65 (model without biomarker: 0.65) for mortality. Models based on data from amyloid-positive patients only had similar discrimination. Conclusions: We constructed prediction models to predict institutionalization and mortality with good accuracy for SCD/MCI patients and moderate accuracy for patients with AD dementia. The developed prediction models can be used to provide patients and their caregivers with prognostic information on time to institutionalization and mortality along the cognitive continuum of AD.
... L'absence de significativité de l'analyse multivariée est relativement compréhensible au regard de celle des analyses univariées sachant la colinéarité de bon nombre de variables entre elles.4 Calcul effectué sur les résidents uniquement présents les deux années consécutives (2019 et 2020).5 Calcul effectué sur les résidents uniquement présents les deux années consécutives (2019 et 2020).6 ...
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Introduction: Following the Covid-19 epidemic affecting 76 of the 97 residents (78.3 %) in a French nursing home, we assessed the impact of this cluster period on the physical and psycho-cognitive health of the residents, expecting in particular to observe effects that were dependent on their state of cognitive-behavioural dependence. Methods: We retained twenty-two variables, 5 relating to demographic data, 6 to the specific care linked to Covid-19 infection, 6 to somatic pathologies and psycho-behavioural disturbances before the epidemic and 5 to the period following it. Results: Eleven residents among those diagnosed positive died. Nine were transferred to a Covid unit, and 35 were asymptomatic. The main consequences of the period of infections were in particular behavioural, nutritional, and motor. A history of disruptive behaviours before the appearance of the cluster increased the risk of an aggravation of these behaviours by four (RR = 3.9, IC95 % = 1.38–11.02, p = 0.0042). Twenty per cent of the residents presented under-nutrition at the end of lockdown, but no specific risk factors could be identified. However, states of under-nutrition for the whole of 2020 were significantly more frequent than in 2019, in particular severe cases (χ² = 5.43, p = 0.02). A history of under-nutrition in the previous year increased twofold the likelihood of under-nutrition in the following year (RR = 2.07, IC95 % = 1.14–3.74, p = 0.02). The Covid cluster period also had an effect on the functional autonomy of certain patients. Conclusion: Our main hypothesis relating to cognitive-behavioural dependence was not completely validated. The impact of the occurrence of the cluster remained moderate, in particular because of the care resources afforded by the nursing home. The advantages of a “medicalised” facility, and the problems associated with the restrictions of lockdown, are viewed in the light of ethical considerations.
... The Mini-Mental State Examination (MMSE) is a widely used screening tool for dementia 78 and mild cognitive impairment 79 , and it is validated for Spanish-speaking communities 80 . Values under 23/24 are considered cognitive impairment 79 . ...
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Physical exercise is one of the treatment approaches with the most robust evidence against fibromyalgia (FM) symptoms. This study aimed to investigate the impact of being physically active on the Stroop Color and Word Test (SCWT) performance as well as to investigate and compare the brain electrocortical activity during SCWT. A total of 31 women completed the SCWT while EEG was recorded. People with FM were divided into two groups (physically and non-physically active) according to the WHO guidelines. Furthermore, magnetic resonance imaging was acquired and health-related quality of life, the impact of the disease, and the six-minute walking test were administered. Physically active group showed better performance in the SCWT, exhibiting less error in name different color patches condition (C), more correct responses in named color-word condition (CW) and higher interference score than non-physically active group. Moreover, a significantly higher theta power spectrum in the Fp1 during the condition C in the SCWT and a higher volume in the right rostral middle frontal gyrus have been found in the physically active group. Furthermore, physically active women with FM showed positively correlations between correct responses in names of colors printed in black condition (W) in the SCWT and theta power in the F3, Fz, Fp2 and F4 scalp positions. Regarding non-physically active women with FM, errors in condition CW negatively correlated with the volume of left superior frontal gyrus, left rostral middle frontal gyrus, right rostral middle frontal gyrus, left caudal middle frontal gyrus and right caudal middle frontal gyrus. Furthermore, physically active group showed increased performance in the 6 min walking test and lower disease impact. Fulfil the physical activity recommendation seems to protect brain health since better SCWT performance, greater frontal theta power and higher volume in the right rostral middle frontal gyrus have been found in physically active women with FM.
... The battery of tests applied included the revised Delirium Rating Scale (DRS-R98), Mini-Mental State Examination, Delirium Motor Subtype Scale, Informant Questionnaire of Cognitive Decline in the Elderly as well as standard clinical assessment, chart review and collateral history [11,[16][17][18]. Assessments were conducted by raters (MM, LL) specifically trained in the use of the tests included and, to further enhance inter-rater reliability, ratings associated with any uncertainty were discussed and agreed. ...
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Background Delirium is extremely prevalent, yet underdiagnosed, in older patients and is associated with prolonged length of hospital stay and higher mortality rates. Impaired attention is the cardinal deficit in delirium and is a required feature in diagnostic criteria. The verbal months backwards test (MBT) is the most sensitive bedside test of attention, however, hospital staff occasionally have difficulty with its administration and interpretation. We hypothesise that the MBT on an electronic tablet may be easier and more consistent to use for both experienced and unexperienced medical professionals and, if the diagnostic efficacy was similar, aid delirium diagnosis. Aim We aim to investigate the correlation of the verbal MBT with a computerised MBT application. Methods Participants recruited (age > 65, n = 75) were allocated to different cohorts (Dementia and Delirium (DMDL), Dementia (DM), Delirium (DL), No Neurocognitive Disorder (NNCD)) and were administered both the verbal and electronic versions. Results Correlation between measurements were: overall Spearman’s rho = 0.772 (p < 0.0001); DMDL rho = 0.666 (p < 0.0001); DL rho = 0.778 (p = 0.039); DM rho = 0.378 (p = 0.203); NNCD rho = 0.143 (p = 0.559). Discussion Overall, and for the delirious subset, statistically significant agreement was present. Poor inter-test correlation existed in the groups without delirium (DM, NNCD). Conclusions The MBTc correlates well with the MBTv in patients who are clinically suspected to have delirium but has poor correlation in patients without delirium. Visuospatial cognition and psychomotor deficits in a dementia cohort and mechanical factors (such as tremor, poor fingernail hygiene and visual impairment) in a group with no neurocognitive disorder may limit the utility of the MBTc in a hospitalised older population.
... Patient B was a male aged 70 years at the time of diagnosis, at which time Donepezil was initially administered. Based on data from MRI's, CT scans, neurological evaluations, and scores on the Mini-Mental State Examination (MMSE), the Quick Dementia Rating System (QDRS) and the Lewy Body Composite Risk Score, the other two patients (Patient C and Patient D) had been diagnosed with NCDLB [36][37][38]. Patient C was a female aged 69 years at the time of diagnosis, at which time Donepezil was initially administered. Patient D was a male aged 74 years at the time of diagnosis, and age 78 years at the time that Donepezil was initially administered. ...
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In a longitudinal case study, the acetylcholinesterase inhibitor (AChEI) Donepezil was used to address the symptoms of constipation, obstipation and impaction in four patients diagnosed at different stages of disease progression with the α‐synuclein or Lewy body disorders Parkinson’s disease (PD) and Neurocognitive Disorder with Lewy Bodies (NCDLB). For each of the four patients, the use of Donepezil was associated with significant symptom reduction. Symptom improvement was maintained in follow-up studies conducted at intervals of six, twelve, eighteen, thirty-six, forty-eight and sixty months, with no apparent reduction in bowel motility. After four or five years, even with progression of other α‐synucleinopathy, bowel motility was preserved. The results suggest that patients with α‐synuclein disorders can experience long-term benefit in the reduction of symptoms including constipation, obstipation and impaction with the use of the AChEI Donepezil. Keywords: Neurocognitive Disorder with Lewy Bodies, Parkinson’s disease, constipation, Donepezil, acetylcholinesterase inhibitor
... Every PD patient finished motor and nonmotor symptom assessments, and the MRI studies were conducted in the "OFF" medication state-achieved by the withdrawal of dopaminergic medications 12-18 h before testing through in-person interviews. Detailed variables of interest and the assessment methods [28][29][30][31][32][33][34][35][36][37][38][39] are shown in Table 1. Severity of frozen gait assessed with FOG-Q [26] and Unified Parkinson Disease Rating Scale, items 14 (UPDRS-14) [28]. ...
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Background Freezing of gait (FOG) is a common, disabling symptom of Parkinson’s disease (PD), and its exact pathophysiological mechanism is still poorly understood. The control of gait is a complex process that may be influenced by emotions modulated by serotonergic networks. Therefore, this study aimed to determine factors associated with FOG in PD patients and to evaluate the importance of the dorsal raphe nucleus (DRN; central node in the serotoninergic system) in FOG pathophysiology. Methods We combined cross-sectional survey data from 453 PD patients. According to the Freezing of Gait Questionnaire (FOGQ), patients were divided into two groups: the “PD with frozen gait (PD-FOG)” and “PD without frozen gait (PD-nFOG)” groups. Demographic characteristics, clinical features, and motor and nonmotor symptoms (NMS) assessments of PD patients were recorded. Univariate statistical analysis was performed between the two groups, and then regression analysis was performed on related factors. We also acquired resting-state functional MRI (rs-fMRI) data from 20 PD-FOG, 21 PD-nFOG, and 22 healthy controls (HCs) who were randomly chosen. We defined seeds in the DRN to evaluate functional connectivity (FC) patterns. Results The overall frequency of FOG was 11.9% patients in the PD-FOG group were older, had a longer disease duration, had a higher levodopa equivalent daily dose, had more severe motor symptoms and worse quality of life, had a higher proportion of dyskinesia, wearing-off and postural instability/gait difficulty (PIGD) clinical phenotype, and experienced more depression and impaired sleep function than those in the PD-nFOG group. Logistic regression analysis showed that H&Ystage ≥ 3, UPDRS-III scores, PIGD clinical phenotype and excessive daytime sleepiness were associated with FOG. In addition, there was significantly lower FC between the DRN and some cortical structures, including the supplementary motor area (SMA), left superior frontal gyrus (SFG), and left median cingulated cortex (MCC) in PD-FOG patients than HCs and PD-nFOG patients. Conclusions These results demonstrate that the severity of PD and PIGD clinical phenotype are associated factors for freezing and that DRN dysfunction may play a key role in PD-related NMS and FOG. An abnormal cortical and brainstem networks may contribute to the mechanisms underlying FOG.
Thesis
Les stratégies non pharmacologiques sont au devant de la prise en charge de la maladie d'Alzheimer (MA) et parmi elles, les interventions psychoeducationnelles. Nous avons émis l'hypothèse qu'une intervention d'Education Thérapeutique (ETP) adressée à la dyade pourrait avoir un impact positif sur la qualité de vie du patient et mené un essai pour la tester. Les objectifs généraux étaient d'évaluer l'efficacité d'une ETP adressée à la dyade sur la qualité de vie du patient atteint de MA et sur le bien-être de l'aidant (fardeau et qualité de vie) mais aussi de mieux caractériser les sous populations cibles et les particularités des dyades pour concevoir de futures interventions. Nous avons aussi souhaité identifier des facteurs associés à l'entrée en EHPAD, chez chaque membre de la dyade. THERAD est un essai monocentrique, randomisé et contrôlé évaluant l'impact de l'ETP sur la qualité de vie du patient atteint de MA à domicile, chez 196 dyades. L'intervention était un programme d'ETP. Le critère de jugement principal était la qualité de vie du patient heteroevaluée par l'aidant, à 2 mois sur l'échelle de qualité de vie QOL (Quality of life) de Logsdon. Les critères de jugement secondaires étaient la qualité de vie du patient autoévaluée, les troubles du comportement (NPI), le fardeau de l'aidant (Zarit), la qualité de vie de l'aidant (échelle NHP) à 6 mois. Nous avons réalisé une analyse en intention de traiter et per protocole dans THERAD. Des analyses en sous-groupes ont été faites pour cibler les sous-populations d'aidants d'intérêt (genre, statut, fardeau). Nous avons aussi caractérisé 153 aidants dans une cohorte de 1711 sujets âgés (> 65 ans) et identifié des facteurs associés à l'entrée en EHPAD dans THERAD à 24 mois, par une analyse multivariée. Nous ne mettons pas en évidence de différence significative sur la qualité de vie du patient rapportée par l'aidant à 2 mois mais une différence significative sur la qualité de vie autodéclarée à 2 mois et 6 mois, sans autres résultats significatifs (art1). Nous retrouvons un effet significatif de l'intervention sur la qualité de vie du patient évaluée par l'aidant à 6 et 12 mois dans le sous-groupes de fardeau élevé > 40 (vs < = 20) et sur la qualité de vie du patient évaluée par l'aidant à 2 mois dans le sous-groupe de fardeau modéré 20-40 (vs < = 20). Il n'y a pas d'autre résultat significatif dans les sous-groupes étudiés (art1). Chez 153 aidants parmi 1711 sujets âgés, l'âge moyen, les comorbidités et le score de fragilité ne sont pas signitifcativement différents entre aidants et non aidants Les hommes sont plus représentés chez les aidants, plus autonomes, avec de meilleures performances physiques, cognitives et nutritionnelles. Une plus importante consommation d'alcool est trouvée chez les aidants (art2). Dans ces dyades, 5 facteurs prédictifs d'entrée en EHPAD ont été trouvés : un haut niveau socio culturel du patient, un fardeau élevé de l'aidant, le statut d'aidant " enfant " et pour le patient, le fait d'être dépendant et une desinhinbition. L'intervention n'est identifiée comme un facteur prédictif. Certains facteurs modifiables pourraient être la cible d'interventions d'ETP ou permettre d'identifier des sous-groupes (aidants enfants) (art3). La qualité de vie du patient n'est pas améliorée par l'ETP, lorsqu'elle est évaluée par l'aidant mais significativement améliorée quand autoévaluée par le patient. Ce résultat souligne l'intérêt d'une double perspective et la nécessité d'efforts méthodologiques limitant les biais.[...]
Article
Resumo Objetivo Estimar o risco representado por condições combinadas de fragilidade e depressão em relação à mortalidade de uma coorte de idosos em medida prospectiva. Método Estudo de coorte prospectivo derivado das medidas de linha de base (2008/2009) e seguimento (2016/2017) do Estudo Fibra - Polo Unicamp. Foram analisados dados de 739 idosos (67,2% feminino; 73,1+5,87 anos) residentes em dois centros urbanos do estado de São Paulo (Brasil) para o exame de curvas de sobrevida e para estimar risco de mortalidade. As análises incluíram quatro condições resultantes da combinação entre depressão (presença x ausência de sintomas) e de fragilidade (frágil x robusto) e as covariáveis sexo, idade, escolaridade, desempenho cognitivo e comorbidades. Resultados A porcentagem de óbitos foi de 25,7%. Houve diferenças significativas entre as curvas de sobrevida referentes às combinações entre fragilidade e depressão. Sexo masculino, idade acima de 75 anos, baixa escolaridade, baixo desempenho cognitivo e as combinações “depressão-robusto”, “depressão-frágil” e “sem depressão-frágil” apresentaram riscos independentes para mortalidade. No modelo multivariado, os maiores riscos foram dados, respectivamente, por idades mais avançadas, as combinações “depressão-robusto”, “depressão-frágil”, “sem depressão-frágil”, sexo masculino e menor desempenho cognitivo. Conclusão Combinações entre fragilidade e depressão podem resultar em diferenças em sobrevida e mortalidade entre idosos. No período de nove anos, depressão revelou ser a variável de ordenação dos grupos em relação às estimativas de risco, mesmo na presença de covariáveis importantes. Investimentos na prevenção de ambas as síndromes e de suas associações podem resultar diminuição na mortalidade de idosos por causas gerais.
Article
Objective To estimate the risk represented by the combined conditions of frailty and depression in relation to mortality in a cohort of older adults in a prospective measure. Method Prospective cohort study derived from baseline (2008/2009) and follow-up (2016/2017) measurements of the FIBRA Study - Polo Unicamp. Data from 739 older adults (67,2% female; 73,1+5.87 years) living in two urban centers in the state of São Paulo (Brazil) were analyzed to examine survival curves and to estimate mortality risk. The analyzes included four conditions resulting from the combination of depression (presence x absence of symptoms) and frailty (frail x robust) and the covariates sex, age, education, cognitive performance and comorbidities. Results The percentage of deaths was 25.7%. There were significant differences between the survival curves regarding the combinations between frailty and depression. Male sex, age over 75 years, low education, low cognitive performance and the combinations “depression-robust”, “depression-frail” and “no depression-frail” presented independent risks for mortality. In the multivariate model, the highest risks were given, respectively, by older ages, the combinations “depression-robust”, “depression-frail”, “no depression-frail”, male sex and lower cognitive performance. Conclusion Combinations between frailty and depression can result in differences in survival and mortality among older adults. In the nine-year period, depression proved to be the ordering variable of the groups in relation to risk estimates, even in the presence of important covariates. Investments in the prevention of both syndromes and their associations may result in a decrease in mortality in older people from general causes.
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Background: Decreased cerebrovascular reactivity, measured as changes in blood-oxygen-level-dependent (BOLD) signal, is a potential new cerebral amyloid angiopathy (CAA) severity marker. Before clinical application, the effect of aging on BOLD parameters, and reproducibility and test-retest reliability of these parameters should be assessed. Purpose: Assess the effect of healthy aging on cerebrovascular reactivity (BOLD amplitude, time to peak, and time to baseline). And determine reproducibility and test-retest reliability of these parameters. Study type: Prospective-observational. Population: Eighty-six healthy adults (mean age 56 years, 55% female), 10 presymptomatic D-CAA mutation carriers (mean age 34 years, 70% female), and 10 symptomatic D-CAA mutation carriers (mean age 54 years, 70% female). Field strength/sequence: 3-T, three-dimensional (3D) T1-weighted MRI and gradient echo BOLD fMRI. Assessment: To assess test-retest reliability of BOLD parameters, i.e. BOLD amplitude, time to peak, and time to baseline, BOLD fMRI scans were repeated three times immediately after each other, in both controls and mutation carriers. To assess reproducibility, BOLD fMRI scans were repeated with a 3-week interval for each subject. Statistical tests: Linear regression analyses and two-way mixed absolute agreement intra-class correlation approach. Results: Healthy aging was associated with decreased BOLD amplitude (β = -0.711) and prolonged time to baseline (β = 0.236) in the visual cortex after visual stimulation Reproducibility of BOLD amplitude was excellent (ICC 0.940) in the subgroup of healthy adults. Test-retest reliability for BOLD amplitude was excellent in healthy adults (ICC 0.856-0.910) and presymptomatic D-CAA mutation carriers (ICC 0.959-0.981). In symptomatic D-CAA mutation carriers, test-retest reliability was poor for all parameters (ICCs < 0.5). Data conclusion: Healthy aging is associated with decreased cerebrovascular reactivity, measured by changes in BOLD response to visual stimulation. The BOLD amplitude appears to be a robust measurement in healthy adults and presymptomatic D-CAA mutation carriers, but not in symptomatic D-CAA mutation carriers.
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Cognitive disorders are common in elderly population and are becoming an increasingly important public health problem, partly because of the rapid aging of the population. This study was conducted to find out the differences between cognitive ability between normal adults and healthy elders of north region. The mild cognitive impairment (MCI) resulting in limitations and delayed treatment of dementia, should be considered an entry point for researching recent changes in the lives of healthy elderly. In this study we have applied MoCA test on the 36 normal healthy elders belonging to high socioeconomic status and normal young adults. Results have shown that there was no significant difference amongst the young normal adults; all the participants had normal MoCA scores. The MoCA scores were significantly impaired in all the healthy elders and there was a significant difference between the normal young adults and healthy elders. Age has a significant influence on MOCA score in older adults. Hence there is a need for age specific stratification in cut-off scores.
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The availability of fast validated screening for dementia is a critical clinical need to improve neurologic examination time efficiency. This study validated a 1-minute timed categorical recall (TCR) method, naming as many US cities as possible and compared TCR to the Folstein Minimental Status Exam (MMSE) as a preliminary cognitive screening tool. Random uncompensated 349 volunteers were recruited ages 18 to 97 from local free clinics, retirement homes, university faculty, and students in Lynchburg, Virginia 2015 to 2020. Participants’ demographic and medical information were collected. After 1 minute preparation, participants were rapidly named as many US cities as possible until they were told to stop (1 minute). The time limitation was withheld in advance. Number of cities and organizational strategies were recorded. Folstein MMSE administration immediately after TCR was administered to 122 subjects recruited in the final 2 study years as a comparison benchmark. A multiple linear regression model and a regression tree model were used to identify important variables for the number of cities named and determine subgroups and their thresholds. TCR resulted in accuracy rate (0.80), sensitivity (0.78), and specificity (0.81). The global TCR threshold (9 cities named) is superseded by 4 subgroup thresholds, categorized by statistically important variables (age, education level, and number of states visited) as follows: For those visiting ≥8 states and 1. 18 to 71 ages with a master’s degree or above, the threshold was naming 20 cities; 2. 18 to 29 ages with a bachelor’s degree or below, the threshold was naming 17 cities; 3. 30 to 71 ages with a bachelor’s degree or below, the threshold was naming 10 cities. For those visiting <8 states or for ages 72 to 97 (regardless of education levels and number of states visited), the threshold was naming 8 cities. American cities are common knowledge across ages and backgrounds, making it a useful bedside screen for dementia. In clinical practice, patients who report fewer cities than the threshold of 9 cities should receive further cognitive testing. If the patient meets the criteria for a subgroup, then the higher subgroup thresholds apply. TCR is a more time-efficient preliminary dementia screening tool with improved sensitivity and similar specificity compared with MMSE.
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Background Prioritizing the maintenance of healthy cognitive aging and personalizing preventive interventions to enhance their effectiveness is crucial as the global population ages. Systemic inflammation and depression in older people have been associated with decreased levels of cognition but results have been inconsistent. Aims To explore the interactive network of inflammation, depression and cognition by sex in older people. Methods We used novel network analysis to explore the unique associations between inflammatory biomarkers, depression, cognition, and somatic, genetic, and lifestyle risk factors in an older (aged 70–90 years), non-demented, community-dwelling sample from the longitudinal Sydney Memory and Aging Study (N = 916) at baseline and at a two-year follow-up. Results The networks of biomarkers, depression, cognition, and relevant covariates were significantly different between males and females. A stable negative link between depression and cognition was found in females only; a stable positive association between biomarker interleukin-6 and depression was found in females only; and a stable positive association between biomarker interleukin-8 and alcohol was found in females only. For both males and females, a stable, positive relationship was found between the presence of APOE-ε4 gene and biomarker C-reactive protein; between education and cognition; and between biomarker interleukin-6 and all other biomarkers. Conclusions These findings suggest different psychophysiological mechanisms underlie the interactive network of biomarkers, depression and cognition in males and females that should be considered when designing personalized preventive interventions to maintain cognitively healthy aging.
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Introduction Ekbom Syndrome (ES) is characterised by fixed, delusional beliefs that one’s body is infested by parasites or other vermin in absence of supporting clinical evidence. Antipsychotic (AP) treatment, including long-acting injectable (LAI) AP in subjects with poor compliance, is prescribed to manage behavioural and psychotic symptomatology. Objectives We describe a 70-year-old woman who was hospitalised after experiencing new-onset delusions of infestation with visual and tactile hallucinations that led to bizarre behaviours and progressive social withdrawal. Methods She was diagnosed with ES and was initially treated with risperidone 3 mg; however, due to poor compliance and a lack of insight, she was switched to LAI palmitate paliperidone (LAI-PP). She was followed up for 8 months, administering Positive and Negative Syndrome Scale, Montreal Cognitive Assessment, Global Assessment of Functioning, Brief Psychiatric Rating Scale, neurocognitive assessment, and neuroimaging. Results After a progressive cognitive deterioration, she was diagnosed with an ES secondary to Lewy body dementia (DLB). Conclusion The LAI-PP treatment determined a complete clinical remission of psychotic symptoms despite the emergence of an iatrogenic akinetic-rigid syndrome. The delay of confirmatory neurological diagnosis, the associated risky behaviours of the patient, and poor treatment adherence led clinicians to prescribe LAI-PP following a good clinical response to oral paliperidone. However, in the case of a suspected DLB diagnosis, the prescription of an LAI-PP as a first-line strategy should be carefully evaluated.
Article
Background: Frailty and sarcopenia are age-associated syndromes that have been associated with the risk of several adverse events, mainly functional decline and death, that usually coexist. However, the potential role of one of them (sarcopenia) in modulating some of those adverse events associated to the other one (frailty) has not been explored. The aim of this work is to assess the role of sarcopenia within the frailty transitions and mortality in older people. Methods: Data from the Toledo Study of Healthy Aging (TSHA) were used. TSHA is a cohort of community-dwelling older adults ≥65. Frailty was assessed according with the Frailty Phenotype (FP) and the Frailty Trait Scale-5 (FTS5) at baseline and at follow-up. Basal sarcopenia status was measured with the standardized Foundation for the National Institutes of Health criteria. Fisher's exact test and logistic regression model were used to determine if sarcopenia modified the transition of frailty states (median follow-up of 2.99 years) and Cox proportional hazard model was used for assessing mortality. Results: There were 1538 participants (74.73 ± 5.73; 45.51% men) included. Transitions from robustness to prefrailty and frailty according to FP were more frequent in sarcopenic than in non-sarcopenic participants (32.37% vs. 15.18%, P ≤ 0.001; 5.76% vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty-to-frailty (12.68% vs. 4.27%; P = 0.0026). Improvement from prefrail-to-robust and remaining robust was more frequent in non-sarcopenic participants (52.56% vs. 33.80%, P ≤ 0.001; 80.18% vs 61.15%, P ≤ 0.001, respectively). When classified by FTS5, this was also the case for the transition from non-frail-to-frail (25.91% vs. 4.47%, P ≤ 0.001) and for remaining stable as non-frail (91.25% vs. 70.98%, P ≤ 0.001). Sarcopenia was associated with an increased risk of progression from robustness-to-prefrailty [odds ratio (OR) 2.34 (95% confidence interval, CI) (1.51, 3.63); P ≤ 0.001], from prefrailty-to-frailty [OR(95% CI) 2.50 (1.08, 5.79); P = 0.033] (FP), and from non-frail-to-frail [OR(95% CI) 4.73 (2.94, 7.62); P-value ≤ 0.001]. Sarcopenia does not seem to modify the risk of death associated with a poor frailty status (hazard ratios (HR, 95%) P > 0.05). Conclusions: Transitions within frailty status, but not the risk of death associated to frailty, are modulated by the presence of sarcopenia.
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Introduction: Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency. Methods: Patients in residential substance use treatment (N = 75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts. Results: Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels. Conclusion: Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.
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Objective: Conducting research in the emergency department (ED) is often complicated by patients' acute and chronic illnesses, which can adversely affect cognition and subsequently capacity to consent for research, especially in older adults. Validated screening tools to assess capacity to consent for research exist, but neither the frequency of use nor which ones are used for ED research are known. Methods: We conducted a scoping review using standard review techniques. Inclusion criteria included (1) randomized controlled trials (RCTs) from publication years 2014-2019 that (2) enrolled participants only in the ED, (3) included patients aged 65+ years, and (4) were fully published in English. Articles were sourced from Embase and screened using Covidence. Results: From 3130 search results, 269 studies passed title/abstract and full text screening. Average of the mean or median ages was 55.7 years (SD 14.2). The mean number of study participants was 311.9 [range 8-10,807 participants]. A few (n = 13, 4.8%) waived or had exception from informed consent. Of the 256 studies requiring consent, a fourth (26.5%, n = 68) specifically excluded patients due to impaired capacity to consent. Only 11 (4.3%) documented a formal capacity screening tool and only 13 (5.1%) reported consent by legally authorized representative (LAR). Conclusions: Most RCTs enrolling older adults in EDs did not report assessment of capacity to consent or use of LARs. This snapshot of informed consent procedures is potentially concerning and suggests that either research consent processes for older patients and/or reporting of consent processes require improvement.
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Background Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of incident cardiovascular events and recurrent stroke. Despite compelling evidence about the efficacy of secondary prevention, a substantial gap exists between risk factor management in real life and that recommended by international guidelines. We conducted the STROKE-CARD trial (NCT02156778), a multifaceted pragmatic disease management program between 2014 and 2018 with follow-up until 2019. This program successfully reduced cardiovascular risk and improved health-related quality of life and functional outcome in patients with acute ischaemic stroke or TIA within 12 months after the index event. To investigate potential long-term effects of STROKE-CARD care compared to standard care, an extension of follow-up is warranted. Methods We aim to include all patients from the STROKE-CARD trial (n = 2149) for long-term follow-up between 2019 and 2021 with the study visit scheduled 3–6 years after the stroke/TIA event. The co-primary endpoint is the composite of major recurrent cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, and vascular death) from hospital discharge until the long-term follow-up visit and health-related quality of life measured with the European Quality of Life-5 Dimensions (EQ-5D-3L) at the final visit. Secondary endpoints include overall mortality, long-term functional outcome, and target-level achievement in risk factor management. Discussion This long-term follow-up will provide evidence on whether the pragmatic post-stroke/TIA intervention program STROKE-CARD is capable of preventing recurrent cardiovascular events and improving quality-of-life in the long run. Trial registration clinicaltrials.gov: NCT04205006 on 19 December 2019.
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With the aging of the population, the number of people with age-related memory complaints has also increased. The purpose of this study was to develop a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies (CRM) and to investigate the effects of CRM in community-dwelling older adults without dementia. This study was an open-label, single-arm, pilot study. We developed a CRM program comprising 8 weekly sessions. The study participants consisted of older adults with normal cognitive function and mild cognitive impairment (MCI). They were recruited from eight dementia counseling centers and one senior welfare center. To assess the effects of CRM, we administered the following tests at baseline and after completion of the program: Subjective Memory Complaints Questionnaire, the Short form of Geriatric Depression Scale, the Euro Quality of life–5 Dimension, and the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery. Thirty-two participants completed the study. Among older adults with normal cognitive function, CRM showed significant improvement in verbal memory function. Among the older adults with MCI, CRM showed significant improvements in language ability, verbal recognition memory, nonverbal memory, attention, and processing speed. CRM improved cognitive function in two distinct populations, older adults with normal cognitive function and older adults with MCI. Additionally, our preliminary findings suggest that older adults with MCI show cognitive improvement in both the trained and non-trained cognitive domains.
Article
The Mini-Mental State Examination (MMSE) was created by Marshal Folstein et al. in 1975 as an instrument for brief (5–10 min) assessment of mental status in hospitalized patients. It is considered the most widely used test for standardized cognitive assessment in the clinical setting, especially with the elderly population. It has countless translations in different languages, and according to the different international (PubMed) and regional (SciELO, Redalyc, and Dialnet) scientific databases, it has been widely used by the scientific community. This article describes the historical evolution of the MMSE, highlights its evaluative properties, and provides bibliometric data on its impact on scientific publications, with a special focus on Ibero-America.
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Introduction: Mild cognitive impairment (MCI) is a neurocognitive state between normal aging and dementia. There is currently no approved treatment for MCI, with acetylcholinesterase inhibitors (AChEI) being the commonly prescribed drugs. The Ginkgo biloba extract EGb 761 is an herbal remedy used for cognitive disorders, including dementia. This study aims to explore the potential synergistic effect of combination therapy with EGb 761 plus AChEI in patients with amnestic MCI in a real-life setting. Methods: We retrospectively identified 133 patients with amnestic MCI who were attending a memory clinic. Patients had received treatment with any of the following drugs: G. biloba extract EGb 761, donepezil, galantamine, or rivastigmine at their standard doses. Subjects were divided into three treatment groups: EGb 761, AChEI, and EGb 761+AChEI. Patients were assessed by Mini-Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), Symbol Digit Modalities Test, Boston Naming Test, Trail Making Test (TMT Parts A and B), Letter and Category Fluency Test (LFT, CFT), Neuropsychiatric Inventory (NPI), and Interview for Deterioration in Daily Living. Mixed-effects model analysis was carried out to evaluate changes in cognitive, functional, and behavioral outcomes over a 12-month follow-up. Results: After 12 months, EGb 761+AChEI showed significant improvement in MMSE, RAVLT, CFT, TMT A-B, and NPI compared to AChEI and in MMSE and RAVLT compared to EGb 761. At 12 months, EGb 761 was superior to AChEI on the CFT, TMT A-B, and NPI. Discussion: Our findings suggest that combined therapy with EGb 761 plus AChEI may provide added cognitive and functional benefits in patients with MCI and provides additional real-world evidence for the combined use of EGb 761 and anti-dementia drugs in patients with MCI. This study can serve as a model for the design of clinical trials that help to support the combined use of EGb 761 and anti-dementia drugs in patients with MCI.
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Objectives Dual sensory impairment (DSI) of hearing and vision in older adults may limit lifestyle activities of daily living and contribute to a reduced life space. This study aimed to investigate how DSI is associated with specific lifestyle activities and predicts changes in mobility in life space. Study design Participants comprised 4214 older adults (52.3 % female, mean age 75.8 years) who met the study's inclusion criteria. The participants were divided into three groups according to the number of sensory impairments: (1) no sensory impairment (NSI), (2) single sensory impairment (SSI), and (3) DSI. Main outcome measure We investigated the association between DSI and specific lifestyle activities at baseline. The Active Mobility Index (AMI) was used to assess life-space. Two years later, the association between DSI and life-space mobility was verified using multinomial logistic regression analysis. Results DSI was more likely to have limited people's instrumental activities of daily living and cognitive, social, and productive activities at baseline (P < 0.05). In the adjusted model with potential covariates, people with DSI had a lower life-space score at 2 years than people with NSI (odds ratio [OR] = 1.40, 95 % confidence interval [CI]: 1.01–1.95), but the difference was not significant for SSI (OR = 0.98, 95 % CI: 0.78–1.24). Conclusions This study suggested that DSI was a factor that limited various activities and narrowed the life-space mobility of older adults. Prevention of DSI may be important for community-dwelling older adults to maintain a more active lifestyle.
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Traditionally, the immune system is understood to be divided into discrete cell types that are identified via surface markers. While some cell type distinctions are no doubt discrete, others may in fact vary on a continum, and even within discrete types, differences in surface marker abundance could have functional implications. Here we propose a new way of looking at immune data, which is by looking directly at the values of the surface markers without dividing the cells into different subtypes. To assess the merit of this approach, we compared it with manual gating using cytometry data from the Singapore Longitudinal Aging Study (SLAS) database. We used two different neural networks (one for each method) to predict the presence of several health conditions. We found that the model built using raw surface marker abundance outperformed the manual gating one and we were able to identify some markers that contributed more to the predictions. This study is intended as a brief proof-of-concept and was not designed to predict health outcomes in an applied setting; nonetheless, it demonstrates that alternative methods to understand the structure of immune variation hold substantial progress.
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statement What is already known about the topic? Literature has clarified that social support and caregiver competence mediate the path relationship between disability severity and home‐based care quality from the perspective of individuals. Long‐term care for disabled older adults affects not only informal caregivers but also the whole family. The role of the family, such as family functioning and family resilience, in the whole process remains unclear. What this paper adds? Findings indicated relationships between disability severity, family functioning, family resilience and home‐based care quality. Disability severity can indirectly influence home‐based care quality not only through family functioning or family resilience but also through family functioning affecting family resilience. The implications of this paper Findings indicate that community nurses should not only pay attention to disabled older adults and their informal caregivers but also consider the impact of family functioning and family resilience when formulating interventions to improve the quality of home‐based care. When disabled older adults are transferred from hospitals to home, community rehabilitation nurses should intervene as early as possible, providing guidance on rehabilitation training and daily living skills for disabled older adults to restore and maintain function and prevent complications. Community nurses can conduct case counselling services for family members to understand and satisfy their care needs, enhancing their confidence, cohesion and problem‐solving abilities to improve the quality of home‐based care.
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Background: The relationship between resting cardiac indices and exercise capacity in older adults was still not well understood. New developments in cardiac magnetic resonance imaging (MRI) enable a much fuller assessment of cardiac characteristics. Purpose/hypothesis: To assess the association between exercise capacity and specific aspects of resting cardiac structure, function, and tissue. Study type: Cross-sectional study. Population: A total of 112 well-functioning older adults (mean age 69 years, 52 men). Field strength/sequence: All participants underwent 3.0 T MRI, using scan protocols including balanced steady-state free precession cine sequence, modified look-locker inversion recovery, and T2-prepared single-shot balanced steady-state free precession. Assessment: Demographic and geriatric characteristics were collected. Blood samples were assayed for lipid and glucose related biomarkers. All participants performed a symptom-limited cardiopulmonary exercise test to achieve peakVO2 . Cardiac MRI parameters were measured with semi-automatic software by S.Y., an 18-year experienced radiologist. Statistical tests: Demographic, geriatric characteristics and MR measurements were compared among quartiles of peakVO2, with different methods according to the data type. Spearman's partial correlation and least absolute shrinkage selection operator regression were performed to select significant MR features associated with peakVO2 . Mediation effect analysis was conducted to test any indirect connection between age and peakVO2 . A two-sided P value of <0.05 was defined statistical significance. Results: Epicardial fat volume, left atrial volume indexed to height, right ventricular end-systolic volume indexed to body surface area and global circumferential strain (GCS) were correlated with peakVO2 (regression coefficients were -0.040, -0.093, 0.127, and 0.408, respectively). Mediation analysis showed that the total effect of peakVO2 change was 43.6% from the change of age. The proportion of indirect effect from epicardial fat volume and GCS were 11.8% and 15.1% in total effect, respectively. Data conclusion: PeakVO2 was associated with epicardial fat volume, left atrial volume, right ventricular volume and GCS of left ventricle. Evidence level: 4 TECHNICAL EFFICACY: Stage 5.
Article
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
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