Dementia and Geriatric Cognitive Disorders最新文献

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.

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: 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.