Dementia and Geriatric Cognitive Disorders最新文献

Introduction: The Toolkit to Examine Lifelike Language (TELL) is a web-based application providing speech biomarkers of neurodegeneration. After deployment of TELL v.1.0 in over 20 sites, we now introduce TELL v.2.0.

Methods: First, we describe the app's usability features, including functions for collecting and processing data onsite, offline, and via videoconference. Second, we summarize its clinical survey, tapping on relevant habits (e.g., smoking, sleep) alongside linguistic predictors of performance (language history, use, proficiency, and difficulties). Third, we detail TELL's speech-based assessments, each combining strategic tasks and features capturing diagnostically relevant domains (motor function, semantic memory, episodic memory, and emotional processing). Fourth, we specify the app's new data analysis, visualization, and download options. Finally, we list core challenges and opportunities for development.

Results: Overall, through its technical and scientific breakthroughs, TELL v.2.0 offers scalable, objective, and multidimensional insights for the field.

Conclusion: This tool can enhance disease detection, phenotyping, and monitoring.

Introduction: Timely detection of cognitive impairment such as mild cognitive impairment (MCI) or dementia is pivotal in initiating early interventions to improve patients' quality of life. Conventional paper-pencil tests, though common, have limited sensitivity in detecting subtle cognitive changes. Computerised assessments offer promising alternatives, overcoming time and manual scoring constraints while potentially providing greater sensitivity.

Methods: A literature search yielded 26 eligible articles (2020-2023). The articles were reviewed according to PRISMA guidelines and the computerised tools were categorised by diagnostic outcome (MCI, dementia, combined).

Results: The subjects included in the studies were aged 55 to 77 years. The overall gender distribution comprised 60% females and 40% males. The sample sizes varied considerably from 22 to 4486. Convergent validity assessments in 20 studies demonstrated strong positive correlations with traditional tests. Overall classification accuracy in detecting MCI or dementia, distinguishing from normal cognition (NC), reached up to 91%. Impressively, 46% of the studies received high-quality ratings, underscoring the reliability and validity of the findings.

Conclusion: The review highlights the advancements in computerised cognitive assessments for assessing MCI and dementia. This shift toward technology-based assessments could enhance detection capabilities and facilitate timely interventions for better patient outcomes.

Introduction: Risperidone is one of the atypical antipsychotics that has been used for the treatment of dementia-related psychosis (DRP). However, the findings concerning its efficacy and safety in DRP are contradictory.

Methods: We conducted a systematic review and meta-analysis to address the effects of risperidone on the alleviation of DRP. We searched Medline via PubMed, Scopus, Web of Science, Google Scholar, and PsychINFO from the inception until May 2024. Appropriate statistical tests were used to test the study hypothesis.

Results: The study included 17 articles and 2311 patients with DRP. Risperidone alleviated DRP with a standardized mean difference (SMD) of 0.355 (95%CI, 0.170 to 0.541, p=0.000). The impact of treatment was positively associated with treatment duration (slope p = 0.038) and dose (slope p= 0.000). Six studies (n=354) reported the data for the effects of risperidone on cognitive function. Analysis showed that risperidone treatment deteriorated cognitive function in DRP patients with an SMD of -0.185 (95%CI, -0.349 to -0.020, p=0.028). The mean effect size was 0.36 with a 95% CI of 0.17 to 0.54. However, the true effect size in 95% of all comparable populations fell in the interval of -0.37 to 1.08. This revealed a high heterogeneity among the included publications as the prediction interval showed a wider range of expected treatment effects than CI.

Conclusion: Our meta-analysis provides evidence for the effectiveness of risperidone in the management of DRP. However, because of safety concerns and high data heterogeneity, risperidone use should be individualized for each patient.

Introduction: This study evaluated psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the United States.

Methods: Data were obtained from the Health and Aging Brain Study - Health Disparities (HABS-HD; N=1691, age=66.5±8.7, education=12.4±4.8, 60.6% female, 33.2% MA Spanish-speaking). Unidimensionality of the SMCQ was evaluated with confirmatory factor analysis. Differential item functioning (DIF) of the SMCQ was assessed across age, sex, education, and ethnicity/language using item response theory (IRT) / logistic ordinal regression. Associations of the SMCQ in relation to cognitive status, Alzheimer's disease (AD) blood-based biomarkers, and psychological distress were examined.

Results: The SMCQ showed excellent fit in a single-factor model (CFI=0.97, TLI=0.97, RMSEA [95% CI] = 0.05 [0.04, 0.05], SRMR=0.07). Significant item-level DIF was detected by education level and ethnicity/language, but not by age or sex; when detected, DIF was not salient (i.e., adverse). The SMCQ was associated with greater psychological distress, worse Clinical Dementia Rating scores, and greater disease burden as measured by total tau and neurofilament light.

Conclusions: Practically negligible item-level bias was identified across education and ethnicity/language. Detected DIF can be described as benign, indicating that some items manifested differently between groups but had minimal impact on measurement properties. These results demonstrate that the SMCQ performs appropriately across demographic variables. Our findings also provide support for the associations of SMCQ scores with self-reported mood, cognitive status, and AD blood-based biomarkers.

Introduction: The early detection of cognitive decline is key to maximizing the benefits of preventive and therapeutic interventions against dementia. Generally, dementia is first assessed by interview-based neuropsychological tests, but the lengthy interview and mental stress during the assessment process make screenings inefficient. We previously developed a rapid screening test for dementia using an eye-tracking technology (eye tracking-based cognitive assessment, ETCA) and reported its utility for clinically detecting cognitive impairment in dementia cases. However, the ETCA's performance in detecting people with mild cognitive decline, which is the major target population for dementia-prevention strategies, remains insufficiently examined. Therefore, this study aimed to evaluate the ETCA's performance in individuals aged 40 years and older (n = 94, mean age; 61.0 [SD 13.1] years) without being formally diagnosed with dementia.

Methods: All participants underwent both the ETCA and neuropsychological tests, including the Mini-Mental State Examination (MMSE), Rivermead Behavioral Memory Test (RBMT), and Addenbrooke's Cognitive Examination-III (ACE-III) on the same day. We examined the correlations in scores between the ETCA and each neuropsychological test. Furthermore, we selected participants who earned normal scores in each neuropsychological test and evaluated the ETCA's performance in this subgroup.

Results: Participants' ETCA scores correlated significantly with their scores on neuropsychological tests, including the MMSE, RBMT, and ACE-III. Notably, the ETCA scores correlated with the RBMT or ACE-III scores in individuals who showed normal scores in each neuropsychological test.

Conclusion: The ETCA has the potential to screen mild cognitive decline efficiently at the predementia stage in nonclinical settings.

Introduction: The prevalence of MCI and dementia is increasing as the oldest-old population grows, requiring a nuanced understanding of their care needs. Few studies have examined need profiles of oldest-old patients with MCI or dementia. Therefore, this study aims to identify patients' need profiles.

Methods: The data analysis included cross-sectional baseline data from N = 716 primary care patients without cognitive impairment (n = 575), with MCI (n = 97), and with dementia (n = 44) aged 85+ years from the multicenter cohort AgeQualiDe study "Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients [85+]". Patients' needs were assessed using the Camberwell Assessment of Need for the Elderly (CANE), and latent class analysis identified need profiles. Multinomial logistic regression analyzed the association of MCI and dementia with need profiles, adjusting for sociodemographic factors, social network (Lubben Social Network Scale, LSNS-6), and frailty (Clinical Frailty Scale, CSHA-CFS).

Results: Results indicated three profiles: 'no needs', 'met physical and environmental needs', and 'unmet physical and environmental needs'. MCI was associated with the met and unmet physical and environmental needs profiles; dementia was associated with the unmet physical and environmental needs profile. Patients without MCI or dementia had larger social networks (LSNS-6). Frailty was associated with dementia.

Conclusions: Integrated care should address the needs of the oldest-old and support social networks for people with MCI or dementia. Assessing frailty can help clinicians to identify the most vulnerable patients and develop beneficial interventions for cognitive disorders.

Introduction: Dementia is caused by various diseases, including Alzheimer's disease dementia (ADD) and dementia with Lewy bodies (DLB). We often encounter patients with dementia who have limited shoulder joint range of motion (ROM), especially those with behavioral and psychological symptoms of dementia (BPSD). But the relationship between the diseases of dementia and restricted shoulder joint ROM is currently unclear.

Methods: We examined cognitive function and shoulder joint ROM in 234 new outpatients at 7 memory clinics in Japan. We assessed cognitive function using the Mini-Mental State Examination (MMSE) and Revised Hasegawa Dementia Scale (HDS-R) and BPSD using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Patients were categorized by dementia diagnosis (ADD, DLB, other dementia, and control). Right, left, and total shoulder joint ROM was assessed using validated the Japanese Orthopaedic Association (JOA) score.

Results: We found significant associations of lower right, left, and total shoulder joint ROM scores with male sex, advanced age, higher NPI-Q score, lower HDS-R, and MMSE scores. Little difference was found between right and left shoulder joint ROM scores. Restricted shoulder joint ROM was related to serial 7, verbal frequency domain scores on the HDS-R and repeat score on the MMSE. It was also related to the hallucinations, irritability/lability and nighttime disturbances scores on the NPI-Q. Furthermore, the dementia groups, especially the DLB group, showed worse shoulder joint ROM than the control group.

Conclusions: Dementia was significantly related to restricted shoulder joint ROM. Maintaining communication and social interaction may help maintain shoulder joint ROM.

Introduction: Exercise has been recommended to suppress or prevent cognitive decline. Aerobic exercise (AE) may suppress cognitive decline via the fibronectin type III domain-containing protein 5 (FNDC5)/irisin/brain-derived neurotrophic factor (BDNF) pathway, and resistance training (RT) has a preventive effect on cognitive decline. However, the underlying mechanism remains unclear. This study verified the differences in the effects of AE and RT in suppressing and preventing cognitive decline based on the FNDC5/irisin/BDNF pathway.

Methods: We divided senescence-accelerated mouse-prone 8 into three groups: control (CON), AE, and RT and evaluated their memory during exercise intervention through a novel object recognition (NOR) task. We quantified FNDC5/irisin, mBDNF, and TrkB in the hippocampus using enzyme-linked immunosorbent assay and FNDC5 in skeletal muscle using Western blotting (WB).

Results: Behavioral analysis using NOR showed that values for both AE and RT were significantly greater than those for CON. WB analysis showed that the peripheral FNDC5 expression in the skeletal muscle was increased in AE. The expression levels of FNDC5/irisin and mBDNF in the hippocampus were significantly increased in both AE and RT compared with that in CON but that if TrkB was increased only in AE.

Conclusion: No significant difference was observed between AE and RT in the inhibitory effect on age-related cognitive decline, and both groups were effective. The FNDC5/Irisin/BDNF pathway, which was the focus of this experiment, may be specific to AE. The mechanism that suppresses cognitive decline may differ depending on the type of exercise.

Introduction: Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and are associated with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum.

Methods: A total of 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI, and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors, and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using area under receiver operating characteristic curves.

Results: Hand frequency and speed were associated with memory and executive domains (p ≤ 0.001). Non-dominant hand rhythm was associated with all cognitive domains. Frequency, rhythm, and speed were associated with SCI, MCI, and dementia. Frequency and speed classified ≥94% of dementia and ≥88% of MCI from controls. Rhythm of the non-dominant hand classified ≥86% of dementia and MCI and 69% of SCI.

Conclusion: Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, is associated with executive and memory domains and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.