Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Cognitive decline causes disability and dependence in older people, affecting the individuals, families, and society. This study aimed to use a gamified smart test, the CogMate™ assessment, to measure the cognitive function of community-dwelling older people and compare the test with the Mini-Mental State Examination (MMSE).

Methods: We recruited 150 older people for testing with two cognitive assessment tools, the MMSE and CogMate™. After completing data collection, we conducted descriptive and inferential statistical analyses.

Results: The MMSE results showed that only 38% (n = 57) of participants had normal cognitive function and their mean brain age was 79.31 ± 9.00 years, 4.41 years more than the actual mean age. Common factors affecting both MMSE and CogMate™ tests included age, education level, marital status, and health status. The weighted kappa of the MMSE and CogMate™ scores for two categories (participants with normal and impaired cognitive function) showed moderate consistency (correlation coefficient, 0.522) and the Pearson product-moment correlation coefficient showed moderately significant positive correlation (r = 0.480). The CogMate™ brain age and difference in brain age test results showed moderately significant negative correlation with the MMSE results. Receiver operator character curve analysis using the MMSE for validation yielded an area under the curve value of 0.736, showing that the CogMate™ tool had good cognitive function prediction results.

Conclusion: CogMate™ is an interesting and simple gamified tool that demonstrates moderate consistency with the MMSE. It can replace the MMSE as a community cognitive screening tool, help community care centers, and identify older people with potential cognitive decline early for referral to interventional medical centers.

Introduction: This study aimed to assess the diagnostics and ecological validity of the Parkinson's Disease Cognitive Rating Scale (PD-CRS) within an Italian cohort of non-demented Parkinson's disease (PD) patients.

Methods: N = 128 non-demented PD patients were administered the PD-CRS, Montreal Cognitive Assessment (MoCA), and Parkinson's Disease Cognitive Functioning Rating Scale (PD-CFRS). Receiver-operating characteristic analyses were performed to explore the diagnostics of both raw and adjusted PD-CRS scores, by operationalizing the positive state as a below-cut-off MoCA score. Correlational analyses were run to test the ecological validity of the PD-CRS against the PD-CFRS.

Results: Both raw and adjusted PD-CRS scores accurately identified patients with a defective MoCA scores (AUC = 0.84-0.85), yielding optimal diagnostics. A cut-off of <73.93, as identified on demographically adjusted PD-CRS scores, yielded the best diagnostics (sensitivity = 0.70; specificity = 0.89; positive and negative predictive values = 0.83 and 0.79; positive and negative likelihood ratios: 6.23 and 0.37: number needed for screening utility: 0.78). The PD-CRS was related to the PD-CFRS (r_s = -0.24; p = 0.018).

Conclusions: The Italian PD-CRS is a diagnostically sound and ecologically valid screener for cognitive impairment in non-demented PD patients.

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: 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: 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 inquired 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: In this systematic review, we aimed to identify suitable assessment and measurement tools for screening individuals for cognitive impairment and Alzheimer's disease (AD). We conducted a comprehensive evaluation of the reliability and validity of cognitive function assessment instruments. Based on our findings, we offer insightful suggestions for further research on cognitive function scale development and clinical researchers in AD.

Methods: We searched the PubMed and CNKI databases for community-based studies aimed at developing or evaluating the validity or reliability of cognitive function assessment scales. Only studies written in English and Chinese that reported the development of cognitive function assessment scales and/or the validation of cognitive impairment severity in patients with cognitive impairment and AD were eligible for inclusion. The methodological quality of the studies, based on reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., construct validity), was assessed using the consensus-based standards for the selection of health measurement instruments (COSMIN) according to the "worst score counts" principle. Subsequently, the measurement properties were rated qualitatively. Results were summarized and rated using the modified Grading of Recommendations, Assessment, Development, and Evaluation. Based on the results, recommendations were categorized into four levels: A, B, C, and D.

Results: We retrieved a total of 804 studies. Following screening, a total of 62 articles were included, which reported 49 cognitive impairment assessment scales. The methodological quality of studies ranged from inadequate to very good, and the measurement properties varied from sufficient (+) to indeterminate (?). We found that the AD Assessment Scale-cognitive subscale (ADAS-Cog), Montreal Cognitive Assessment (MoCA), Baylor Profound Mental Status Examination (BPMSE), Clinical Dementia Rating (CDR), and the other 28 scales had sufficient validity and reliability.

Conclusion: Our evaluation according to the COSMIN guidelines suggested that the ADAS-Cog, MoCA, BPMSE, CDR scale, and Mini-mental State Examination could be used to assess the degree of cognitive impairment in patients with AD. When developing cognitive function assessment scales, factors such as time and linguistic and cultural differences could be carefully considered.

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: 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: 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.