Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Timely detection of cognitive impairment such as mild cognitive impairment (MCI) or dementia is pivotal in initiating early interventions to improve patients' quality of life. Conventional paper-pencil tests, though common, have limited sensitivity in detecting subtle cognitive changes. Computerized assessments offer promising alternatives, overcoming time and manual scoring constraints while potentially providing greater sensitivity.

Methods: A literature search yielded 26 eligible articles (2020-2023). The articles were reviewed according to PRISMA guidelines, and the computerized tools were categorized by diagnostic outcome (MCI, dementia, combined).

Results: The subjects included in the studies were aged 55-77 years. The overall gender distribution comprised 60% females and 40% males. The sample sizes varied considerably from 22 to 4,486. Convergent validity assessments in 20 studies demonstrated strong positive correlations with traditional tests. Overall classification accuracy in detecting MCI or dementia, distinguishing from normal cognition (NC), reached up to 91%. Impressively, 46% of the studies received high-quality ratings, underscoring the reliability and validity of the findings.

Conclusion: The review highlights the advancements in computerized cognitive assessments for assessing MCI and dementia. This shift toward technology-based assessments could enhance detection capabilities and facilitate timely interventions for better patient outcomes.

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: White matter hyperintensity (WMH) is associated with cognitive impairment, although the clinical significance of WMH remains unclear. We aimed to elucidate the clinical significance of WMH volume and whether a fully automated quantitative analysis of WMH would be an effective marker of cognitive function.

Methods: Patients with suspected cognitive impairment were retrospectively examined. Clinical data, including patient information, neuropsychological examinations, diagnoses of dementia disorders, and fluid-attenuated inversion recovery (FLAIR) images, were collected. Patient information included sex, age, and educational level. Neuropsychological examinations included the Mini-Mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J). WMH volumes were analyzed from FLAIR images using a fully automatic analysis software. The relationship between WMH volume and clinical data was investigated.

Results: WMH volume was analyzed using 889 FLAIR cases. The WMH volume did not differ significantly between the sexes. WMH volume showed a positive correlation with age. Multiple comparison tests showed no significant difference in WMH volume between junior high school and high school graduates, but all other differences were significant. Multiple comparison tests revealed significant differences in mean WMH volume among all groups in the classified MMSE. The Mann-Whitney U test revealed significant differences in WMH volume between the two groups. Multiple comparison tests revealed significant differences in WMH volume among all the groups of classified diagnostic results.

Conclusion: Quantitative analysis of WMH volume from FLAIR images may provide useful information for dementia treatment and may be effective as a new marker in cognitive function examinations.

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: 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: Dementia represents a global public health challenge, and no conclusive evidence exists on how to prevent its onset or at least reduce its risk. This umbrella review aimed to identify interventions or exposures that can reduce the incidence of dementia or cognitive impairment.

Methods: A search of meta-analyses and systematic reviews published from 2018 to 2025 (January) was conducted across four databases. Articles assessing associations between interventions or exposures to protective factors and incidence of dementia or cognitive decline in non-demented older adults were selected.

Results: Out of 6,324 articles, 177 underwent full-text screening, and 17 were included. They showed that psychosocial factors (social engagement, purpose in life, life satisfaction, and cognitive reserve) and influenza vaccination protect against dementia. Evidence on antihypertensives is promising, while evidence on low-dose aspirin is promising yet inconclusive. No clear results emerged for both single- and multi-domain lifestyle interventions.

Conclusions: These results offer new insight on potential targets for dementia prevention, a global public health priority. In particular, favorable psychosocial factors and influenza vaccination, undervalued in the scientific debate on dementia prevention, emerged as promising and feasible targets for preventive initiatives. Future research should focus on fine-tuning interventions to promote brain health, exploring their underlying mechanisms, and developing targeted and personalized strategies for specific population subgroups.

Introduction: This study evaluated the psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the USA.

Methods: Data were obtained from the Health and Aging Brain Study - Health Disparities (HABS-HD; N = 1,691, age = 66.5 ± 8.7, education = 12.4 ± 4.8, 60.6% female, 33.2% MA Spanish speaking). Unidimensionality of the SMCQ was evaluated with confirmatory factor analysis. Differential item functioning (DIF) of the SMCQ was assessed across age, sex, education, and ethnicity/language using item response theory/logistic ordinal regression. Associations of the SMCQ in relation to cognitive status, Alzheimer's disease (AD) blood-based biomarkers, and psychological distress were examined.

Results: The SMCQ showed excellent fit in a single-factor model (CFI = 0.97, TLI = 0.97, RMSEA [95% CI] = 0.05 [0.04, 0.05], SRMR = 0.07). Significant item-level DIF was detected by education level and ethnicity/language, but not by age or sex; when detected, DIF was not salient (i.e., adverse). The SMCQ was associated with greater psychological distress, worse Clinical Dementia Rating scores, and greater disease burden as measured by total tau and neurofilament light.

Conclusions: Practically negligible item-level bias was identified across education and ethnicity/language. Detected DIF can be described as benign, indicating that some items manifested differently between groups but had minimal impact on measurement properties. These results demonstrate that the SMCQ performs appropriately across demographic variables. Our findings also provide support for the associations of SMCQ scores with self-reported mood, cognitive status, and AD blood-based biomarkers.

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: Alzheimer's disease dementia (ADD) is a common cognitive disease in Japan. Mild cognitive impairment (MCI) is regarded as an early, but abnormal state of cognitive impairment, and amnestic MCI (aMCI) as a precursor of ADD. The Revised Hasegawa Dementia Scale (HDS-R) and the similar Mini-Mental State Examination (MMSE) are quick cognitive assessments widely used in Japan. Behavioral and psychological symptoms of dementia (BPSD) are commonly assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). However, when the different types of BPSD appear and how they progress with the progression of ADD is not clear.

Methods: A total of 553 outpatients with ADD or aMCI participated. We divided the patients into six cognitive function groups. We examined the relationship between the individual NPI-Q domain scores and cognitive function to reveal the appearance and progression of BPSD. We also examined the relationship of the NPI-Q domains with the HDS-R and MMSE domains to reveal the cognitive functions that affect the BPSD.

Results: Our results suggested that hallucinations, agitation/aggression, anxiety, irritability/lability appeared in association with high MMSE scores and progressed slowly. Apathy/indifference and aberrant motor behaviors appeared in association with middle MMSE scores and progressed slowly. Delusions and nighttime behavior disturbances appeared in association with high MMSE score and progressed consistently with the ADD. Memory and orientation were the cognitive functions most related to NPI-Q domain scores and thus to progression of BPSD.

Conclusions: Memory and orientation may be the most important cognitive functions related to the progression of BPSD in patients with ADD.