Dementia and Geriatric Cognitive Disorders最新文献

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.

Introduction: Studies on Alzheimer's disease (AD) indicate inflammation does not just follow but drives neurodegeneration. Protein aggregation in neurodegeneration can trigger neuroinflammation, worsening protein aggregation and neurodegeneration. The aim of this study was to use bidirectional Mendelian randomization (MR) approach to find the causal link between specific inflammatory proteins and AD, creating new hypotheses for studying AD's pathological mechanisms.

Methods: Independent genetic variants for 91 inflammatory proteins (14,824 individuals) and AD (111,326 clinically diagnosed/"proxy" AD patients and 677,663 controls) were selected as instrumental variables (IVs) from published genome-wide association studies among individuals of predominantly European ancestry. MR analyses included the inverse-variance-weighted (IVW) method, weighted median estimator, MR-Egger regression, sample mode, weighted mode, and sensitivity analyses of Cochran's Q test, MR-PRESSO, leave-one-out analysis, false discovery rate correction, and MR-Egger intercept test. We employed a bidirectional two-sample MR approach to explore the causal relationship between inflammatory proteins and AD.

Results: Our findings are mainly based on the IVW approach. Our results indicate that elevated levels of TNF-β (OR = 0.917, 95% CI = 0.862-0.975, p = 0.006) and IL-6 (OR = 0.941, 95% CI = 0.899-0.985, p = 0.009) are significantly associated with a reduced AD risk, while AD has no impact on the levels of the 91 inflammatory proteins selected in this paper. The results of the sensitivity analyses were robust.

Conclusion: Elevated levels of TNF-β and IL-6 exert a protective effect against the occurrence of AD.

Introduction: We aimed to identify cognitive subgroups of clinically diagnosed Alzheimer's disease (Alzheimer syndrome) and related dementias and test if age of presentation influences patterns of cognitive impairment.

Methods: Participants were individuals with mild cognitive impairment (n = 360), vascular mild cognitive impairment (n = 73), Alzheimer syndrome (n = 127), vascular dementia (n = 32), mixed dementia (n = 23), and healthy controls (n = 305). Principal component analysis was run on 25 cognitive variables measured by the Toronto Cognitive Assessment (TorCA). We used hierarchical clustering to identify cognitive subgroups.

Results: We identified seven subgroups. The youngest group was characterized by the lowest scores on the overall TorCA mean, and also on executive function, visuospatial function, and attention, while showing the highest scores on Memory, Orientation, and Language. The oldest clusters had low scores on Memory and Orientation but higher scores on attention. The intermediary clusters had similar age and severity distributions.

Conclusion: The results demonstrate that patterns of cognitive impairment are different in different age groups.

Introduction: The apolipoprotein E (APOE) gene is a well-established risk factor for Alzheimer's disease, with the APOE ε4 allele being the most strongly associated genetic variant. Research has suggested that the influence of APOE ε4 on cognitive decline may vary across different populations. This study aimed to investigate the relationship between APOE genotype and cognitive aging in Hispanics.

Methods: A diverse sample of Hispanic adults was recruited for a study on cognitive aging. Data were analyzed for n = 725 participants from the Panama Aging Research Initiative - Health Disparities (PARI-HD) study. Participants were divided into 2 groups, an outpatient cohort (n = 269) and a community cohort (n = 456) and underwent comprehensive neuropsychological assessments.

Results: A greater number of participants in the outpatient cohort were cognitively impaired than the community cohort, and the outpatient cohort had a significantly higher frequency of ε4 (33.8% vs. 25.7%). Results showed that carrying at least one copy of the APOE ε4 allele was a significant predictor of cognitive impairment in the community cohort (OR = 2.06, 95% CI = 1.14-3.72, p = 0.017) but was not significantly associated with performance on cognitive tests for either cohort.

Conclusion: These findings suggest that APOE ε4 confers risk for cognitive deterioration in the Panamanian population, highlighting the importance of considering genetic and demographic factors in understanding the heterogeneity of cognitive impairment.

Introduction: Mild cognitive impairment (MCI) is a growing global health concern that increases dementia risk in older adults, including those in Thailand. Using an eight-session Multi-Modal Cognitive Stimulation Program (MCSP) is an effective non-pharmacological intervention for slowing cognitive decline and improving cognition and quality of life (QOL).

Method: This randomized controlled trial examined the effects of an eight-session MCSP on cognition and QOL in Thai older adults with MCI. Sixty-six participants were randomized into intervention (n = 32) and control (n = 34) groups. Cognitive assessments included the Mini-Mental Statement Examination Thai version 2002, Consortium to Establish a Registry for Alzheimer's Disease, Color Trails Test, and Digit Span, alongside the QOL-AD. Principal component analysis was used to aggregate cognitive assessment scores. Demographic data were analyzed using chi-square and t tests, and analysis of covariance (ANCOVA) was employed for cognition and QOL outcomes.

Results: After the intervention, the MCSP group exhibited significantly higher cognitive and QOL scores than the control group. ANCOVA demonstrated that group, sex, age, education, and baseline scores significantly predicted changes in cognition and QOL outcomes. The intervention group showed significant improvements in overall cognition (F(1, 58) = 4.75, p = 0.033, ηp2 = 0.076) and QOL (F(1, 58) = 6.05, p = 0.017, ηp2 = 0.094).

Conclusion: An eight-session MCSP significantly improves cognition and QOL in Thai older adults with MCI, as assessed by a comprehensive cognitive battery and the QOL-AD, compared to a control group.

Introduction: Neuropsychiatric symptoms (NPS) are common in neurocognitive disorders. However, the differences in presentation of NPS in high-risk states for dementia such as mild neurocognitive disorder (Mild NCD) and remitted major depressive disorder (rMDD) remain unclear. The purpose of this study was to compare the frequency and factor structure of NPS in Mild NCD, rMDD, and Mild NCD with rMDD (Mild NCD-rMDD).

Methods: We analyzed baseline data from the multicenter Prevention of Alzheimer's Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression trial (NCT0238667). NPS were assessed using the Neuropsychiatric Inventory Questionnaire in those with Mild NCD, rMDD, and Mild NCD-rMDD. We compared the NPS frequency and factor structure across the three groups.

Results: Among 374 participants with a mean (SD) age = 72.0 (6.3) years, the overall frequency of any NPS was highest in Mild NCD-rMDD (75.9%), as compared to Mild NCD (63.5%) or rMDD (55.7%) groups (p = 0.014). Depression/dysphoria was the most common NPS in all three groups. In factor analyses, NPS grouped into four factor structures in all three groups, but the composition of factors of individual symptoms (delusions, motor disturbances, nighttime behaviors, anxiety, and apathy) were different.

Conclusion: NPS are common in high-risk states of dementia, and the frequency of NPS is higher in Mild NCD-rMDD as compared to only Mild NCD or rMDD. Further, there are key differences in presentation of NPS in Mild NCD, rMDD, and Mild NCD-rMDD. Future studies should investigate the relevance of these differences for cognition, function, and disease biomarkers.

Introduction: As global population aging intensifies, falls among older adults have emerged as a critical public health challenge. While evidence indicates sex differences in fall rates, few Chinese studies have examined sex-specific risk factors. This study aimed to investigate sex disparities and determinants of falls among Chinese adults aged 45 and above using data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: The research analyzed data on 9,284 participants from the fifth wave of the CHARLS. The study investigated the prevalence and associated factors of falls among older individuals, stratified by sex, using logistic regression analysis. Additionally, we examined the interactions between other covariates and sex.

Results: The prevalence of falls among the elderly population in China was 20.1%, with 23.12% among women and 14.99% among men (p < 0.001). Age, self-perceived health, mental health, sleep duration, alcohol consumption, social activity, bodily pain, and number of chronic diseases were correlated with falls in both sexes (p < 0.05), with no significant interaction (p > 0.050). Age over 80 years and having a chronic disease were significantly associated with falls in men (p < 0.05), but not in women (p = 0.163). The correlation between depression and falls was stronger in females than in males (p < 0.001), inverse in self-perceived health (p < 0.001) group. Females who drank alcohol had an increased prevalence of falls (p < 0.05). Taking part in social activities was correlated with falls in females (p = 0.002), but not in males (p = 0.738).

Conclusions: Falls are a serious health issue in China. There is an urgent need for prevention and intervention activities for older individuals, and these needs diverge along sex lines.

Introduction: Evaluating formal and informal care utilization in Alzheimer's disease (AD) is crucial for assessing the economic impact of novel disease-modifying treatments. The Resource Utilization in Dementia-Lite (RUD-Lite) scale is widely used to measure care utilization in dementia; however, RUD-Lite data are limited for mild cognitive impairment (MCI) and mostly from observational studies. We analyzed RUD-Lite data from a study of semorinemab (NCT03289143) in MCI (i.e., prodromal AD) and mild AD dementia (i.e., mild AD) to explore potential differences in care utilization between observational and interventional studies.

Methods: We analyzed cross-sectional and longitudinal RUD-Lite indices in prodromal (pAD: n = 160) and mild (mAD: n = 288) AD groups, examining formal care usage and informal caregiver time. Unadjusted and adjusted analyses were performed on longitudinal data. North American and European cohorts were compared to explore potential regional differences.

Results: More informal caregiving assistance was required for mAD versus pAD participants at baseline and the mAD group demonstrated significant greater increases over 18 months. Cross-sectional data indicated more caregiver assistance for instrumental activities of daily living in North America versus Europe, with comparable longitudinal increases in caregiver assistance across regions.

Conclusion: Longitudinal RUD-Lite changes in interventional early AD studies are detectable but smaller than in observational studies, possibly due to differences in cohort characteristics. These factors, along with subtle regional differences in care utilization, should be considered when using observational data to guide interventional trials.

Introduction: As a major contributor to dementia burden worldwide, Alzheimer's disease (AD) pathogenesis involves critical phosphorylated tau (p-tau) abnormalities. This research employed bibliometric methods to systematically evaluate worldwide scientific trends, emerging foci, and international collaboration patterns regarding p-tau in AD research.

Methods: Relevant publications spanning 1991-2024 from the Web of Science Core Collection were extracted. Bibliometric analysis was performed using R package "Bibliometrix" (v4.3.3), CiteSpace (v6.1.R2) and VOSviewer (v1.6.20).

Results: A total of 2,685 publications were included. China led in publication volume (612, 22.8%), followed by the USA (586, 21.8%) and Sweden (212, 7.9%). University of London was the most productive institution (603 publications). Blennow Kaj stood out with publications and citations of 270 and 18,093. The Journal of Alzheimer's Disease and Neurology were the top-ranked journal, with the highest publications (321) and citations (6,446), respectively. Cluster analysis revealed four major clusters, including mechanisms underlying p-tau in AD, p-tau as biomarker in AD, diagnosis of AD using p-tau, and consensus in AD. Keyword burst analysis emphasized recent terms such as "neurofilament light," "dysfunction," "performance," and "biomarker."

Conclusion: This study systematically analyzed the researches on p-tau in AD. Research hotspots have evolved from the early focus on pathological features to the exploration of biomarkers-based diagnosis. Recently, the comprehensive assessment AD is emphasized, suggesting that future studies should pay more attention to regulatory mechanism of abnormal p-tau for identification of therapeutic targets and overcome the challenges of p-tau as biomarkers during clinical diagnosis.

Introduction: Standard cognitive screening instruments such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) often fail to identify cognitive impairment in individuals with low literacy or no formal education as these tests rely heavily on reading, writing, and abstract reasoning. In Morocco and other low- and middle-income countries (LMICs), this limitation contributes to the under-recognition and diagnostic inaccuracy of dementia, particularly in communities with limited access to education or healthcare resources. The aim of the study was to develop and validate a culturally adapted, literacy-independent cognitive screening battery, the Jilla Moroccan Dementia Scale (J-MDS), specifically designed for use among adults with limited schooling in Morocco.

Methods: The J-MDS comprises 17 entirely oral and pictorial subtests assessing memory, attention, language, executive function, praxis, and orientation. A total of 109 participants were included (54 living with dementia and 55 cognitively healthy controls). Dementia diagnosis was established according to DSM-5 clinical criteria, which served as the gold standard. Psychometric properties of the J-MDS were compared with the Moroccan Arabic version of the MoCA (MoCA-Darija). Internal consistency, concurrent validity, and diagnostic accuracy were assessed following the STARDem guidelines.

Results: The J-MDS demonstrated excellent internal consistency (Cronbach's α = 0.936) and a strong correlation with the MoCA (ρ = 0.944, p < 0.001). Receiver operating characteristic analysis showed an area under the curve (AUC) of 0.986, with an optimal cutoff score of 82, yielding 98.15% sensitivity and 94.55% specificity for dementia detection. Test performance was unaffected by gender, moderately influenced by age and education level, and remained robust across literacy groups.

Conclusion: The J-MDS is a reliable, culturally relevant, and clinically feasible cognitive screening tool for low-literacy populations. Its strong psychometric performance and simple administration make it well suited for community and primary care settings in Morocco and comparable LMICs. Future multicentre and longitudinal studies are recommended to establish normative data and confirm its applicability across diverse cultural contexts.