Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Despite the high prevalence of cognitive impairment or dementia post-coronary artery bypass grafting (CABG), the incidence of cognitive impairment or dementia post-CABG in contemporary practice is currently unclear. Therefore, this paper aims to investigate the incidence and associated risk factors of cognitive impairment or dementia in patients' post-CABG.

Methods: A systematic search across three databases (PubMed, SCOPUS, and Embase) was conducted for studies published in or after 2013 that reported cognitive impairment or dementia post-CABG. Subgroup analyses and meta-regression by risk factors were performed to determine their influence on the results.

Results: This analysis included 23 studies with a total of 2,620 patients. The incidence of cognitive impairment or dementia less than 1 month, 2 to 6 months, and more than 12 months post-CABG was 35.96% (95% confidence interval [CI]: 28.22-44.51, I2 = 87%), 21.33% (95% CI: 13.44-32.15, I2 = 88%), and 39.13% (95% CI: 21.72-58.84, I2 = 84%), respectively. Meta-regression revealed that studies with more than 80% of the cohort diagnosed with hypertension were significantly associated with incidence of cognitive impairment or dementia less than 1 month post-CABG.

Conclusion: This meta-analysis demonstrates a high incidence of cognitive impairment or dementia in patients' post-CABG in contemporary practice, particularly less than 1 month post-CABG and more than 12 months post-CABG. We found that hypertension was a significant risk factor in the short-term (less than 1 month) follow-up period for cognitive impairment or dementia post-CABG. Future research should be done to assess strategies to reduce cognitive impairment post-CABG.

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.

Introduction: Creutzfeldt-Jakob disease (CJD) is a rare, neurodegenerative disorder that is incurable, always fatal, and transmissible. EEG is an integral part of the diagnostic workup with typical periodic sharp wave complexes indicative of CJD, but early in the disease EEG is often unaltered. Accordingly, we aimed at evaluating disruption of brain network functional connectivity (FC) in regions belonging to the default mode network (DMN) as a potential early marker in CJD when EEG is considered visually normal.

Methods: EEGs considered visually normal obtained from 7 CJD patients were compared to EEGs of 7 patients with subjective cognitive impairment (SCI) using Brainstorm application for MATLAB. FC was calculated using the phase locking value separately for the delta-, theta-, alpha-, and beta-frequency band. The global efficacy of the DMN was calculated as the inverse characteristic path length with brain regions belonging to the DMN as nodes.

Results: CJD versus SCI had significantly lower global efficacy of the DMN in the gamma band. FC was decreased between bilateral orbitofrontal regions and the right parahippocampal gyrus and between bilateral orbitofrontal gyrus and the right anterior cingulate gyrus in CJD.

Conclusion: Our findings provide evidence of disruption of the DMN in the gamma band and alterations of FC between specific brain regions in early CJD patients with visually normal EEGs. EEG brain network properties bear potential as a diagnostic tool for CJD early in the disease course in addition to established criteria. These findings call for further studies evaluating the diagnostic value of FC in early CJD.

Introduction: Emergency department (ED) screening for cognitive impairment (CI) is crucial for early intervention, yet guidance on dementia screening protocols remains limited. Our objective was to assess the concordance between the Ascertain Dementia 8 (AD8) tool, a brief screening tool for CI, administered to ED patients and their informants.

Methods: We conducted a prospective observational study of dyads, including patients ≥65 years without a diagnosis of dementia seeking care in the ED and their informants (e.g., family, friend with close contact). Trained research assistants used the 4AT to exclude patients with concern for delirium. The AD8 was then administered to blinded patients (pAD8) and informants (iAD8), with scores ranging from 0 to 8 and scores of ≥2 indicating CI. We used the intraclass correlation coefficient (ICC) to calculate the level of agreement between AD8 scores.

Results: Our analytic sample included 538 dyads, of which 63.3% of patients were female with a mean age of 73.5 years. A total of 131 (24.3%) patients without a diagnosis of dementia self-identified as having CI using the pAD8, in comparison to 110 (20.4%) informants using the iAD8. The ICC of 0.519 (95% CI 0.454-0.578) indicated moderate agreement between pAD8 and iAD8 scores.

Conclusions: When seeking emergency care, one in four older adults without a diagnosis of dementia and approximately 20% of informants indicated that patients were cognitively impaired. Our finding of moderate agreement between the pAD8 and iAD8 has important implications for clinicians providing care to patients with suspected CI and investigators conducting dementia-related studies.

Introduction: Obstructive sleep apnea (OSA) is associated with subjective cognitive decline (SCD) and increased risk of cognitive decline and dementia. These relations are understudied in ethnoracially diverse groups. We examined associations among self-reported OSA risk, SCD, and cognitive performance in community-dwelling older Latinos. High OSA risk was hypothesized to be associated with greater SCD and worse cognitive performance.

Methods: 112 participants (40 female) from the Boston Latino Aging Study (BLAST) were included (Mage = 67.0 years [SD = 8.0]; Meducation = 11.0 years [SD = 5.1]). Participants completed the Preclinical Alzheimer's Cognitive Composite-5 (PACC5; z-scores), the Berlin Questionnaire (high vs. low OSA risk), and the Cognitive Function Instrument (SCD). The Mini-Mental State Examination (MMSE) indexed global cognition. Hierarchical regressions assessed associations among OSA risk, SCD, and cognitive performance while controlling for demographics. t tests examined demographic and cognitive differences between those at high/low OSA risk.

Results: On average, participants had an MMSE score of 25.9 (SD = 3.7, range 11-30; 37 participants with MMSE <26) and mild SCD (CFI; M = 4.2 [3.6]). OSA risk did not predict SCD (β = 0.09, p = 0.33) or PACC5 performance (β = 0.01, p = 0.92). No differences in SCD or PACC5 performance were observed between those at low versus high OSA risk (p's ≥ 0.21).

Conclusion: Preliminary findings suggest that self-reported OSA risk may not signal cognitive decline risk for older Latinos. Questionnaires screening for OSA may need to be used in tandem with other assessments to identify those experiencing early cognitive decline. More work with larger sample sizes is needed; BLAST data collection is ongoing.

Introduction: The aim of the study was 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 (odds ratio = 3.18, 95% confidence interval [95% CI; 1.60, 6.33], p < 0.01), a lower UPDRS III score (mean difference [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 (standardized MD = 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 2,798 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 the 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 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 quantified using Q statistics from χ2 tests and I2 statistics. Outcome analysis was conducted using a random-effects model, and the standardized mean difference, mean difference, and 95% confidence interval were calculated.

Results: A total of 24 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 h of therapy.

Background: 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 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.