Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Technological advancements like digital monitoring tools, disease modifying therapies and artificial intelligence have been shown to improve the clinical management of neurocognitive diseases like Alzheimer's disease (AD). To enhance implementation in daily practice, users' input is essential in the technology development process. This study aimed to determine clinician's perspective of clinical decision support systems (CDSS) in the management of dementia and AD.

Method: A survey was conducted targeting clinicians practicing in the field of dementia across Europe. A sixty-five-item digital questionnaire was administered, and opinions were enquired across the domains of diagnosis, disease modifying therapy and prognosis, including factors that affect tool implementation and utilization.

Results: Eighty-four clinicians (including specialist physicians, psychologists and nurses) responded to this survey, and more than 50% had no knowledge or experience with CDSS. Most of the respondents reported the ability to predict the likelihood of AD as the most important diagnostic function. It was surprising to find the middling responses for the ability to predict amyloid positivity. The majority indicated assessment of treatment eligibility for disease-modifying therapy as vital, and the ability to predict cognitive and functional decline as the most important prognostic functions. Data accuracy and ease of use were noted as most necessary to facilitate CDSS adoption and implementation.

Conclusion: Findings from this study contribute to the future development of CDSS in this field, especially regarding the approval and imminent use of disease modifying therapies, a comprehensive tool that is precise and user friendly would improve clinical decisions and efficiency.

Introduction: Given the elevated dementia risk in underrepresented demographic groups in the US-particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals-it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library and CINAHL. We explored the percent White participants for trials using vs. not using a specific eligibility criterion or recruitment strategy using Hodges-Lehmann median difference estimation.

Results: Of forty-four studies meeting the inclusion criteria, twenty-seven reported on racial/ethnic diversity. Analyses demonstrated that criteria regarding cardiovascular disease, pulmonary disease, hearing impairment, and sedentary lifestyle were associated with relatively high participant diversity, while gastro-intestinal/liver disease, motivation to participate, and language proficiency criteria were associated with relatively little diversity. Information on recruitment strategies was often lacking. Three studies described recruitment efforts explicitly aimed at increasing diversity. Recruitment strategies associated with relatively high racial/ethnic diversity included recruitment via referral/word-of-mouth, television/radio advertising, and recruitment at church.

Conclusion: Eligibility criteria could be improved by revisiting and revising how they are defined (e.g. motivation to participate). Regarding recruitment, several recommendations are provided, including 1) lifting barriers to study participation (e.g. through reimbursement), 2) collaborating with community partners, and 3) formally studying the effectiveness of recruitment strategies.

Introduction: Neuropsychiatric symptoms (NPSs) such as increased apathy, affective symptoms, psychosis and hyperactivity are common in Alzheimer's disease (AD) and are associated with increased disease severity and caregiver burden. In contrast to well-characterized associations between AD-related cognitive deficits and focal neuropathology (e.g., memory and hippocampal atrophy), fewer studies have focused on associations between NPS-brain associations in AD. Furthermore, studies focusing on MRI measures of gray matter (GM) abnormalities associated with NPSs in AD have not been systematically reviewed.

Methods: To address this gap, a systematic literature review was undertaken to identify articles that assessed structural brain differences associated with NPSs in AD. This review identified 29 such articles that tested associations between NPSs and gray matter loss (GML: reduced GM density, reduced GM volume, decreased cortical thickness, etc.).

Results: Across all NPSs, most symptoms were associated with GML the prefrontal cortex and medial temporal lobe highlighting key limbic/limbic adjacent structures including orbitofrontal cortex and parahippocampal regions. Other regions exhibiting associations included the superior and middle temporal gyri as well as anterior and posterior cingulate cortex.

Conclusion: Understanding how GM changes in the brain relate to NPSs in AD may not only improve our understanding of NPSs and AD but may also provide help to identify homologies/correspondence with brain changes in psychiatric diseases.

Introduction: Subjective cognitive decline (SCD) is considered a preclinical manifestation of Alzheimer's disease (AD). Recent research suggests that subtle cognitive changes in SCD are linked to an increased risk of clinical decline. This study investigates the longitudinal trajectories of both objective and self-reported cognitive functions in individuals with SCD, with a focus on the impact of subtle cognitive impairment (SCI).

Methods: A total of 107 individuals with SCD, with at least two annual follow-ups, were included in this study. We analyzed the trajectories of both objective and subjective cognitive functions, assessed changes in medial temporal lobe regional volumes, and compared baseline AD biomarkers between SCD individuals with SCI (n = 22, SCI group) and without SCI (n = 85).

Results: SCD individuals with SCI showed a faster decline in objective cognitive function over time compared to those without SCI, who exhibited cognitive improvement. Self-reported cognitive complaints showed no differences between groups at baseline or in annual changes over time. The SCI group had lower baseline entorhinal cortical volumes and greater volume reductions over time, and also exhibited more abnormalities in AD biomarkers, including higher amyloid PET positivity, a lower Aβ 42/40 ratio, and elevated p-tau181.

Conclusion: SCI status in SCD individuals is associated with significant cognitive decline, along with more abnormal AD biomarkers. These findings suggest that early identification of SCI status in individuals with SCD may improve the prediction of cognitive decline. However, self-reported cognitive complaints may have a limited role in monitoring clinical changes in SCD.

Introduction: Cognitive impairment among older adults is a significant public health concern worldwide. This study aimed to investigate the prevalence of cognitive impairment, its correlates, and the mediating role of depressive symptoms between frailty and cognitive impairment among older adults in northeast region of China.

Methods: This was a cross-sectional study which used the intercept interview method to recruit participants. Social demographic characteristic, health-related behaviours, physical health, and functional status of the participants were collected. Univariate and multivariate analyses were conducted to correlates of cognitive impairment. Additionally, mediating effect analysis was performed using the Bootstrap tool.

Results: Among the 2,859 older adults included in the study, 32.4% of participants screened positive for cognitive impairment. Higher educational attainment had negative association with cognitive impairment in older adults (p < 0.05). Living in rural areas, fair/poor self-rated health, pre-frailty, frailty, having depressive symptoms, impaired activities of daily living, poor sleep quality, and inactive physical activity had positive association with cognitive impairment in older adults (p < 0.05). Furthermore, depressive symptoms exhibited a partial mediating role between frailty and cognitive impairment, with a mediating effect of 58.0%.

Conclusions: Preventive measures should be implemented to address the associated factors with cognitive impairment. Promoting higher education levels, advocating for a positive and healthy lifestyle, and ensuring their physical and mental well-being among older adults are essential. Early diagnosis and proactive prevention of frailty and depressive symptoms in older adults may effectively decelerate cognitive decline.

Introduction: Postoperative cognitive dysfunction constitutes an extremely prevalent implication in individuals subjected to cardiac or noncardiac surgery. This study aimed to assess the validity and reliability of a culturally adapted Greek version of the Addenbrooke's Cognitive Examination III (ACE-III) scale as a screening tool for perioperative neurocognitive status determination in elderly surgical patients.

Methods: A cross-cultural adaptation and validation of instruments throughout the cross-sectional study was conducted. The study sample consisted of 128 individuals over 55 years old scheduled for surgical intervention. All participants were screened twice: at the preadmission clinic and the day before surgery using the already established MoCA scale and the culturally adapted Greek version of the ACE-III scale. Subjects with a MoCA score of <26 constituted the cognitively impaired group.

Results: Regarding construct validity, ACE-III's performance in detecting cognitive impairment was excellent (AUC = 0.942; 95% CI: 0.899-0.971). Convergent validity between ACE-III and MoCA scales was excellent (r = 0.876; 95% CI: 0.839-0.905). Known group validity was confirmed since advanced age and lower educational attainment adversely impacted ACE-III's total score (p < 0.001). Additionally, specialists suggested face validity (mean 8.7 out of 10, SD 1.1). In terms of reliability, ACE-III demonstrated good internal consistency (Cronbach's alpha 0.786) and high inter-rater (intraclass correlation coefficient [ICC] = 0.936 [95% CI: 0.921-0.941]) and test-retest reliability (ICC = 0.972 [95% CI: 0.958-0.981]).

Conclusion: The Greek version of ACE-III is a valid and reliable screening tool that could be routinely employed perioperatively as a valid alternative to the MoCA test to distinguish the mild cognitively impaired from healthy elderly candidates for surgical interventions.

Introduction: The cognitive screening usually requires a face-to-face format, which might limit its use in many circumstances. We aimed to develop a new application-based cognitive screening test (ACST) to serve as an accessible and valid tool in the community.

Methods: The ACST was developed by using paired association and digit span tests. This test was administered to 70 cognitively normal participants, 62 participants with MCI, and 64 participants with dementia. The 2nd edition of the Mini-Mental State Examination (MMSE-2) and the Montreal Cognitive Assessment (MoCA) were collected by certified psychologists. The ACST was self-administered by the participants, with a clinician providing instructions for those with dementia or technological limitations. The diagnosis was made according to DSM-5 criteria by an experienced geriatric neurologist blinded to the application score. Content validity, test-retest reliability, interrater reliability, and correlations between application scores and MMSE-2 and MoCA scores were analyzed.

Results: The sensitivity and specificity for distinguishing cognitively normal participants from non-normal participants were 92.9% and 70%, respectively (cutoff point ≤7). The sensitivity and specificity for distinguishing between the cognitively normal group and the MCI group were 87.1% and 70%, respectively (cut point ≤7). The sensitivity and specificity for distinguishing cognitively normal participants from participants with dementia were 93.8% and 82.9%, respectively (cut point ≤6). A cutoff point ≤6 was considered suitable for participants aged 75 years or older or with 6 or fewer years of education.

Discussion: The ACST is an easy-to-use and valid tool for cognitive screening in older Thai adults in clinical practice. Patients with an application score ≤7 are considered to be at risk of cognitive impairment and to require further evaluation.

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: How education affects the relationship between sedentary behavior and cognitive function remains unclear. The aim of this study was to investigate the relationship between mentally active sedentary behavior and cognitive function in rural older Chinese across different levels of education.

Methods: Data from 517 participants aged 60 years and older in rural China at baseline, 4 weeks, 8 weeks, 6 months, 12 months, and 24 months were analyzed. Univariate analysis was carried out using descriptive statistical techniques and bivariate analysis was performed using linear mixed effects models.

Results: Total mentally active sedentary behavior time and playing cards/mahjong time were significantly associated with global cognition (0.25 points [95% CI, 0.15-0.35], p < 0.001; 0.27 points [95% CI, 0.16-0.37], p < 0.001, respectively), the attention dimension (0.07 points [95% CI, 0.01-0.12], p = 0.025; 0.08 points [95% CI, 0.02-0.14], p = 0.011, respectively), and the memory dimension (0.20 points [95% CI, 0.13-0.26], p < 0.001; 0.18 points [95% CI, 0.12-0.25], p < 0.001, respectively). Such associations were more pronounced in illiterate participants.

Conclusion: Our study suggested a positive association between mentally active sedentary behavior and cognitive function, with the association being more pronounced among illiterate older adults compared to the relatively well-educated. Future cognitive interventions should focus more on mentally active behavior. In addition, education-specific intervention strategy may be considered in cognitive interventions.