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Mini-mental state-practical method for grading cognitive state of patients for clinicians
... Thus, neglect may not be unitary but reflect interactions between spatial and non-spatial attentional processes [28,53,[79][80][81]. By extension, attention problems following brain injury may manifest distinctly across individuals in multidimensional trait space [82][83][84], defined here as individual-level behavioural performance patterns across a comprehensive suite of visuospatial attentional metrics. ...
... We recruited clinician controls without brain injury and patients with brain injury from The Rehabilitation and Geriatrics Ward at Logan Hospital in Logan, Australia. Patients were eligible if they were clinically stable, had no history of epilepsy, had no reported visual field problems, had intact mobility of one or both hands, were not strongly susceptible to motion sickness (Simulator Sickness Questionnaire (SSQ) [89] scores < moderate nausea), and had high cognitive functioning on the orientation to time and space questions of Mini-Mental State Examination (scores ≥ 6 out of 10) [84]. Clinician controls were also required to be unsusceptible to motion sickness (SSQ scores < moderate nausea). ...
Background
In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries.
Methods
In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds.
Results
The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients—those with and without neglect.
Conclusion
Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.
... The inclusion criteria were (a) 55-80 years; (b) unilateral internal carotid artery (ICA) stenosis ≥ 70%; (c) right-handed; (d) free of stroke, transient ischemic attack, or dementia; (e) free of functional disability (Modified Rankin Scale (Sulter and Steen et al., 1999) score of 0 or 1). Exclusion criteria were (a) contralateral ICA stenosis ≥ 50%; (b) posterior circulation diseases; (c) Mini-Mental State Examination (MMSE) (Folstein and Folstein et al., 1975) score < 26; (d) functional disability (Modified Rankin Scale ≥ 2); (e) severe systemic diseases and neuropsychiatric diseases; (f) contraindications for MRI; and (g) poorly educated (< 6 years). Meanwhile, we recruited 24 comorbidity-and demographically-matched healthy controls (HCs) ( Table 1). ...
... The neurobehavioral assessments, which have been described previously (Gao and Ruan et al., 2021;Gao and Xiao et al., 2021), include the MMSE (Folstein and Folstein et al., 1975), the Montreal Cognitive Assessment (MoCA) (Nasreddine and Phillips et al., 2005), the Digit Symbol, and the Rey Auditory Verbal Learning Tests, which were performed within 7 days of the MRI scan. These tests measure cognitive domains, including (1) global cognition: the MMSE and MoCA; (2) information processing speed: the Digit Symbol Test; (3) memory and verbal learning ability: the Rey Auditory Verbal Learning Test; (4) verbal memory, forward span, and backward span tests. ...
Advanced carotid stenosis is a known risk factor for ischemic stroke and vascular dementia, and it is associated with multidomain cognitive impairment as well as asymmetric alterations in hemispheric structure and function. Here we introduced a novel measure—the asymmetry index of amplitude of low-frequency fluctuations (ALFF_AI)—derived from resting-state functional magnetic resonance imaging. This measure captures the hemispheric asymmetry of intrinsic brain activity using high-dimensional registration. We aimed to investigate functional brain asymmetric alterations in patients with severe asymptomatic carotid stenosis (SACS). Furthermore, we extended the analyses of ALFF_AI to different frequencies to detect frequency-specific alterations. Finally, we examined the coupling between hemispheric asymmetric structure and function and the relationship between these results and cognitive tests, as well as the white matter hyperintensity burden. SACS patients presented significantly decreased ALFF_AI in several clusters, including the visual, auditory, parahippocampal, Rolandic, and superior parietal regions. At low frequencies (0.01–0.25 Hz), the ALFF_AI exhibited prominent group differences as frequency increased. Further structure-function coupling analysis indicated that SACS patients had lower coupling in the lateral prefrontal, superior medial frontal, middle temporal, superior parietal, and striatum regions but higher coupling in the lateral occipital regions. These findings suggest that, under potential hemodynamic burden, SACS patients demonstrate asymmetric hemispheric configurations of intrinsic activity patterns and a decoupling between structural and functional asymmetries.
... o Alzheimer's Disease Assessment Scale (ADAS), item 11 and 13, and Delayed Word recall (Q4); for assessing the memory, language, and praxis domains with 11 tasks both subject-completed tests and observer-based assessments [51]. o Mini-Mental State Examination (MMSE), 30 questions on orientation, short-term memory retention, attention, short-term recall and language to measure cognitive impairment and stage the severity level [52]. o Rey Auditory Verbal Learning Test (RAVLT), immediate, learning, forgetting and percent forgetting [53]. ...
... Interestingly, the first three important features FDG, ABETA42 and HCI were the same not only in the three global explanations on training set, but also in the local explanation of test set. The feature FDG is the average counting of angular, temporal, and posterior cingulate regions [52] and it is considered as an independent biomarker for AD diagnosis, as demonstrated in a longitudinal study by Ou et al. [69]. Abnormal FDG-PET were found in the 72.82% of pMCI [69], suggesting that subjects with low glucose metabolism have a higher risk to progress to AD as in the present work, where FDG had the highest mean |SHAP| value in local explanation (+ 0.53, Fig. 3B). ...
Random Survival Forests (RSF) has recently showed better performance than statistical survival methods as Cox proportional hazard (CPH) in predicting conversion risk from mild cognitive impairment (MCI) to Alzheimer’s disease (AD). However, RSF application in real-world clinical setting is still limited due to its black-box nature.
For this reason, we aimed at providing a comprehensive study of RSF explainability with SHapley Additive exPlanations (SHAP) on biomarkers of stable and progressive patients (sMCI and pMCI) from Alzheimer’s Disease Neuroimaging Initiative. We evaluated three global explanations—RSF feature importance, permutation importance and SHAP importance—and we quantitatively compared them with Rank-Biased Overlap (RBO). Moreover, we assessed whether multicollinearity among variables may perturb SHAP outcome. Lastly, we stratified pMCI test patients in high, medium and low risk grade, to investigate individual SHAP explanation of one pMCI patient per risk group.
We confirmed that RSF had higher accuracy (0.890) than CPH (0.819), and its stability and robustness was demonstrated by high overlap (RBO > 90%) between feature rankings within first eight features. SHAP local explanations with and without correlated variables had no substantial difference, showing that multicollinearity did not alter the model. FDG, ABETA42 and HCI were the first important features in global explanations, with the highest contribution also in local explanation. FAQ, mPACCdigit, mPACCtrailsB and RAVLT immediate had the highest influence among all clinical and neuropsychological assessments in increasing progression risk, as particularly evident in pMCI patients’ individual explanation. In conclusion, our findings suggest that RSF represents a useful tool to support clinicians in estimating conversion-to-AD risk and that SHAP explainer boosts its clinical utility with intelligible and interpretable individual outcomes that highlights key features associated with AD prognosis.
Graphical Abstract
... Cognitive function was assessed based on a Chinese version [40] of the Mini-Mental State Examination (MMSE) [41], in which the maximum score is 30, and a higher score indicates better cognition. It is divided into 11 items, including: time recognition, place recognition, short-term memory, attention and calculation, memory check of recent things, object names, repeating what others say, understanding what others say, and understanding the meaning of words or pictures, write sentences and draw graphics. ...
... The test-retest reliability was 0.89 and the interrater agreement was 0.83 [40]. Impaired cognition was defined as those who were uneducated and had MMSE scores less than 14, and the educated with scores less than 24 [41]. The internal consistency Cronbach's α was 0.80 in this study. ...
Background
With the rapid aging of the population structure, and the suicide ideation rate also increasing year by year, the ratio of people over 65 to the total number of deaths is increasing yearly. The study provides a reference for researchers interested in older adults’ care to explore SI further affecting older adults in the future and provide a reference for qualitative research methods or interventional measures.
Objective
The objective of this study is to explore the influence of mental health status, life satisfaction, and depression status on suicidal ideation (SI) among hospitalized older adults.
Methods
In a cross-sectional correlation study, taking inpatients over 65 years old in a regional teaching hospital in eastern Taiwan, and the BSRS-5 ≧ 5 points of the screening cases, a total of 228 older adults agree to conduct data analysis in this study. Mainly explore the influence of personal characteristics, mental health status, life satisfaction, and depressed mood on SI among the hospitalized older adults. The basic attributes of the cases used in the data, mental health status, cognitive function, quality of life, depression, and suicide ideation, the data obtained were statistically analyzed with SPSS 20/Windows, and the descriptive statistics were average, standard deviation, percentage, median, etc. In the part of inference statistics, independent sample t-test, single-factor analysis of variance, Pearson performance difference correlation, and logistic regression analysis were used to detect important predictors of SI.
Results
Research results in (1) 89.5% of hospitalized older adults have a tendency to depression. 2.26.3% of the older adults had SI. (2) Here are significant differences in the scores of SI among hospitalized older adults in different economic status groups and marital status groups. (3) The age, marital status, and quality of life of the hospitalized older adults were negatively correlated with SI; economic status, self-conscious health, mental health, and depression were positively correlated with SI. (4) The results of the mental health status and SI is (r = .345, p < .001), higher the score on the BSRS-5 scale, the higher the SI. The correlation between the depression scale score (SDS-SF) and SI was (r = .150, p < .05), the higher the depression scale score, the higher the SI.
Conclusion
The results of the study found that there was a statistically significant correlation between SI in older adults and age, marital status, economic status, mental health, quality of life, and depression, and also showed that they might interact with each other; the older adults in BSRS-5, GDS-SF, quality of life scale scores have statistically significant differences as essential predictors of SI. The results of this study suggest that medical staff can use the BSRS-5 scale to quickly screen and evaluate the mental health status of older adults, hoping to detect early and provide preventive measures, thereby improving the quality of life of older adults.
... 19 Additionally, 76 participants with MCI, diagnosed according to the National Institute on Aging-Alzheimer's Association criteria, 20 and 72 individuals with SCD, as per the guidelines outlined by Jessen et al., 21 were included. The assessment of dementia severity and general cognitive function was conducted using the clinical dementia rating (CDR) 22 and the Korean Mini-Mental State Examination, 2nd edition (K-MMSE-2), 23,24 respectively. Furthermore, we assessed depressive symptoms using the geriatric depression scale (GDS), 25 and cognitive performance across 5 domains (attention, language, visuospatial abilities, memory, and frontal executive functions) using the Seoul Neuropsychological Screening Battery (SNSB), the 2nd edition of SNSB (SNSB-II). ...
Background and Purpose
Facial emotion recognition deficits impact the daily life, particularly of Alzheimer’s disease patients. We aimed to assess these deficits in the following three groups: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and mild Alzheimer’s dementia (AD). Additionally, we explored the associations between facial emotion recognition and cognitive performance.
Methods
We used the Korean version of the Florida Facial Affect Battery (K-FAB) in 72 SCD, 76 MCI, and 76 mild AD subjects. The comparison was conducted using the analysis of covariance (ANCOVA), with adjustments being made for age and sex. The Mini-Mental State Examination (MMSE) was utilized to gauge the overall cognitive status, while the Seoul Neuropsychological Screening Battery (SNSB) was employed to evaluate the performance in the following five cognitive domains: attention, language, visuospatial abilities, memory, and frontal executive functions.
Results
The ANCOVA results showed significant differences in K-FAB subtests 3, 4, and 5 (p=0.001, p=0.003, and p=0.004, respectively), especially for anger and fearful emotions. Recognition of ‘anger’ in the FAB subtest 5 declined from SCD to MCI to mild AD. Correlations were observed with age and education, and after controlling for these factors, MMSE and frontal executive function were associated with FAB tests, particularly in the FAB subtest 5 (r=0.507, p<0.001 and r=−0.288, p=0.026, respectively).
Conclusions
Emotion recognition deficits worsened from SCD to MCI to mild AD, especially for negative emotions. Complex tasks, such as matching, selection, and naming, showed greater deficits, with a connection to cognitive impairment, especially frontal executive dysfunction.
... MMSE consists of 11 questions and tests for orientation to time and place, attention, short-term memory, language skills, visual and spatial relationships between objects, and the ability to understand and follow instructions. There are 30 items, and a score <24 is suggestive of cognitive impairment [12,13]. It is also important to exclude any reversible causes for cognitive impairment such as delirium, major depressive disorder, and any medications that the patient might be taking. ...
Pain in dementia patients is common, poorly measured, and undertreated. It is important to discuss the challenges in the pain assessment and management to find a possible solution for adequate pain management. The aim of this article is to discuss the challenges in the assessment of pain in geriatric patients with dementia. An extensive online database search was conducted via multiple websites using the following keywords: "dementia," "pain assessments," "pain assessment with dementia," "causes of pain with dementia," "pain assessments using recent technology," "geriatric," and "old age" to identify the relevant articles. Our inclusion criteria were articles that focused on pain in geriatric patients diagnosed with dementia, in English, published between January 2018 and January 2023, and available as free full text and those which were clinical trials, observational studies, review articles, systemic reviews, meta-analysis, or case series. The exclusion criteria were articles that did not have pain in geriatric patients diagnosed with dementia as their primary focus, involving geriatric or non-geriatric patients with major psychological distress, not in the English
... Mini-mental State Examination (MMSE) MMSE consists of temporal and spatial localization, word retelling, calculation, language use, comprehension, and basic motor skills [54], which has been the most common method for decades to detect the presence of cognitive decline [55]. It will be performed in the screening phase of the study. ...
Background
Age-related hearing loss (ARHL) signifies the bilateral, symmetrical, sensorineural hearing loss that commonly occurs in elderly individuals. Several studies have suggested a higher risk of dementia among patients diagnosed with ARHL. Although the precise causal association between ARHL and cognitive decline remains unclear, ARHL has been recognized as one of the most significant factors that can be modified to reduce the risk of developing dementia potentially. Mild cognitive impairment (MCI) typically serves as the initial stage in the transition from normal cognitive function to dementia. Consequently, the objective of our randomized controlled trial (RCT) is to further investigate whether the use of hearing aids can enhance cognitive function in older adults diagnosed with ARHL and MCI.
Methods and design
This study is a parallel-arm, randomized controlled trial conducted at multiple centers in Shanghai, China. We aim to enlist a total of 688 older adults (age ≥ 60) diagnosed with moderate-to-severe ARHL and MCI from our four research centers. Participants will be assigned randomly to either the hearing aid fitting group or the health education group using block randomization with varying block sizes. Audiometry, cognitive function assessments, and other relevant data will be collected at baseline, as well as at 6, 12, and 24 months post-intervention by audiologists and trained researchers. The primary outcome of our study is the rate of progression to dementia among the two groups of participants. Additionally, various evaluations will be conducted to measure hearing improvement and changes in cognitive function. Apart from the final study results, we also plan to conduct an interim analysis using data from 12-month follow-up.
Discussion
In recent years, there has been a notable lack of randomized controlled trials (RCTs) investigating the possible causal relationship between hearing fitting and the improvement of cognitive function. Our findings may demonstrate that hearing rehabilitation can be a valuable tool in managing ARHL and preventing cognitive decline, which will contribute to the development of a comprehensive framework for the prevention and control of cognitive decline.
Trial registration
Chinese Clinical Trial Registry chictr.org.cn ChiCTR2000036139. Registered on 21 August 2020.
... ; https://doi.org/10.1101/2023.11.22.23298931 doi: medRxiv preprint State Examination (MMSE) for cognitive function (with a score ranging from 0 to 30; lower scores indicating more severe cognitive dysfunction), 20 and the Patient Health Questionnaire-9 (PHQ-9) consisting of nine questions (with a score ranging from 0 to 27; higher scores indicating the presence of more severe symptoms related to depression) as a screening tool for depression or depressive symptoms 21 were assessed at discharge. All patients were scheduled to undergo blood tests including renal function, plasma brain natriuretic peptide (BNP), lipid profile, and glycosylated hemoglobin (HbA1c) at discharge and 3 months (3M). ...
Background
Outpatient cardiac rehabilitation (CR) is a promising tool for improving functional outcome in stroke survivors, however, evidence for improving emotional health is limited. We aimed to clarify the effects of outpatient CR following in-hospital stroke rehabilitation on health-related quality of life (HRQOL) and motor function.
Methods
Patients with acute ischemic stroke or transient ischemic attack discharged directly home were recruited, and 128 patients (male, 92, mean age,73.5 years) who fulfilled criteria for insurance coverage of CR were divided into the CR (+) group (n=46) and CR (−) group (n=82). All patients underwent in-hospital stroke rehabilitation, and within 2 months after stroke onset, patients in the CR (+) group started a 3-month outpatient CR program of supervised outpatient sessions (1-3 times/week). Changes of motor function and HRQOL assessed by the short form-36 version 2 (SF-36) from discharge to 3 months post-discharge were compared between the two groups.
Results
Twenty-six patients in the CR (+) group completed the program and 66 patients in the CR (−) group were followed up at a 3-month examination. Least-square mean changes in 6-minute walk distance and isometric knee extension muscle strength were significantly higher in the CR (+) group than the CR (−) group (52.6 vs. 16.3 m; 10.1 vs. 3.50 kgf/kg). Improvement of HRQOL at 3 months was not observed in the CR (+) group.
Conclusions
Outpatient CR followed by in-hospital stroke rehabilitation within 2 months after stroke onset improved exercise tolerance and functional strength but not HRQOL after completion of CR.
... Neuropsychological tests were acquired annually to measure functioning across cognitive domains. Global cognitive functioning was assessed with the Mini-Mental State Examination (MMSE) [17]. Two tests for memory were used; verbal memory (immediate recall) using the Dutch version of the Rey Auditory Verbal Learning Test (i.e., 15-word test total score) and episodic memory using the Visual Association Test (VAT) [18]. ...
Background
Previous studies demonstrated increases in diagnostic confidence and change in patient management after amyloid-PET. However, studies investigating longitudinal outcomes over an extended period of time are limited. Therefore, we aimed to investigate clinical outcomes up to 9 years after amyloid-PET to support the clinical validity of the imaging technique.
Methods
We analyzed longitudinal data from 200 patients (Mage = 61.8, 45.5% female, MMMSE = 23.3) suspected of early-onset dementia that underwent [¹⁸F]flutemetamol-PET. Baseline amyloid status was determined through visual read (VR). Information on mortality was available with a mean follow-up of 6.7 years (range = 1.1–9.3). In a subset of 108 patients, longitudinal cognitive scores and clinical etiological diagnosis (eDx) at least 1 year after amyloid-PET acquisition were available (M = 3.06 years, range = 1.00–7.02). VR − and VR + patients were compared on mortality rates with Cox Hazard’s model, prevalence of stable eDx using chi-square test, and longitudinal cognition with linear mixed models. Neuropathological data was available for 4 patients (mean delay = 3.59 ± 1.82 years, range = 1.2–6.3).
Results
At baseline, 184 (92.0%) patients were considered to have dementia. The majority of VR + patients had a primary etiological diagnosis of AD (122/128, 95.3%), while the VR − group consisted mostly of non-AD etiologies, most commonly frontotemporal lobar degeneration (30/72, 40.2%). Overall mortality rate was 48.5% and did not differ between VR − and VR + patients. eDx at follow-up was consistent with baseline diagnosis for 92/108 (85.2%) patients, with most changes observed in VR − cases (VR − = 14/35, 40% vs VR + = 2/73, 2.7%, χ² = 26.03, p < 0.001), who at no time received an AD diagnosis. VR + patients declined faster than VR − patients based on MMSE (β = − 1.17, p = 0.004), episodic memory (β = − 0.78, p = 0.003), fluency (β = − 1.44, p < 0.001), and attention scores (β = 16.76, p = 0.03). Amyloid-PET assessment was in line with post-mortem confirmation in all cases; two cases were VR + and showed widespread AD pathology, while the other two cases were VR − and showed limited amyloid pathology.
Conclusion
In a symptomatic population, we observed that amyloid-status did not impact mortality rates, but is predictive of cognitive functioning over time across several domains. Also, we show particular validity for a negative amyloid-PET assessment, as these patients did not receive an AD diagnosis at follow-up.
... (2) MMSE. An assessment tool to reflect the subjects' mental state and the degree of cognitive impairment [23]. The total score ranges from 0-30 points. ...
Background: One of the most popular ways to address cognitive decline is cognitive training. The fact that cognitive deterioration is permanent is one of the main issues. This issue might be resolved by preventive cognitive training when it is acute. As a result, this study aims to design and assess how well stroke patients respond to hierarchical, multi-dimensional preventative cognitive training. Objective: To describe the study design of this center implementation trial. Methods: Participants in the study will be recruited from a hospital in China and randomly assigned to the intervention group or the usual care group. Interventions will include four-week hierarchical multi-dimensional preventive cognitive training through a WeChat program. for Primary outcome measures will be the Montreal Cognitive Assessment, Mini-Mental State Examination, and Post-Stroke Cognitive Impairment (PSCI) Incidence. The secondary outcome measure will include the Hamilton Depression Scale, Hamilton Anxiety Scale, Modified Barthel Index, and National Institutes of Health Neurological Deficit Score. Outcomes will be measured at baseline, 12 weeks, and 24 weeks from the baseline. Results: We expect that the hierarchical multi-dimensional preventive cognitive training program will be easy to implement, and the cognitive function, cognitive psychology, ability of daily living will vary in each setting. Conclusions: The results will provide evidence highlighting differences in a new strategy of cognitive training through the WeChat program, which allows the home-based practice, puts forward an advanced idea of preventive cognitive training in the acute stage, and has the highest effectiveness of reducing cognitive impairment, and Alzheimer’s disease.
... Evaluación neurocognitiva de pacientes. Se administraron las pruebas de screening Mini-Mental State Examination (MMSE; Butman et al., 2001;Folstein et al., 1975) y Clock Drawing Test (CDT; Freedman et al., 1994). ...
Los estímulos emocionales son mejor recordados que los neutros. La música genera activación emocional y se utiliza para modular los recuerdos en adultos jóvenes y mayores. Los estudios muestran que en pacientes con demencia tipo alzhéimer (DTA) la música mejora la codificación de palabras y recuperación de recuerdos autobiográficos. Pocos estudios utilizaron la música como tratamiento postaprendizaje y mostraron disminución de falsos positivos en el reconocimiento. El objetivo del presente trabajo es estudiar la modulación de la memoria a través de la música en pacientes con DTA. Se evaluaron 75 pacientes con DTA. Observaron imágenes emocionales y neutras, y luego se les aplicó un tratamiento: música activante, relajante o ruido blanco. Luego, evocaron las imágenes que recordaban, seguido de una tarea de reconocimiento. Esto último se repitió una semana después (recuerdo diferido). Los resultados indicaron una disminución de falsos positivos en el reconocimiento diferido en el grupo expuesto a la música activante. En conclusión, la música es capaz de modular los recuerdos en pacientes con DTA. Esta modulación difiere de lo que sucede en otras poblaciones, lo cual podría deberse a las diferencias anatómicas. Los resultados apoyan la utilización de la música como posible tratamiento para la consolidación de la memoria.
... The cognitive state of the study population was assessed using MMSE [28] at baseline. The MCI patients were followed up for a median of 58 (± 12.5) months to assess their progression to AD. ...
Genetic, metabolic, and clinical evidence links lipid dysregulation to an increased risk of Alzheimer’s disease (AD). However, the role of lipids in the pathophysiological processes of AD and its clinical progression is unclear. We investigated the association between cerebrospinal fluid (CSF) lipidome and the pathological hallmarks of AD, progression from mild cognitive impairment (MCI) to AD, and the rate of cognitive decline in MCI patients. The CSF lipidome was analyzed by liquid chromatography coupled to mass spectrometry in an LC-ESI-QTOF-MS/MS platform for 209 participants: 91 AD, 92 MCI, and 26 control participants. The MCI patients were followed up for a median of 58 (± 12.5) months to evaluate their clinical progression to AD. Forty-eight (52.2%) MCI patients progressed to AD during follow-up. We found that higher CSF levels of hexacosanoic acid and ceramide Cer(d38:4) were associated with an increased risk of amyloid beta 42 (Aβ42) positivity in CSF, while levels of phosphatidylethanolamine PE(40:0) were associated with a reduced risk. Higher CSF levels of sphingomyelin SM(30:1) were positively associated with pathological levels of phosphorylated tau in CSF. Cholesteryl ester CE(11D3:1) and an unknown lipid were recognized as the most associated lipid species with MCI to AD progression. Furthermore, TG(O-52:2) was identified as the lipid most strongly associated with the rate of progression. Our results indicate the involvement of membrane and intracellular neutral lipids in the pathophysiological processes of AD and the progression from MCI to AD dementia. Therefore, CSF neutral lipids can be used as potential prognostic markers for AD.
... (a) we excluded individuals with type 2 diabetes to assess whether they drive the observed associations; (b) we adjusted for antidepressant medication use; (c) we excluded participants who used antidepressant medication; (d) to restrict analyses to 'de novo' depression, we excluded participants who had a history of major depressive disorder diagnosis (assessed through the Mini-International Neuropsychiatric Interview 25 ) before baseline; (e) we additionally adjusted for cognitive status using Mini-Mental State Examination score. 26 Finally, we tested whether these associations differed according to gender, and T2DM status, by use of interaction analyses. All statistical analyses were performed in R 4.0.2 ...
Background
Late-life depression has been associated with volume changes of the hippocampus. However, little is known about its association with specific hippocampal subfields over time.
AimsWe investigated whether hippocampal subfield volumes were associated with prevalence, course and incidence of depressive symptoms.
Method
We extracted 12 hippocampal subfield volumes per hemisphere with FreeSurfer v6.0 using T1-weighted and fluid-attenuated inversion recovery 3T magnetic resonance images. Depressive symptoms were assessed at baseline and annually over 7 years of follow-up (9-item Patient Health Questionnaire). We used negative binominal, logistic, and Cox regression analyses, corrected for multiple comparisons, and adjusted for demographic, cardiovascular and lifestyle factors.
ResultsA total of n = 4174 participants were included (mean age 60.0 years, s.d. = 8.6, 51.8% female). Larger right hippocampal fissure volume was associated with prevalent depressive symptoms (odds ratio (OR) = 1.26, 95% CI 1.08–1.48). Larger bilateral hippocampal fissure (OR = 1.37–1.40, 95% CI 1.14–1.71), larger right molecular layer (OR = 1.51, 95% CI 1.14–2.00) and smaller right cornu ammonis (CA)3 volumes (OR = 0.61, 95% CI 0.48–0.79) were associated with prevalent depressive symptoms with a chronic course. No associations of hippocampal subfield volumes with incident depressive symptoms were found. Yet, lower left hippocampal amygdala transition area (HATA) volume was associated with incident depressive symptoms with chronic course (hazard ratio = 0.70, 95% CI 0.55–0.89).
Conclusions
Differences in hippocampal fissure, molecular layer and CA volumes might co-occur or follow the onset of depressive symptoms, in particular with a chronic course. Smaller HATA was associated with an increased risk of incident (chronic) depression. Our results could capture a biological foundation for the development of chronic depressive symptoms, and stresses the need to discriminate subtypes of depression to unravel its biological underpinnings.
... At each cycle, during the in-home interview, 4 performance of cognitive functioning tests were conducted, consisting of 2 measures of episodic memory: immediate and delayed recall of 12 ideas contained in the East Boston Story, 17,18 one measure of perceptual speed 19,20 : the oral form of the Symbol Digit Modalities Test, 21 and the Mini-Mental State Examination, 22 a widely used 30-item measure of global cognition. In a previous principal components analysis, all tests had loadings of 0.79 or more on a single factor accounting for 74% of the variance. ...
Objective
To examine the association of whole grain consumption and longitudinal change in global cognition, perceptual speed, and episodic memory by different race/ethnicity.
Methods
We included 3,326 participants from the Chicago Health and Aging Project who responded to a Food Frequency Questionnaire (FFQ), with two or more cognitive assessments. Global cognition was assessed using a composite score of episodic memory, perceptual speed, and the MMSE. Diet was assessed by a 144-item FFQ. Linear mixed effects models were used to estimate the association of intakes of whole grains and cognitive decline.
Results
The study involved 3,326 participants (60.1% African American [AA], 63.7% females) with mean age of 75 years at baseline with a mean follow-up of 6.1 years. Higher consumption of whole grains was associated with a slower rate of global cognitive decline. Among AA participants, those in the highest quintile of whole grain consumption had a slower rate of decline in global cognition [β = 0.024, 95% CI: (0.008-0.039), P =0.004], perceptual speed [β = 0.023, 95% CI: (0.007, 0.040), P =0.005], and episodic memory [β = 0.028, 95% CI: (0.005, 0.050), p =0.01] compared to those on the lowest quintile, respectively.
Regarding the amount consumed, in AA participants, those who consumed >3 servings/d versus those who consumed < 1 serving/d, had a slower rate of decline in global cognition [β = 0.021, 95% CI: (0.005, 0.036), p =0.0093]. In White participants, with >3 servings/d, we found a suggestive association of whole grains with global cognitive decline when compared to those who consumed <1 serving/d [β = 0.025, 95% CI: (-0.003, 0.053), P =0.08].
Conclusions
Among AA participants, individuals with higher consumption of whole grains and more frequent consumption of whole grain had slower decline in global cognition, perceptual speed, and episodic memory. We did not see a similar trend in White adults.
... As described below, all patients in the clinic are assessed with cognitive screening tests as part of the basic diagnostic assessment. One of the criteria for referral to more comprehensive neuropsychological evaluation (approximately 2 hours) in the clinic is a Mini-Mental State Examination (MMSE; Folstein et al., 1975) or Rowland Universal Dementia Assessment Scale (RUDAS; Storey et al., 2004) score ≥ 22 at the initial visit in the clinic, but patients with lower MMSE or RUDAS scores may also be referred if necessary (e.g., in the case of patients with aphasia). In total, 169 patients who completed both the Copenhagen Cross-Linguistic Naming test (C-CLNT) and BNT were included in the study. ...
Objective
Despite recent advances in cross-cultural neuropsychological test development, suitable tests for cross-linguistic assessment of language functions are not widely available. The aims of this study were to develop and validate a brief naming test, the Copenhagen Cross-Linguistic Naming Test (C-CLNT), for the assessment of culturally, linguistically, and educationally diverse older adult populations in Europe.
Method
The C-CLNT was based on a set of standardized color drawings. Items for the C-CLNT were selected by considering name agreement and frequency across five European and two non-European languages. Ambiguities in some of the selected items and scoring criteria were resolved after pilot testing in 10 memory clinic patients. The final 30-item C-CLNT was validated by verifying its psychometric properties in 24 controls and 162 diverse memory clinic patients with affective disorder, mild cognitive impairment, and with dementia.
Results
The C-CLNT had acceptable scale reliability (coefficient alpha = .67) and good construct validity, with moderate to strong correlations with traditional language tests ( r = .42– .75). Diagnostic accuracy for dementia was good and significantly better than that of the Boston Naming Test (areas under the curve of .80 vs .64, p < .001), but was poor for mild cognitive impairment. Only 3% of the variance in C-CLNT test scores was explained by immigrant background, while 6% was explained by age and years of education. In comparison, these proportions were 34 and 22% for the BNT.
Conclusions
The C-CLNT has promising clinical utility for cross-linguistic assessment of naming impairment in culturally, linguistically, and educationally diverse older adults.
... El MMSE fue desarrollado por Marshall Folstein en 1975, con el objeto de contar con una herramienta portátil, rápida y fácil de aplicar para la evaluación cognitiva multifuncional (13). La puntuación entre 30 y 27 puntos evidencia que no existe deterioro cognitivo; entre 26 y 25 puntos, que existen dudas o pudiera existir un posible deterioro cognitivo; entre 24 y 10 puntos, que existe un deterioro cognitivo de leve a moderado; y entre 9 y 6 puntos, un deterioro cognitivo de moderado a severo (14). ...
Con el presente caso se busca incrementar la funcionalidad del miembro superior izquierdo durante el desempeño de actividades básicas de la vida diaria. El proceso de intervención en terapia ocupacional se basó en marcos y modelos propios de la profesión para el proceso de rehabilitación: marco del neurodesarrollo, método Brunnstrom y método Bobath. Adicionalmente, se incluyó el uso del kinesiotaping durante la realización de actividades funcionales para mejorar el desempeño en las actividades básicas de la vida diaria del paciente. Asimismo, se utilizaron evaluaciones para medir el progreso en el desempeño ocupacional del paciente: el índice de Barthel, escala de Lawton y Brody, Mini Mental State Examination de Folstein. Los estímulos propioceptivos y el uso del kinesiotaping contribuyeron en el proceso de rehabilitación, que evidenciaron un mejor desempeño ocupacional del paciente. El tratamiento de terapia ocupacional, usando los marcos y modelos con base en neurorrehabilitación, ofrece resultados favorables en la recuperación del movimiento voluntario en el paciente postaccidente cerebrovascular.
... Prediction models play a significant role in clinical settings by categorising individuals based on their risk levels for targeted interventions. The main motive for using such algorithms is connected to a human's restricted ability to cope with vast volumes of information and various attributes in a dataset [3]. Despite the variety of existing models in the literature, their overall accuracy remains low, due to the limited size of data used in studies and the often lack external validity. ...
This study uses a large dataset from the UK Biobank to understand the link between cardiovascular diseases (CVDs) and increased risk of dementia. We analysed a dataset of over half a million patients. Data included 16043 variables on demographics, health status and genetic information. To the best of our knowledge, this is the largest study conducted with the UK population. To address the complexity and size of the data, we have developed a pipeline focused on data unpacking, prepro-cessing, descriptive and predictive analysis, and interpretation. Using post-training interpretation techniques, the study identified the top 40 variables to predict risk of dementia in people with CVD. For our predictive models, we employed support vector machines, logistic regression and random forest classifiers. The study revealed a strong correlation between CVD and dementia in the UK Biobank cohort, highlighting that individuals with CVD are at an elevated risk of developing dementia, indicated by a higher recall score of 0.89, in comparison to the overall population recall score of 0.82 for dementia.
... Individuals attended the neuropsychological testing session approximately one week after the first session. A psychologist or a trained advanced psychology student applied the following neuropsychological tests: (a) MMSE [25], (b) Logical Memory [26], (c) Category fluency [27], (d) Trail Making Test [28], (e) Digit Symbol Substitution Test [13], (f) Boston Naming Test [29], (g) Block Design [26], (h) Stroop Test [30], (i) Free and Cued Selective Reminding Test [31], (j) Crossing Off [32], (k) Letter Number Sequencing [26], (l) Digit Span Test [26], (m) Hidden Patterns [33], and (n) Identical Pictures [33]. After the neuropsychological evaluation, an exercise scientist carried out the remaining physical measure; a body composition assessment using a dual-energy X-ray absorptiometer (DXA) General Electric™, model Lunar Prodigy Advance (GE Medical Systems Lunar, Madison, WI), with the enCORE 2011 software version 13,60,033. ...
Background
Valid and reliable measurements are necessary to understand and monitor age-related changes.
Aims
To describe the factor structure and provide validity evidence of a neuropsychological and a physical testing batteries using factor analysis.
Methods
We performed a secondary analysis of data from the Epidemiology and Development of Alzheimer’s Disease (EDAD) project. Community-dwelling adults aged 55 to 85 years underwent comprehensive physical and neuropsychological assessments. An exploratory factor analysis was performed on both assessment batteries. The models were later confirmed with a random subsample using confirmatory factor analysis.
Results
Data from 238 adults (163 females and 75 males) was included. The neuropsychological model revealed a four-factor structure formed by “Executive Functioning”, “Verbal Memory”, “Logical Memory”, and “Labeling And Reading” (Extraction Sums of Squared Loadings [ESSL] = 56.41% explained variance; Standardized Root Mean Square Residual [SRMSR] = 0.06; Comparative Fit Index [CFI] = 0.98). The physical model was formed by a two-factor structure including “Health-related Fitness and “Functional Fitness” (ESSL = 50.54% explained variance; SRMSR = 0.07; CFI = 0.93).
Discussion
To our knowledge, this is the first study to analyze the structure of comprehensive testing batteries for the Latin-American older adults. Our analysis contributes to the understanding of theoretical constructs that are evaluated in the EDAD project.
Conclusion
Our findings provide validity evidence for simplified and reduced testing batteries, which imply shorter testing times and fewer resources.
... The patients were classified using the Global Deterioration Scale (GDS), in which GDS 4 equals possible mild dementia and GDS 1 equals no subjective or objective cognitive decline [25]. The classification into GDS groups were based on medical history, checklists, and instruments for cognitive symptoms [6]: 1) Stepwise Comparative Status Analysis (STEP) variables 13-20 [26]; 2) I-FLEX, a short form of the Executive Interview (EXIT) [27]; 3) MMSE [28]; and 4) Clinical Dementia Rating (CDR) [29]. Guidelines for GDS 4 was: STEP > 1, I-FLEX > 3, CDR > 1.0, and MMSE ≤ 25. ...
Background: The subcortical small vessel type of dementia (SSVD) is a common subtype of vascular dementia, but there is a lack of disease-specific cerebrospinal fluid (CSF) biomarkers. Objective: We investigated whether CSF concentrations of neurofilament light chain (NFL), soluble amyloid-β protein precursor α (sAβPPα), sAβPPβ, and CSF/serum albumin ratio could separate SSVD from healthy controls, Alzheimer’s disease (AD), and mixed dementia (combined AD and SSVD). Methods: This was a mono-center study of patients with SSVD (n = 38), AD (n = 121), mixed dementia (n = 62), and controls (n = 96). The CSF biomarkers were measured using immunoassays, and their independent contribution to the separation between groups were evaluated using the Wald test. Then, the area under the receiver operating characteristics curve (AUROC) and 95% confidence intervals (CIs) were calculated. Results: Elevated neurofilament light chain (NFL) and decreased sAβPPβ independently separated SSVD from controls, and sAβPPβ also distinguished SSVD from AD and mixed dementia. The combination of NFL and sAβPPβ discriminated SSVD from controls with high accuracy (AUROC 0.903, 95% CI: 0.834–0.972). Additionally, sAβPPβ combined with the core AD biomarkers (amyloid-β42, total tau, and phosphorylated tau181) had a high ability to separate SSVD from AD (AUROC 0.886, 95% CI: 0.830–0.942) and mixed dementia (AUROC 0.903, 95% CI: 0.838–0.968). Conclusions: The high accuracy of NFL and sAβPPβ to separate SSVD from controls supports that SSVD is a specific diagnostic entity. Moreover, SSVD was distinguished from AD and mixed dementia using sAβPPβ in combination with the core AD biomarkers.
... We anticipate a diversity of diagnostic criteria being used across the included studies, which may encompass the following: (a) the Frascati criteria (≥ 1 SD below the mean of normative test scores in ≥ 2 neurocognitive domains [8]); (b) the Gisslén criteria (≥ 1.5 SD below the mean of normative test scores [29]); (c) the global deficit score (the average of reclassified T scores on a 0 to 5 scale for all assessed neurocognitive domains, with a cut-off score exceeding 0.5 to delineate impairment [30]); (d) clinical rating scale (reclassified T scores on a 1 to 9 scale, with scores exceeding 5 in ≥ 2 domains to evidence impairment [30]); (e) multivariate normative comparisons (use of multivariate statistics to construct and compare profiles of test scores [31]); and (f ) various cut-off criteria of instrument-specific screening analogues (e.g. Cogstate [32], International HIV Dementia Scale [33], Mini Mental State Examination [34], or Montreal Cognitive Assessment [35]). ...
Background
Chronic HIV infection significantly elevates the risk of brain pathology, precipitating neurocognitive impairment (NCI) among people living with HIV (PLWH). The diagnosis of NCI in PLWH hinges on evaluating deviations in neuropsychological test performance in comparison to HIV-seronegative normative controls. However, the adverse psychosocial conditions experienced by PLWH can also result in reduced test performance, potentially confounding the accurate NCI attribution to HIV infection. This planned systematic review aims to investigate potential disparities in the excess burden of NCI among PLWH in two groups of studies: (a) studies enrolling controls who shared a similar mode of HIV exposure (MoHE) with the PLWH participants (MoHE-adjusted) and (b) studies enrolling normative controls or controls without undefined MoHE (MoHE-naive).
Methods
We will systematically search five electronic databases (MEDLINE, Embase, PsycINFO, Web of Science, ProQuest) and registries (OpenGrey, ClinicalTrials.gov, ISRCTN registry). Studies reporting NCI in PLWH and HIV-seronegative controls with cross-sectional or baseline measurements, published from January 2007 to September 2023, will be included. To be classified as MoHE adjusted, a study must evidence ≥ 90% enrolment of both PLWH and their seronegative controls from the same MoHE group (e.g. men who have sex with men, people who use drugs or alcohol). Reports of test performance scores will be transformed into NCI proportions using simulated score distributions, applying a global deficit score cut-off ≥ 0.5 to estimate NCI cases.
The Newcastle–Ottawa scale adapted to the purpose of the review will be used to appraise study quality. Random-effects meta-analysis will be used to pool the excess burden of NCI in prevalence ratios and test the difference between MoHE-adjusted and MoHE-naive studies. Furthermore, subgroup analyses and meta-regression will be undertaken across categorical study-level covariates (e.g. study locations, NCI diagnostic criteria) and continuous/ordinal covariates (nadir CD4, number of neurocognitive domains assessed), respectively.
Discussion
This systematic review will contribute towards a greater appreciation of the unique psychosocial conditions of PLWH that are missing from the current case definition of HIV-associated neurocognitive disorder. The findings will additionally highlight possible disparities in the distribution of the excess burden of NCI by MoHE groups, thereby guiding the prioritization of mitigation efforts.
Systematic review registration
PROSPERO CRD42021271358
... Background neuropsychological assessment -General cognitive function assessment: For general cognitive function we used the Mini Mental State Examination (MMSE) (12,(18)(19)(20) and the Montreal Cognitive Assessment (MoCA) (13,21). Both tests are adequately adapted and validated for the Portuguese population with the MoCA been speci cally validated for FTD (22) and for AD (23). ...
Introduction
Emotional perception has been described as the capacity which enables humans to correctly identify cues that guide interpersonal interaction, forming the basis for social behavior. The parahippocampal cortex seems to be a key player in mediating the association between context and emotion, thus helping perceiving emotions in others. Behavioral Variant Frontotemporal Dementia (bvFTD) and Alzheimer’s Disease (AD) patients appear to exhibit deficits in this process. Studying how emotion perception is impaired in these patients may provide insights into social cognition mechanisms, emphasizing the parahippocampal role in social behavior.
Methods
We have included convenience samples of 29 bvFTD, 25 AD and 15 controls. Extensive[IS1] [RM2] neuropsychological assessment was performed, complemented with the Comprehensive Affect Testing System (CATS) thus enabling a nuanced evaluation of emotion perception process. Multiple regression analysis was used to assess the relation between CATS main quotients scores and parahippocampal thickness (p £ 0,001).
Results
BvFTD patients obtained higher scores in cognitive tests than AD but had a more severe deficit in social behavior. Interestingly, the bvFTD group revealed a significant deficit in all three emotional quotients (face, prosody and global) evaluated by the CATS battery, with a statistically significant relation with parahippocampal thickness.
AD group displayed milder deficits in all three emotion quotients, although facial emotion recognition deficits were close to reaching statistical significance.
Conclusion
Our data suggest a profound emotion perception deficit in bvFTD, supporting the pivotal role of the parahippocampal gyrus in context associations. Targeted rehabilitation with the objective of reducing these emotion deficits might be valuable.
... In addition, information on personal medical history, medication use, smoking, current and past alcohol use is collected along with family history of dementia and other neurological illnesses. The Mini Mental State Examination (MMSE) (Folstein et al., 1975) is conducted to assess sufficient mental health to be part of the cohort. ...
Background
Neurocognitive aging and the associated brain diseases impose a major social and economic burden. Therefore, substantial efforts have been put into revealing the lifestyle, neurobiological and genetic underpinnings of healthy neurocognitive aging. However, these studies take place almost exclusively in a limited number of highly-developed countries. Thus, it is an important open question to what extent their findings may generalize to neurocognitive aging in other, not yet investigated regions.
Purpose
The purpose of the Hungarian Longitudinal Study of Healthy Brain Aging (HuBA) is to collect multi-modal longitudinal data on healthy neurocognitive aging to address the data gap in this field in Central and Eastern Europe.
Methods
We adapted the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging study protocol to local circumstances and will collect demographic, lifestyle, mental and physical health, medication and medical history related information as well as record a series of magnetic resonance imaging (MRI) data. In addition, participants will also be offered to participate in the collection of blood samples to assess circulating inflammatory biomarkers as well as a sleep study aimed at evaluating the general sleep quality based on multi-day collection of subjective sleep questionnaires and whole-night electroencephalographic (EEG) data.
Results & Discussion
Data collection will be longitudinal with 18 months between measurements and at least three sessions are intended. The collected data might reveal specific local trends or could also indicate the generalizability of previous findings. Moreover, as the HuBA protocol also offers a sleep study designed for thorough characterization of participants' sleep quality and related factors, our extended multi-modal dataset might provide a base for incorporating these measures into healthy and clinical aging research.
Conclusion
Besides its straightforward national benefits in terms of health expenditure, we hope that this Hungarian initiative could provide results valid for the whole Central and Eastern European region and could also promote aging and Alzheimer's disease research in these countries.
... Клиническое обследование включало сбор анамнестических данных, неврологический осмотр с детальной оценкой статики и локомоции (шкала Тинетти [27]), нейропсихологическое тестирование (MMSE [13], CDR [17], луриевские тесты [4], исследование памяти TIME-test [25]), оценку нарушения активности в повседневной жизни (шкала BADL [7]). Пациентам проводили магнитно-резонансную (МРТ) или компьютерную (КТ) томографию головного мозга. ...
Вивчали латентність та амплітуду слухового викликаного потенціалу Р300 в 11 осіб похилого та старечого віку без когнітивних порушень (БКП), середній вік – (70,73 ± 4,24) року, у 20 хворих з субкортикальним судинним легким когнітивним порушенням (ССЛКП), середній вік – (75,35 ± 5,48) року та у 20 пацієнтів із субкортикальною судинною деменцією (ССД), середній вік – (75,80 ± 6,51) року. Встановлено, що величина латентності хвилі Р300 достовірно збільшується на етапах розвитку ССД у пацієнтів похилого та старечого віку. Середні значення даного показника в групі БКП становили (341,09 ± 107,70) мс, у хворих із ССЛКП – (655,70 ± 87,08) мс, у хворих із ССД – (732,45 ± 74,64) мс. За даним показником можна диференціювати пацієнтів із ССЛКП й осіб БКП, хворих із ССД і ССЛКП. Збільшення латентності Р300 пов’язане з тяжкістю та специфікою когнітивного дефіциту етапів розвитку ССД, відображаючи прогресуюче погіршення функції уваги, оперативної пам’яті, наростання кінетичної та регуляторної апраксії.
... BPRS subscales were derived according to the model proposed by Velligan and colleagues (Velligan et al., 2005). Moreover, according to our usual clinical routine, Mini-Mental State Examination (MMSE) was also administered (Folstein et al., 1975), whenever possible, at baseline and at follow-up approximately every 4 to 6 months to monitor cognitive impairments. ...
Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up ( P < 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI ( P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI ( P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement.
... Participants were followed at 6-12 monthly intervals for 5 years. Clinical dementia rating (CDR) [23], mini-mental state examination (MMSE) [24], Neuropsychiatric Inventory-Clinician (NPI-C) [25], Instrumental Activities in Daily Living Scale (IADL) [26], and HR-QoL [11] information were collected at baseline and each follow-up visit. Cerebrospinal fluid (CSF) examination and positron emission tomography (PET) scans are optional in this cohort. ...
Background
Health-related quality of life (HR-QoL) is an important outcome for patients and crucial for demonstrating the value of new treatments. Health utility estimates in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are limited, especially in biomarker-confirmed populations. Besides, little is known about the longitudinal HR-QoL trajectory. This study aims to provide health utility estimates for SCD and MCI and investigate the QoL trajectory along the disease continuum.
Methods
Longitudinal data from 919 SCD and 1336 MCI patients from the MEMENTO cohort were included. SCD was defined as clinical dementia rating (CDR) = 0, and MCI as CDR = 0.5. HR-QoL was measured using the EQ-5D-3L patient-reported instrument. Linear mixed-effect models (LMM) were used to assess the longitudinal change in HR-QoL and identify predictors of these changes.
Results
Baseline health utilities were 0.84 ± 0.16 and 0.81 ± 0.18, and visual analogue scale (VAS) were 75.8 ± 14.82 and 70.26 ± 15.77 in SCD and MCI. In amyloid-confirmed cases, health utilities were 0.85 ± 0.14 and 0.86 ± 0.12 in amyloid-negative and amyloid-positive SCD, and 0.83 ± 0.17 and 0.84 ± 0.16 in amyloid-negative and amyloid-positive MCI. LMM revealed an annual decline in health utility of − 0.015 (SE = 0.006) and − 0.09 (SE = 0.04) in moderate and severe dementia (P < 0.05). There was a negative association between clinical stage and VAS where individuals with MCI, mild, moderate, and severe dementia were on average 1.695 (SE = 0.274), 4.401 (SE = 0.676), 4.999 (SE = 0.8), and 15.386 (SE = 3.142) VAS points lower than individuals with SCD (P < 0.001). Older age, female sex, higher body mass index, diabetes, cardiovascular history, depression, and functional impairment were associated with poor HR-QoL. Amyloid positivity was associated with an annual decline of − 0.011 (SE = 0.004, P < 0.05) health utility over time.
Conclusions
Health utility estimates from this study can be used in economic evaluations of interventions targeting SCD and MCI. Health utility declines over time in moderate and severe dementia, and VAS declines with advancing clinical stages. Amyloid-positive patients show a faster decline in health utility indicating the importance of considering biomarker status in HR-QoL assessments. Future research is needed to confirm the longitudinal relationship between amyloid status and HR-QoL and to examine the level at which depression and IADL contribute to HR-QoL decline in AD.
... One hundred healthy subjects (HCs) were recruited and screened for eligibility. Prior to their participation in the study, people underwent a brief neuropsychological assessment using the Mini-Mental State Examination (MMSE) [44] and Raven's Colored Progressive Matrices [45] tests. The MMSE test consists of a 30-point questionnaire that takes from 5 to 10 min, and it examines people's functionalities, including orientation, attention, memory, language, and visual-spatial skills. ...
People's acceptance and trust in robots are a direct consequence of people's ability to infer and predict the robot's behavior. However, there is no clear consensus on how the legibility of a robot's behavior and explanations should be assessed. In this work, the construct of the Theory of Mind (i.e., the ability to attribute mental states to others) is taken into account and a computerized version of the theory of mind picture sequencing task is presented. Our tool, called the human–robot interaction (HRI) video sequencing task (HRIVST), evaluates the legibility of a robot's behavior toward humans by asking them to order short videos to form a logical sequence of the robot's actions. To validate the proposed metrics, we recruited a sample of 86 healthy subjects. Results showed that the HRIVST has good psychometric properties and is a valuable tool for assessing the legibility of robot behaviors. We also evaluated the effects of symbolic explanations, the presence of a person during the interaction, and the humanoid appearance. Results showed that the interaction condition had no effect on the legibility of the robot's behavior. In contrast, the combination of humanoid robots and explanations seems to result in a better performance of the task.
... All participants (including healthy, PwPD, and PwMCI) were required to meet the same set of inclusion and exclusion criteria to address cognitive impairment, depression, peripheral nerve disorders, history that might affect olfactory function, and orthopedic or neurological conditions that might affect proprioception. Inclusion criteria were as follows: 1) Mini-mental state examination (MMSE) score ≥ 24 [15]; 2) Beck depression inventory score ≤ 20 [16]; 3) no signs or symptoms of peripheral nerve disorders, such as peripheral neuropathy; 4) no history of smoking; and 5) no medical history, including chronic rhinosinusitis, nasal allergy, history of nasal surgery, or head trauma, which might affect olfactory function, as determined by an otorhinolaryngologist. Exclusion criteria included: 1) diagnosis of any other neurological disorders, such as stroke; 2) any medical history of injury to the extremities that may affect proprioceptive sensitivity, such as shoulder dislocation or joint replacement; 3) diabetes (owing to its association with peripheral neuropathy); 4) inability to follow instructions and focus on the procedure for 30 min; and 5) upper respiratory tract infection. ...
Background
Individuals with neurodegenerative diseases such as Parkinson disease (PD) and Alzheimer’s (AD) disease often present with perceptual impairments at an early clinical stage. Therefore, early identification and quantification of these impairments could facilitate diagnosis and early intervention.
Objectives
This study aimed to compare proprioceptive and olfactory sensitivities in individuals diagnosed with PD and mild cognitive impairment (MCI).
Methods
Proprioception in the forearm and olfactory function were measured in neurotypical older adults, individuals with PD, and individuals with MCI. Position and passive motion senses were assessed using a passive motion apparatus. The traditional Chinese version of the University of Pennsylvania smell identification test (UPSIT-TC) and the smell threshold test (STT) were used to identify and discriminate smell, respectively.
Results
Position sense threshold between the groups differed significantly ( p < 0.001), with the PD ( p < 0.001) and MCI ( p = 0.004) groups showing significantly higher than the control group. The control group had significantly higher mean UPSIT-TC scores than the PD ( p < 0.001) and MCI ( p = 0.006) groups. The control group had a significantly lower mean STT threshold than the PD and MCI groups ( p < 0.001 and p = 0.008, respectively). UPSIT-TC scores significantly correlated with disease progression in PD (r = − 0.50, p = 0.008) and MCI (r = 0.44, p = 0.04).
Conclusions
Proprioceptive and olfactory sensitivities were reduced in individuals with PD and MCI, and these deficits were related to disease severity. These findings support previous findings indicating that perceptual loss may be a potential biomarker for diagnosing and monitoring disease progression in individuals with neurodegenerative diseases.
... Some tasks will engage cognitive control, whereby participants have to decide when to act ('GO') but also when not to act ('NO-GO'), while others may require a participant to place themselves in the mind of another person (theory of mind). More general questionnaires of cognition, such as the Mini Mental State Examination (MMSE) [20] and Montreal Cognitive Assessment (MoCA) [21], may have subcomponents of executive function. These can be useful as scalable tests of cognitive ability for large-scale studies but do not assess executive function with the detail of dedicated tasks. ...
Purpose of Review
To review the literature examining the relationship between sleep and cognition, specifically examining the sub-domain of executive function. We explore the impact of sleep deprivation and the important question of how much sleep is required for optimal cognitive performance. We consider how other sleep metrics, such as sleep quality, may be a more meaningful measure of sleep. We then discuss the putative mechanisms between sleep and cognition followed by their contribution to developing dementia.
Recent Findings
Sleep duration and executive function display a quadratic relationship. This suggests an optimal amount of sleep is required for daily cognitive processes. Poor sleep efficiency and sleep fragmentation are linked with poorer executive function and increased risk of dementia during follow-up. Sleep quality may therefore be more important than absolute duration. Biological mechanisms which may underpin the relationship between sleep and cognition include brain structural and functional changes as well as disruption of the glymphatic system.
Summary
Sleep is an important modifiable lifestyle factor to improve daily cognition and, possibly, reduce the risk of developing dementia. The impact of optimal sleep duration and sleep quality may have important implications for every ageing individual.
... A serum and urine pregnancy test was performed for female participants of childbearing potential. To confirm cognitive function was normal, the participants older than 60 underwent a set of cognitive examinations consisting of a Mini-Mental Status Examination [20], a Clinical Dementia Rating [21], and an education-adjusted Logical Memory II [11], or a brief computerized cognitive testing battery (Cogstate: https:// Cogst ate. com/ compu teriz ed-tests) consisting of the Identification, Detection, One-Back, and International Shopping List Tests. ...
Purpose
Aging is a major societal concern due to age-related functional losses. Synapses are crucial components of neural circuits, and synaptic density could be a sensitive biomarker to evaluate brain function. [¹¹C]UCB-J is a positron emission tomography (PET) ligand targeting synaptic vesicle glycoprotein 2A (SV2A), which can be used to evaluate brain synaptic density in vivo.
Methods
We evaluated age-related changes in gray matter synaptic density, volume, and blood flow using [¹¹C]UCB-J PET and magnetic resonance imaging (MRI) in a wide age range of 80 cognitive normal subjects (21–83 years old). Partial volume correction was applied to the PET data.
Results
Significant age-related decreases were found in 13, two, and nine brain regions for volume, synaptic density, and blood flow, respectively. The prefrontal cortex showed the largest volume decline (4.9% reduction per decade: RPD), while the synaptic density loss was largest in the caudate (3.6% RPD) and medial occipital cortex (3.4% RPD). The reductions in caudate are consistent with previous SV2A PET studies and likely reflect that caudate is the site of nerve terminals for multiple major tracts that undergo substantial age-related neurodegeneration. There was a non-significant negative relationship between volume and synaptic density reductions in 16 gray matter regions.
Conclusion
MRI and [¹¹]C-UCB-J PET showed age-related decreases of gray matter volume, synaptic density, and blood flow; however, the regional patterns of the reductions in volume and SV2A binding were different. Those patterns suggest that MR-based measures of GM volume may not be directly representative of synaptic density.
... Written informed consent was obtained from all participants. Inclusion criteria for MIST were: (i) age within 50-80 years, (ii) English fluency, (iii) cognitively normal (Montreal Cognitive Assessment (MoCA) score [96] ≥23, Mini-Mental State Examination (MMSE) score [97] ≥26), and (iv) self-reported sleep difficulties (Pittsburgh Sleep Quality Index (PSQI) [98] score ≥5 AND >30 min sleep latency and/or >30 min wakefulness after sleep onset and/or <6.5 h sleep time). Participants were excluded if they had: (i) any neurological or psychiatric disorders, (ii) use of long-term sleep medications, (iii) prior mindfulness-based intervention, or (iv) MRI contraindications. ...
Mindfulness-based interventions are showing increasing promise as a treatment for psychological disorders, with improvements in cognition and emotion regulation after intervention. Understanding the changes in functional brain activity and neural plasticity that underlie these benefits from mindfulness interventions is thus of interest in current neuroimaging research. Previous studies have found functional brain changes during resting and task states to be associated with mindfulness both cross-sectionally and longitudinally, particularly in the executive control, default mode and salience networks. However, limited research has combined information from rest and task to study mindfulness-related functional changes in the brain, particularly in the context of intervention studies with active controls. Recent work has found that the reconfiguration efficiency of brain activity patterns between rest and task states is behaviorally relevant in healthy young adults. Thus, we applied this measure to investigate how mindfulness intervention changed functional reconfiguration between rest and a breath-counting task in elderly participants with self-reported sleep difficulties. Improving on previous longitudinal designs, we compared the intervention effects of a mindfulness-based therapy to an active control (sleep hygiene) intervention. We found that mindfulness intervention improved self-reported mindfulness measures and brain functional reconfiguration efficiency in the executive control, default mode and salience networks, though the brain and behavioral changes were not associated with each other. Our findings suggest that neuroplasticity may be induced through regular mindfulness practice, thus bringing the intrinsic functional configuration in participants’ brains closer to a state required for mindful awareness.
... Their cognitive state was evaluated according to the Clinical Dementia Rating Scale (CDR) [29,33] and the Mini-Mental State Examination (MMSE) [20,31] with a diagnosis of Subjective Memory Disorder (SCM) corresponding to a CDR=0, a Mild Cognitive Impairment (MCI) according to the criteria of the Diagnostic and Statistic Manual V (DSM-V) corresponding to a CDR=0.5, and a Mild or Moderate Dementia (AD) corresponding respectively to a CDR=1 and CDR=2. The clinical characteristics of the patients were the following: illness duration in years 3.9 ± 7 (in the range 1-8); MMSE 25.8 ± 3 (in the range 16-30); 8 patients with CDR=0, 16 patients with CDR=0.5, 20 patients with CDR=1, 6 patients with CDR=2. ...
We performed a study to evaluate if the acceptance of a social humanoid robot used for monitoring the activities of elderly users with cognitive deficits increased after interacting with the robot. In addition, we evaluated if the robot’s acceptance is improved when the interaction with the robot occurred in different modalities modulated according to each user’s cognitive and personality profile. A group of 7 participants underwent assessment tools for cognitive and personality traits and for the level of acceptability of the robot. They interacted with the robot at their private home for a minimum of two weeks. The interaction with the robot occurred under two different modalities: standard modality where the robot performed tasks by approaching the subject at a fixed pre-defined frequency of interactions, and at fixed pre-defined times; modulated modality where the robot performed tasks by approaching the subject at different frequencies set according to some personality traits and cognitive profile of the user. The results showed no change in the acceptability level of the robot after direct interaction. Still, personality traits such as Neuroticism and Openness influenced the acceptability of the robot in the elderly only before an interaction. At the same time, these personality traits did not seem to influence the acceptability of the new technology after a direct interaction. Different is the case of cognitive profiles and demographic characteristics. Finally, the score on the pleasantness scale was higher when the interaction with the robot was set in modulated modality rather than standard modality. In conclusion, the identification of the personality traits and the cognitive status in the elderly with cognitive deficits seems to be useful to modulate the type and frequency of interaction of the robot with the user to increase the acceptability of the instrument and pleasures in every daily life.
... Inclusion criteria were: diagnosis of a NPMD according to ICD-10 criteria, suicidal ideation, age 18 years or older, ability to give informed consent and comply with the study protocol. Exclusion criteria were: cognitive impairment (score less than or equal to 24 on the Mini-Mental State Examination (MMSE) [26], current psychotic disorder or lifetime diagnosis of primary psychotic disorder, alcohol and substance use disorders, severe comorbid somatic (e.g., diabetes mellitus, autoimmune or oncologic diseases) and neurologic disorders (e.g., Alzheimer's and Parkinson's diseases). ...
Non-suicidal self-injurious behavior (NSSI), prevalent in patients with non-psychotic mental disorders (NPMD), is associated with numerous adverse outcomes. Despite active research into the clinical and psychological aspects of NSSI, the underlying biological mechanisms remain obscure. Early adverse experiences are believed to induce long-lasting changes in neuroendocrine mechanisms of stress control playing a key role in NSSI development. The aim of the study was to evaluate parameters potentially predicting development of NSSI in female patients with NPMD. Eighty female patients over 18 years with NPMD and suicidal ideation (40 with and 40 without NSSI) and 48 age matching women without evidence of mental illness (healthy controls) were enrolled. Diagnostic interviews and self-report measures were used to assess childhood maltreatment, presence, frequency, and characteristics of suicidal and self-injurious thoughts and behaviors, the Beck Depression Inventory scale to assess severity of depression. Hypothalamic-pituitary-adrenal axis markers, hormones, and neurotrophic factors were measured in blood serum. The likelihood of developing NSSI in patients with NPMD was associated with early adverse family history and elevated adrenocorticotropic hormone levels. Dysregulation of hypothalamic-pituitary-adrenal axis as a result of early chronic stress experiences may represent critical biological mechanism promoting the development of NSSI behaviors in patients with NPMD.
... • Level of Loneliness as assessed by the UCLA 3-Item Loneliness Scale [41]. • Cognition (normal, mild or moderate/severe cognitive problems) as assessed by the Montreal Cognitive Assessment (MoCA) [42] or Mini Mental Status Examination (MMSE) [43]. • Mobility as measured by the Timed Up and Go (TuG) [44] and Tinetti-Test [45]. ...
Background
Self-management of health refers to various actions and decisions that impact health outcomes. To improve health, independence, and quality of life (QoL) while reducing healthcare utilization and costs, patients’ self-management abilities can be enhanced. However, disease-specific self-management interventions may not be applicable for older adults with multiple illnesses. Instead, focusing on prevalent geriatric syndromes, such as frailty, cognitive decline, pain, incontinence, or impaired mobility, may be more beneficial. To achieve this, a detailed understanding of the specific needs of the older population is crucial.
Methods
Patients who are 70 years old or older will be chosen from four geriatric hospitals, which include both inpatient and outpatient facilities. At baseline, each participant will undergo a comprehensive geriatric evaluation and answer various questionnaires that focus on their current self-management abilities, self-efficacy, anxiety, aging perception, and QoL. Moreover, extensive data on the presence and impact of geriatric syndromes will be gathered. Three and six months after the initial evaluation, follow-up assessments will be conducted to identify any changes in participants’ health, independence in daily activities, geriatric syndromes, cognition and mood, QoL, and self-management.
Discussion
The present investigation aims to assess the factors that may facilitate or impede self-management in older adults afflicted with geriatric syndromes. Instead of concentrating on particular diseases, this study will analyze the association between self-management and geriatric syndromes. The information obtained will contribute to clinical expertise on the self-management habits of older adults and their effects on their well-being, autonomy, and overall QoL, as well as provide insights into geriatric syndromes. This valuable knowledge will be crucial for developing personalised programs to enhance self-management among older adults.
Trial registration
German Trial Register (Deutsches Register Klinischer Studien) DRKS00031016.
... The Groningen Frailty Index (GFI) was used preoperatively to assess patients' condition with regards to the physical, cognitive, social and psychological domains [20]. Furthermore, Charlson Comorbidity score (CCS) and Mini-Mental State Examination (MMSE) were used preoperatively to classify comorbidities and measure cognitive impairment, respectively [21,22]. Anaesthesia and procedure related relevant intraoperative data were recorded perioperatively. ...
Background
Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery.
Methods
We analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score.
Results
Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8–27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001–1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]).
Conclusion
In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients’ scores on cognitive tests improved postoperatively.
... The first group is composed of sex, age, schooling, and foreign-born status. Health variables are: bad or regular self-rated health (dichotomized from a 5-category variables), cognitive status based on a short version of the Mini-Mental test (Folstein and Folstein, 1975;Quiroga, Albala and Klaasen, 2004), and whether respondents receive help for Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Most of the labour market variables refer to the main job during the life course: salaried or independent worker, main occupation (classified as "Blue-collar and basic services", "White-collar, sales and professionals", and "Agriculture"). ...
Objective. The coverage of pension plans in Latin America is relatively low and so, people postpone retirement and decide to continue working. The aim of the paper is to analyze the family characteristics that predict the decisions of leaving the job market with or without pension benefits. Methodology. Data from CRELES, a longitudinal survey of the elderly with two cohorts were used. Results and conclusions. Among people aged 55 and older who were working at the baseline, 25% left the labor market, and 9% started receiving retirement money, even though some of them continued working. People who make informal cash transfers to family members are more likely to retire, especially earlier than others. Those who looked after children were more likely to stop working without a formal pension. There was no evidence that the spouse’s working status was related to retirement decisions.
Background
Stroke is a prevalent, severe, and incapacitating worldwide health issue, and a key component of patient care is rehabilitation. Mixed reality (MR) allows participants to fully submerge in a virtual space while interacting with real objects and is especially useful for hand training because of its tangible user interface. For the potential benefit of MR rehabilitation in hand training, the recognition of individual finger movements is required. We updated the MR-based rehabilitation system (MR-board 2) by adding a palm camera and specific training programs for individual fingers. This study aimed to assess the effectiveness of MR-board 2 on the self-rehabilitation of patients with stroke.
Methods
MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions (5 days per week for 4 weeks) involving 30-min training using MR-board 2 in a research intervention room. The outcome measurements for upper extremity function were the Fugl–Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). MR-board 2 recorded the finger active range of motion (AROM) during training.
Results
Except for the FMA-proximal score, other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery were improved significantly during MR-board 2 training and were maintained until follow-up (4 weeks after the intervention). All AROM values of the finger joints changed significantly during training.
Conclusions
MR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.
Trial registration
This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).
INTRODUCTION
Protein‐based plasma assays provide hope for improving accessibility and specificity of molecular diagnostics to diagnose dementia.
METHODS
Plasma was obtained from participants (N = 837) in our community‐based University of Kentucky Alzheimer's Disease Research Center cohort. We evaluated six Alzheimer's disease (AD)‐ and neurodegeneration‐related (Aβ40, Aβ42, Aβ42/40, p‐tau181, total tau, and NfLight) and five inflammatory biomarkers (TNF𝛼, IL6, IL8, IL10, and GFAP) using the SIMOA‐based protein assay platform. Statistics were performed to assess correlations.
RESULTS
Our large cohort reflects previous plasma biomarker findings. Relationships between biomarkers to understand AD–inflammatory biomarker correlations showed significant associations between AD and inflammatory biomarkers suggesting peripheral inflammatory interactions with increasing AD pathology. Biomarker associations parsed out by clinical diagnosis (normal, MCI, and dementia) reveal changes in strength of the correlations across the cognitive continuum.
DISCUSSION
Unique AD–inflammatory biomarker correlations in a community‐based cohort reveal a new avenue for utilizing plasma‐based biomarkers in the assessment of AD and related dementias.
Highlights
Large community cohorts studying sex, age, and APOE genotype effects on biomarkers are few.
It is unknown how biomarker–biomarker associations vary through aging and dementia.
Six AD (Aβ40, Aβ42, Aβ42/40, p‐tau181, total tau, and NfLight) and five inflammatory biomarkers (TNFα, IL6, IL8, IL10, and GFAP) were used to examine associations between biomarkers.
Plasma biomarkers suggesting increasing cerebral AD pathology corresponded to increases in peripheral inflammatory markers, both pro‐inflammatory and anti‐inflammatory.
Strength of correlations, between pairs of classic AD and inflammatory plasma biomarker, changes throughout cognitive progression to dementia.
Los datos de la Organización Mundial de la Salud (OMS) muestran que la población mundial está envejeciendo a pasos acelerados, por lo que acorto plazo el aumento de la esperanza de vida y la disminución de la tasa de fecundidad traerá consigo la denominada transición demográfica, incidiendo de forma directa en la salud del adulto mayor, a este respectó dos condiciones que ponen el riesgo la homeostasia de este grupo son el deterioro cognitivo y riesgo de caídas, por lo que acorto plazo será necesario establecer estrategias como la visita domiciliaría y educación de la familia a fin de prevenir dichas condiciones. Objetivo. Realizar un estudio de salud familiar por medio de visitas domiciliarias en un adulto mayor con riesgo de caídas y deterioro cognitivo. Metodología: Se realizó un estudio de valoración familiar en un adulto mayor identificado en la consulta de enfermería de una unidad de medicina familiar en Culiacán, Sinaloa, México; realizada en tres visitas domiciliarias; para la recolección de los datos se utilizó una guía de valoración geriátrica integral, guía de valoración de las catorce necesidades de Virginia Henderson, el Examen Mini Mental Folstein, (EMMF-11); Escala De Tinetti (VFET-20); el diseño de la intervención educativa se realizó con base a la metodología NANDA, NIC,NOC y se contó con un consentimiento informado firmado por el sujeto de cuidado y cuidador primario. Resultados. La valoración familiar permitió identificar a una familia nuclear, compuesta solo por la madre y sus dos hijos, en donde la madre tiene un problema de deterioro cognitivo, además de un alto riesgo de caídas, los hijos mantienen una relación cercana. Conclusión: Se instrumentó la intervención educativa con buena aceptación de la persona identificada y su familia, la valoración permitió identificar la necesidad de referir al sujeto de cuidado a medicina familiar para valoración geriátrica integral, por lo que será necesario planear nuevas revistas de reforzamiento.
Background
With population ageing, a wide range of hospital specialties now manage older people with complex conditions and cognitive or physically frailty with associated poor outcomes as highlighted in current guidelines aimed at improving care. However, to implement guidelines, secure resources and undertake clinically-meaningful audit/research, hospital data systems must be able identify and quantify patients with complexity and cognitive and physical frailty. The advent of hospital electronic patient records (EPRs) offers the opportunity to exploit large scale routinely acquired data at scale without additional burden to patients or staff at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, compared to retrospective administrative datasets based on ICD-10 coded diagnoses in which clinical complexity is often poorly captured. We therefore set-up the Oxford and Reading Comorbidity Frailty and Ageing Research Database exploiting hospital Electronic Patient Records (ORCHARD-EPR).
Methods
ORCHARD-EPR uses routinely-acquired individual patient data on all patients aged >65 years with unplanned admission or Same Day Emergency Care unit attendance at Oxford University Hospitals NHS Foundation Trust-OUHFT (comprising four acute general hospitals serving a population of >800,000) with the plan to extend to Royal Berkshire NHS Foundation Trust (>1,000,000). Datafields include diagnosis, comorbidities, nursing risk assessments, frailty, observations, illness acuity, laboratory tests and raw brain scan images. Importantly, ORCHARD-EPR contains the results from mandatory hospital-wide cognitive screening (>70 years) comprising the 10-point Abbreviated Mental Test and dementia and delirium diagnosis (Confusion Assessment Method-CAM). Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions, and death. The rich multimodal data are further enhanced by linkage to secondary care electronic mental health records. Selection of appropriate subgroups or linkage to existing cohorts allows disease specific studies.Over 200,000 patient episodes are included (2015-2021) of which 129,248 are admissions with a LOS >1 day in 64,641 unique patients.
Discussion
ORCHARD-EPR contains rich, multimodal real-world electronic hospital data which will enable accurate phenotyping of cognitive and physical frailty including in disease-specific studies, and risk prediction for outcomes including dementia, thereby filling existing knowledge gaps and informing the design, delivery and resourcing of clinical services.
Both navigation abilities and gait can be affected by the atrophy in the medial temporal cortex. This study aimed to determine whether navigation abilities could differentiate seniors with and without medial temporal lobe atrophy who complained about their cognitive status. The participants, classified to either the medial temporal atrophy group ( n = 23) or the control group ( n = 22) underwent neuropsychological assessment and performed a spatial navigation task while their gait parameters were recorded. The study showed no significant differences between the two groups in memory, fluency, and semantic knowledge or typical measures of navigating abilities. However, gait parameters, particularly the propulsion index during certain phases of the navigation task, distinguished between seniors with and without medial temporal lobe lesions. These findings suggest that the gait parameters in the navigation task may be a valuable tool for identifying seniors with cognitive complaints and subtle medial temporal atrophy.
We tested if a dance trial yielded improvements in physical function and cardiorespiratory fitness (CRF) in middle-aged/older Latino adults. Physical activity was assessed using the Community Healthy Activities Model Program for Seniors, physical function with the Short Physical Performance Battery (SPPB) protocol, and estimated CRF with the Jurca nonexercise test model. Multivariate analysis of covariance models found significant change in SPPB protocol total scores, F (1, 329) = 4.23, p = .041, and CRF, F (1, 329) = 5.16, p = .024, between the two study arms in favor of the dance group. Mediation models found moderate- to vigorous-intensity physical activity to mediate to mediate between group and SPPB scores (β = 0.054, 95% confidence interval [0.0142, 0.1247]). Moderate- to vigorous-intensity physical activity and total physical activity were found to partially mediate between group and CRF (β = 0.02, 95% confidence interval [−0.0261, 0.0751]), with the direct pathway no longer being significant ( p > .05). This provides support for Latin dance programs to have an effect on SPPB protocol and CRF.
The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test.
Objective
To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample.
Methods
We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE.
Results
We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores.
Conclusion
Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.
The present study aimed to establish whether habitual alcohol consumption benefits verbal and spatial working memory performance after addressing the main criticisms that have been raised against the finding that alcohol benefits cognition. An adult lifespan sample of 1,652 healthy adults between 21 and 80 years of age participated in the study. Participants were classified as lifetime nondrinkers or drinkers, and several demographic and biological variables were controlled. Alcohol consumption was assessed through a lifestyle questionnaire created for the study. Working memory was measured through a 2-back computerized task. Discrimination and speed in verbal and spatial working memory among drinkers were superior to those among nondrinkers. Total alcohol intake across life and the amount of alcohol intake per week predicted higher verbal and spatial working memory discrimination. Beer drinkers showed more accurate and faster responses in verbal and spatial working memory than nondrinkers, wine drinkers and spirit drinkers. The optimal amount of alcohol intake to benefit working memory for women and men was 100 g per week, which is equivalent to one drink per day. After consuming 350 g of alcohol per week, equivalent to 25 drinks per week, the effects of alcohol on working memory become more negative than the effects of alcohol abstinence. While alcohol consumption is considered a risk factor for several diseases, we found that moderate alcohol intake benefits working memory performance throughout the adult lifespan to a greater extent than whole-life abstinence.
Objective
@ctivehip is a home-based multidisciplinary telerehabilitation programme for older adults with hip fracture, conducted with the assistance of their family caregivers. This programme was useful in improving their functional recovery. Nevertheless, we were concerned about how the programme might have affected caregivers, whose assistance was essential for supporting older adults in using new technologies and ensuring their safety during the exercises and activities at home. The aim of the present study was to compare the burden, psychological factors and physical fitness of the family caregivers of older adults who opted the @ctivehip telerehabilitation programme versus those family caregivers of older adults who received the face-to-face rehabilitation provided by the Andalusian Public Healthcare System (in Spain).
Methods
In this single-blinded, non-randomized clinical trial, participants were older adults with hip fracture and their family caregivers. The telerehabilitation group (n = 30) underwent a 12-week multidisciplinary telerehabilitation programme, and the comparative group (n = 32) received face-to-face rehabilitation. Caregivers outcomes measured were (i) the burden using the Zarit Burden Interview, (ii) the anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and (iii) the Physical Fitness with the International Fitness Scale (IFIS).
Results
There were not statistically significant differences on caregiver burden between family caregivers in the @ctivehip and the comparative group, although there was a trend towards lower values [[Mean (95%CI); 14.73 (9.09 to 20.37) vs 16.03 (10.63 to 21.43); p = 0.771] as well as for anxiety and depression [5.66 (3.21 to 8.78) vs 11.19 (8.52 to 13.86); p = 0.022]. Likewise achieved better, though not statistically significant, scores in physical fitness [19.37 (17.94 to 20.81) vs 17.15 (15.77 to 18.53); p = 0.055].
Conclusion
Caregiver burden is not associated with telerehabilitation. In addition, telerehabilitation is associated with lower anxiety and depression levels among family caregivers who opt for this programme. Physical fitness is not related with telerehabilitation.
Predicting cognitive scores using magnetic resonance imaging (MRI) can aid in the early recognition of Alzheimer’s disease (AD) and provide insights into future disease progression. Existing methods typically ignore the temporal consistency of cognitive scores and discard the subjects with incomplete cognitive scores. In this paper, we propose a Weakly supervised Alzheimer’s Disease Prognosis (WADP) model that incorporates an image embedding network and a label embedding network to predict cognitive scores using baseline MRI and incomplete cognitive scores. The image embedding network is an attention consistency regularized network to project MRI into the image embedding space and output the cognitive scores at multiple time-points. The attention consistency regularization captures the correlations among time-points by encouraging the attention maps at different time-points to be similar. The label embedding network employs a denoising autoencoder to embed cognitive scores into the label embedding space and impute missing cognitive scores. This enables the utilization of subjects with incomplete cognitive scores in the training process. Moreover, a relation alignment module is incorporated to make the relationships between samples in the image embedding space consistent with those in the label embedding space. The experimental results on two ADNI datasets show that WADP outperforms the state-of-the-art methods.
Introduction
Subclinical epileptiform activity (SEA) and sleep disturbances are frequent in Alzheimer's disease (AD). Both have an important relation to cognition and potential therapeutic implications. We aimed to study a possible relationship between SEA and sleep disturbances in AD.
Methods
In this cross‐sectional study, we performed a 24‐h ambulatory EEG and polysomnography in 48 AD patients without diagnosis of epilepsy and 34 control subjects.
Results
SEA, mainly detected in frontotemporal brain regions during N2 with a median of three spikes/night [IQR1–17], was three times more prevalent in AD. AD patients had lower sleep efficacy, longer wake after sleep onset, more awakenings, more N1%, less REM sleep and a higher apnea‐hypopnea index (AHI) and oxygen desaturation index (ODI). Sleep was not different between AD subgroup with SEA (AD‐Epi+) and without SEA (AD‐Epi–); however, compared to controls, REM% was decreased and AHI and ODI were increased in the AD‐Epi+ subgroup.
Discussion
Decreased REM sleep and more severe sleep‐disordered breathing might be related to SEA in AD. These results could have diagnostic and therapeutic implications and warrant further study at the intersection between sleep and epileptiform activity in AD.
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