Dementia and Geriatric Cognitive Disorders最新文献

Introduction The Mini-Mental State Examination (MMSE) is widely utilized in clinical settings for cognitive screening, yet its diagnostic accuracy is often influenced by demographic factors such as educational attainment. This study investigates the educational gradient in MMSE performance and evaluates whether uniform cutoff scores adequately distinguish cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD) patients across different educational strata. Methods A total of 300 older adults (CN = 100; MCI = 100; AD = 100) were retrospectively recruited from the Severance Hospital memory clinic, intentionally balanced to ensure statistical power and avoid class-imbalance bias across diagnostic groups. All participants completed the Korean version of MMSE and the Seoul Neuropsychological Screening Battery-II (SNSB-II) and underwent 3T brain MRI for hippocampal volumetry. Education level was categorized as low (≤6 years), medium (7-12 years), and high (≥13 years). MMSE diagnostic accuracy was evaluated using ROC curve analyses stratified by education. Interaction effects were tested via multiple linear regression, and correlations with hippocampal volume were assessed. Results MMSE scores showed a significant educational gradient, with higher education associated with higher performance (p < 0.001). MMSE scores demonstrated a pronounced educational gradient, with particularly reduced performance in individuals with low educational attainment, suggesting potential overestimation of cognitive impairment when uniform MMSE cutoffs are applied. ROC analyses revealed only moderate diagnostic accuracy of MMSE in the higher education groups (AUC = 0.83 and 0.78). The AUC was 0.73 (95% CI 0.58-0.88) in the low-education group; the AUC was 0.83 (95% CI 0.75-0.91) in the middle-education group; and 0.78 (95% CI 0.70-0.87) in the high-education group, suggesting only moderate diagnostic accuracy of MMSE. Conversely, lower education groups showed underperformance potentially unrelated to pathology. Regression models confirmed that education and diagnosis had additive but non-interacting effects on MMSE scores. MMSE correlated strongly with hippocampal volume (r = 0.739, p < 0.001), validating its general neuroanatomical relevance. Conclusion MMSE performance is substantially modulated by education, with uniform cutoffs yielding differential diagnostic validity across educational strata. We suggest education-adjusted interpretation of MMSE and emphasize the need for integrative diagnostic approaches combining cognitive testing with neuroimaging biomarkers.

Background: Post-stroke cognitive impairment is associated with increased mortality and healthcare costs. However, its characteristics in patients with large vessel occlusion after mechanical thrombectomy (MT) remain unclear. In this study, we aimed to evaluate the feasibility of administering the Montreal Cognitive Assessment (MoCA) in the acute phase after MT and examine its association with long-term cognitive outcomes.

Methods: We retrospectively analyzed patients with acute ischemic stroke who underwent MT and completed MoCA within five days of admission, using data from a prospective registry. Patients were classified into acute MoCA feasible and non-feasible groups. Clinical characteristics and cognitive outcomes were compared between the groups, including MoCA and modified Rankin Scale (mRS) scores post-MT.

Results: In total, 161 patients were enrolled: 77 (median age, 73 years; 56 men) in the feasible group and 84 (median age, 77 years; 50 men) in the non-feasible group. Multivariate analysis showed that higher National Institute of Health Stroke Scale score on admission (OR 1.09, 95% CI 1.03-1.14; p<0.01) and left-sided occlusion (OR 2.17, 95% CI 2.17-4.00, p=0.01) were independently associated with MoCA feasibility. Among 51 patients assessed at six months, over 80% had persistent cognitive impairment. The chronic MoCA score in the feasible group was 24 and in the non-feasible group was 17. Both groups achieved a favorable functional outcome (mRS score ≤ 2).

Conclusion: Over 80% of patients with acute ischemic stroke who underwent MT experienced chronic cognitive impairment, even among those with favorable functional outcomes.

Introduction: Cerebrospinal fluid (CSF) glial fibrillary acidic protein (GFAP) is a neuroinflammatory marker reflecting reactive astrogliosis and is measured regularly in clinical practice. However, its diagnostic utility in differentiating dementia subtypes remains unclear. This study aimed to evaluate differences in CSF GFAP concentrations and its associations with markers of disease severity and amyloid pathology.

Methods: We conducted a retrospective cohort study using three datasets encompassing a broad range of dementia diagnoses. Included variables were CSF GFAP, β-amyloid 42 (Aβ42), the Aβ42/Aβ40 ratio, mini-mental state exam (MMSE) scores, and time from sampling to death.

Results: A total of 1345 individuals were included. In Parkinson's disease dementia (PDD) and Lewy body dementia (LBD), GFAP levels were similar (p>.05). Lower levels were observed in PDD compared to early-onset Alzheimer's disease (AD), late-onset AD (LAD), and vascular dementia (VaD) (all p<.05); however, the discriminative performance was low-to-moderate: PDD versus LAD (AUROC=.74, CI=.64-.84, p<.001), VaD (AUROC=.71, CI =.61-.81, p<.001) and EAD (AUROC=.59, CI=.47-.71, p=.13). Associations were seen with MMSE in mixed AD and VaD (MIX) (p=.027), but not in the other diagnostic categories. GFAP levels did not differ between subjects grouped according to Aβ42/Aβ40 status (p>.05).

Conclusion: CSF GFAP did not exhibit clinically relevant diagnostic or prognostic value in dementia. Further studies are needed to clarify its role in PDD.

Introduction: Recent multidomain intervention trials for dementia show it is possible to improve cognition by targeting combinations of risk factors. We aimed to identify the most prevalent co-occurring risk factor combinations that are strongly associated with low cognition.

Methods: This cross-sectional analysis included 30,097 participants aged 45 to 85 in the Canadian Longitudinal Study on Aging. The five most prevalent dyad, triad, and tetrad combinations of 12 modifiable risk factors were identified. Neuropsychological test battery composite Z score was calculated to assess cognition. Multivariable linear regression was used to explore the association between the prevalent combinations of risk factors and cognition. Synergistic interaction between risk factors was assessed using interaction terms.

Results: The most prevalent dyadic combination was physical inactivity and sleep disturbance, with hypertension added for the triad, and obesity added for the tetrad. The dyadic combination associated with both high prevalence and the strongest association with low cognition was hearing loss and physical inactivity (prevalence 27%; mean difference -0.12 [95% CI: -0.14 to -0.09]). For the triad, it was hearing loss, physical inactivity, and hypertension (14%; -0.14 [-0.16 to -0.11]), and with the addition of obesity for the tetrad (5.1%; -0.15 [-0.19 to -0.12]). Synergistic interaction was observed between hypertension and physical inactivity (p < 0.001).

Conclusion: Prevalent and detrimental combinations of modifiable risk factors for dementia were identified to inform targeted intervention strategies. The synergistic interaction between hypertension and physical inactivity highlights the benefit of addressing both risk factors simultaneously to maximize cognitive benefits.

Introduction: The Addenbrooke's Cognitive Examination III (ACE-III) is a widely recognized cognitive screening tool; however, its diagnostic accuracy and optimal cutoff values for distinguishing mild cognitive impairment (MCI) and Alzheimer's disease dementia (AD-D) have not been established in the Polish population. This study aimed to evaluate the reliability, diagnostic performance, and optimal cutoff scores of the ACE-III in differentiating between controls, MCI, and AD-D patients.

Methods: A total of 1,265 Polish participants were assessed: 767 with AD-D (321 men; mean age, 74.9 ± 8.2 years), 216 with MCI (90 men; mean age, 72.2 ± 8.4 years), and 282 controls (77 men; mean age, 67.1 ± 8.7 years). All underwent cognitive screening using the ACE-III and the Mini-Mental State Examination (MMSE). Group differences were examined using the Kruskal-Wallis test, while receiver operating characteristic analyses determined diagnostic accuracy and optimal cutoff points. ANCOVA with bootstrap resampling was used to control for age and education.

Results: Internal consistency of the ACE-III was strong (McDonald's ω = 0.889). The ACE-III demonstrated superior diagnostic accuracy compared with the MMSE, with optimal cutoffs of 88.5 (sensitivity, 98%; specificity, 92%) for distinguishing controls from MCI and 72.5 (sensitivity, 90%; specificity, 76%) for distinguishing MCI from AD-D.

Conclusions: The ACE-III is a reliable and sensitive tool for detecting early cognitive decline in the Polish population. Its superior diagnostic utility compared with the MMSE, particularly in identifying early neurocognitive impairment, supports its use in timely diagnosis and intervention.

Introduction: Cognitive impairment is a critical concern in patients after aneurysm repair. This meta-analysis aimed to compare the cognitive outcomes following two common treatment modalities for ruptured cerebral aneurysms: endovascular coiling and microsurgical clipping.

Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted, without language restriction at the search stage, to identify relevant studies up to October 2024. Studies of adults with aneurysmal subarachnoid hemorrhage treated by coiling or clipping and reporting quantitative cognitive outcomes were included, provided a full text (or sufficient extractable data) was available from randomized controlled trials or observational studies. The primary outcome was cognitive function, measured using standardized mean differences (SMDs) across various domains such as memory, attention, and executive function. A random-effects model was applied to account for heterogeneity, and publication bias was assessed using Egger's regression and Begg and Mazumdar rank correlation tests.

Results: Ten studies with a total of 1,044 participants were included. The pooled analysis demonstrated that coiling was associated with better short-term cognitive outcomes (SMD = 0.984, 95% CI = 0.639 to 1.330, p < 0.000), likely due to its minimally invasive nature. However, long-term cognitive outcomes were uncertain. Sensitivity and publication bias analyses confirmed the robustness of the findings, with no significant evidence of publication bias.

Conclusion: This meta-analysis suggests that endovascular coiling is associated with better cognitive outcomes compared to microsurgical clipping in the treatment of ruptured cerebral aneurysms. Future research should focus on long-term follow-ups, standardized cognitive assessments, and investigating novel treatment strategies to further enhance cognitive outcomes after aneurysm repair.

Objective: The aim of this systematic review and meta-analysis was to assess the impact of pre-stroke dementia (PSD) on stroke outcomes.

Methods: Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus were searched from inception till 15th February 2025. Outcomes pooled were short-term mortality (<6 months), long-term mortality (>6 months), poor functional outcomes, recurrence, and discharge to home.

Results: 20 studies were eligible. The pooled prevalence of PSD was 10.4% (95% CI, 7.5%-14.4%). Meta-analysis of crude and adjusted data showed a significant association between PSD and short-term mortality, long-term mortality, and poor functional outcomes. Pooled analysis showed decreased odds of discharge to home with PSD but without any significant effect on stroke recurrence. A separate analysis of ischemic stroke patients undergoing reperfusion therapy showed a significant association between PSD and short-term mortality on analysis of crude but not adjusted data. There was also an increased risk of symptomatic intra-cerebral hemorrhage (ICH) with PSD but the risk of all ICH did not achieve statistical significance. Most outcomes had high inter-study heterogeneity.

Conclusions: Pre-stroke dementia is associated with increased mortality and poorer functional recovery after stroke, but this effect diminishes after adjustment for confounders. Dementia alone should not deter the use of reperfusion therapy, although careful monitoring for symptomatic ICH is advised. PSD should form an integral part of stroke assessment and prognostication and clinicians should incorporate dementia status into individualized treatment and rehabilitation plans, balancing the potential benefits and risks of aggressive therapies.

Introduction: With the global increase in dementia due to demographic aging, dementia not only affects those diagnosed but also their primary caregivers, often leading to significant caregiver burden. This study aimed to synthesize existing interventions to understand their effectiveness in reducing psychological distress - specifically anxiety, depression, and subjective well-being (SWB) - among dementia caregivers.

Methods: We conducted a multilevel meta-analysis of 175 studies involving 342 intervention treatments on caregivers. Interventions were categorized into various psychological outcomes. The effects of demographic characteristics on intervention effectiveness were also analyzed using multilevel meta-regression.

Results: Interventions generally showed a significant reduction in anxiety and depression with varied effects on SWB. Training of the care recipient showed the largest observed effect on SWB, although this estimate is based on only 10 observations and should be regarded as promising rather than definitive. CBT also produced a robust positive effect. Younger, male, and non-spousal caregivers tended to experience greater reductions in anxiety and depression compared to older, female, or spousal caregivers.

Conclusion: These findings highlight the importance of tailoring interventions to caregiver characteristics and outcome type. While interventions broadly reduce caregiver distress, the degree of benefit varies, indicating that personalized approaches may yield the best results. We also emphasize the need for rigorous methodology (e.g., handling nonindependence and publication bias) in future caregiver intervention research.

Introduction: Effective mild cognitive impairment (MCI) screening requires accessible testing. This study compared two tests for distinguishing MCI patients from controls: rapid automatized naming (RAN) for naming speed and low-contrast letter acuity (LCLA) for sensitivity to low-contrast letters.

Methods: Two RAN tasks were used: the Mobile Universal Lexicon Evaluation System (MULES, picture naming) and the Staggered Uneven Number test (SUN, number naming). Both RAN tasks were administered on a tablet and in a paper/pencil format. The tablet format was administered using the Mobile Integrated Cognitive Kit application. LCLA was tested at 2.5% and 1.25% contrast.

Results: Sixty-four participants (31 MCI, 34 controls; mean age 73.2 ± 6.8 years) were included. MCI patients were slower than controls for paper/pencil (75.0 vs. 53.6 s, p < 0.001), and tablet MULES (69.0 s vs. 50.2 s, p = 0.01). The paper/pencil SUN showed no significant difference (MCI: 59.5 s vs. controls: 59.9 s, p = 0.07) nor did the tablet SUN (MCI: 59.3 s vs. controls: 55.7 s, p = 0.36). MCI patients had worse performance on LCLA testing at 2.5% contrast (33 letters vs. 36, p = 0.04*) and 1.25% (0 letters vs. 14 letters, p < 0.001). Receiver operating characteristic (ROC) analysis showed similar performance of paper/pencil and tablet MULES in distinguishing MCI from controls (area under the ROC curve [AUC] = 0.77), outperforming both SUN (AUC = 0.63 paper, 0.59 tablet) and LCLA (2.5% contrast: AUC = 0.65, 1.25% contrast: AUC = 0.72).

Conclusion: The MULES, in both formats, may be a valuable screening tool for MCI.