Dementia and Geriatric Cognitive Disorders最新文献

Objectives: To systematically analyze the therapeutic effectiveness of hyperbaric oxygen therapy compared with conventional drug therapy in patients with Parkinson's disease.

Methods: PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Database, searched to the end of March 2023. Two authors independently screened and abstracted data from each trial. The primary outcome measures included the efficacy rate and the Unified Parkinson's Disease Rating Scale III (UPDRS III). Secondary outcome measures included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Depression Scale (HAMD), Minimum Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Hoehn-Yahr staging.

Results: Thirteen studies with a total of 958 participants were included in the meta-analysis. After intervention, the experimental group exhibited a higher treatment efficacy rate compared to the control group [OR=3.18, 95%CI (1.60, 6.33), P<0.01], a lower UPDRS III score [MD=-2.96, 95%CI (-4.31, -1.61), P<0.01], and lower Hoehn-Yahr staging [MD=-0.14, 95%CI (-0.26, -0.02), P<0.01]. The experimental group also outperformed the control group in non-motor symptoms, with higher scores in MoCA, PSQI, and ESS [SMD=0.65, 95%CI (0.45, 0.85), P<0.01], [MD=-2.52, 95%CI (-2.85, -2.18), P<0.01], and [MD=-3.30, 95%CI (-3.77, -2.83), P<0.01], respectively.

Conclusion: Hyperbaric oxygen therapy improves motor function, relieves the severity of the disease, ameliorates cognitive function, and improves sleep quality while alleviating excessive daytime sleepiness in patients with Parkinson's disease. The therapeutic mechanism of hyperbaric oxygen therapy may be related to increased cerebral tissue oxygen content, which contributes to anti-hypoxic, anti-inflammatory, anti-apoptotic, and antioxidant stress.

Introduction: The prevalence of peripheral neuropathy (PN) in the lower limb increases with age and with the presence of diabetes. Studies show an association of PN with advanced cognitive impairment. Here we examine the association of PN with measures of early cognitive deficits in a cohort of older adults without apparent cognitive impairment, with or without diabetes.

Methods: A total of 2798 participants from the Cardiovascular Health Study were examined, mean age 80 years. All underwent tests of overall cognition (3MSE), executive function (DSST), and visual memory (BVRT). Impairment of vibration sensation in the toes, ankles, and tibial tuberosities was ascertained. Participants were graded according to the extent of impairment. Adjusted linear regression analyses of the extent of impaired vibration sensation with cognitive tests were performed. Results were further categorized by presence or absence of diabetes.

Results: 70% of participants had intact vibration sensation in the toes; 8% had no vibration sensation in the tibial tuberosities or below. Compared to participants with intact vibration sensation in the toes, those with no vibration sensation in the tibial tuberosities had lower 3MSE scores. Tests of executive function were lower in a stepwise manner with greater impaired vibration sensation. Visual memory was less strongly associated with impaired vibration sensation. Findings did not differ significantly by diabetes status.

Conclusion: In older adults, impaired vibration sensation in the lower limb is associated with impaired executive function and visual memory. These findings did not differ by diabetes status.

Introduction: Studies have not comprehensively examined key variables in music therapy (MT) interventions such as exposure time, session length, and frequency, particularly in relation to patients with dementia. This study investigated the effects of MT on cognitive function, depression, anxiety, behavior, and quality of life in individuals with dementia.

Methods: Relevant articles published before April 23, 2023, were sourced from five databases, including PubMed, Web of Science, and Embase. Only randomized controlled trials (RCTs) comparing the effects of MT and standard care on the cognitive function, depression levels, anxiety levels, behaviors, and quality of life of individuals with dementia were included. The Reviewers independently extracted data and assessed the studies' methodological quality. Heterogeneity was quantifed using Q statistics from 2 tests and I2 statistics. Outcome analysis was conducted using a random-effects model, and the standardized mean difference (SMD), mean difference, and 95% confidence interval (CI) were calculated.

Results: A total of 23 RCTs were included. Compared with the control group, patients who received MT had higher cognitive function, lower levels of depression, and lower levels of anxiety. Meta-regression analysis revealed that the total MT period, total number of MT sessions, weekly MT frequency, MT exposure time, and length of each MT session were associated with an improvement in cognitive function. However, no significant difference was observed in behaviors or quality of life.

Conclusions: MT yielded improved cognitive function in individuals with dementia if the intervention spans at least 12 weeks, has at least 16 sessions, and has at least 8 hours of therapy.

Introduction: Intrinsic capacity, a concept proposed by the World Health Organization, includes multidimensions to better understand older adults' health conditions for successful healthy aging. One of the key dimensions of intrinsic capacity is cognition. The present study aimed to examine if the cognitive test in Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) is a suitable instrument for screening cognition impairment.

Methods: Older adults from community or medical center settings in Tainan were recruited (n=553; mean±SD age=75.80±8.32; 60.8% females). All participants were administered the ICOPES-TW cognitive test, the Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living (IADL), and Barthel Index (BI) in an in-person interview conducted by a well-trained research assistant.

Results: The ICOPES-TW cognitive test was highly correlated with the MMSE total score (r=-0.752) and moderately correlated with IADL (r=-0.426) and BI scores (r=-0.390). When using a cutoff score of 1 for the ICOPES-TW cognitive test, its accuracy to identify cognitive impairment defined by the MMSE was 60% (sensitivity=0.98, specificity=0.41). When using cutoff score of 2, the accuracy was 83% (sensitivity=0.69, specificity=0.90). Moreover, the ICOPES-TW cognitive test had similar properties to the MMSE in terms of known-group validity (distinguishing different age and educational level groups).

Conclusions: Using ICOPES-TW cognitive test with appropriate cutoff point in different healthcare settings could help providers and researchers quickly identify if an older adult has a cognitive impairment. However, the screening ability of ICOPES-TW cognitive test was deemed fair but future studies are recommended to help improve it.

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, TELL v.2.0 offers scalable, objective, and multidimensional insights for the field.

Conclusion: Through its technical and scientific breakthroughs, 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. Computerized 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 computerized tools were categorized by diagnostic outcome (MCI, dementia, combined).

Results: The subjects included in the studies were aged 55-77 years. The overall gender distribution comprised 60% females and 40% males. The sample sizes varied considerably from 22 to 4,486. 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 computerized 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 2,311 patients with DRP. Risperidone alleviated DRP with a standardized mean difference (SMD) of 0.355 (95% CI: 0.170-0.541, 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 0.17-0.54. 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 the psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the USA.

Methods: Data were obtained from the Health and Aging Brain Study - Health Disparities (HABS-HD; N = 1,691, 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/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.