Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Amnestic mild cognitive impairment (aMCI) represents an intermediate stage between normal aging and dementia. Hyperbaric oxygen (HBO) therapy has shown promise in enhancing brain oxygenation and promoting neural stem cell proliferation.

Methods: Eighty SD male adult rats were randomly divided into control group, amnestic mild cognitive impairment group (aMCI group), and hyperbaric oxygen group (HBO group). The HBO group was divided into 6 subgroups according to different treatment pressures: 1.6 ATA subgroup, 1.8 ATA subgroup, 2.0 ATA subgroup, 2.2 ATA subgroup, 2.5 ATA subgroup, and 2.8 ATA subgroup, with 10 in each group. The HBO group received HBO therapy at the specified pressure for 60 min per day for 5 consecutive days.

Results: After HBO treatment, compared with the aMCI group, the escape latency of each HBO subgroup was significantly shortened (p < 0.001). The 2.0 ATA subgroup (p = 0.001), 2.2 ATA subgroup (p = 0.001), and 2.5 ATA subgroup (p = 0.002) significantly increased the number of platform crossings. The levels of superoxide dismutase were significantly increased in 1.6 ATA subgroup (p = 0.019), 1.8 ATA subgroup (p = 0.003), 2.0 ATA subgroup (p = 0.010), and 2.2 ATA group (p = 0.016) and malondialdehyde contents were significantly decreased in the 1.6 ATA subgroup (p = 0.015), 1.8 ATA subgroup (p = 0.012), 2.0 ATA subgroup (p = 0.002), and 2.2 ATA subgroups (p < 0.001), and the levels of endothelial nitric oxide were significantly decreased in the 1.8 ATA subgroup (p = 0.007) and 2.0 ATA subgroup (p = 0.029), and the expression of neuronal nitric oxide were significantly decreased in the 1.8 ATA subgroup (p = 0.006), 2.0 ATA subgroup (p < 0.001), and the 2.2 ATA subgroup (p < 0.001).

Conclusion: In aMCI model rats, HBO treatment at a pressure of 2.0 ATA with a stabilization time of 60 min per day for 5 days was the most effective.

Introduction: Brief cognitive tests like the RUDAS are useful for early detection of neurodegenerative diseases, especially in low-literacy populations in low- and middle-income countries. This study assesses the diagnostic performance of the RUDAS by subdomains to detect MCI and dementia in illiterate individuals in Lima, Peru.

Methods: We performed a secondary analysis of a cohort of randomly selected illiterate individuals, recruited for validation of RUDAS in Lima, Peru. We compared the RUDAS domain and total scores to a battery of neuropsychological tests (FDS, BDS, ROCF, MINT and Craft 21) using a Spearman correlation coefficient. For diagnostic performance, we calculated the area under the curve (AUC) for each RUDAS domain.

Results: We included 187 patients (64 controls, 60 MCI, and 63 dementia patients). Average RUDAS score was 23.87 ± 0.93, 20.43 ± 1.39, and 14.97 ± 2.21, respectively. Differences were statistically significant between groups for all domains, except for ideomotor praxis and visuo-spatial praxis. For convergent validity, most significant correlations from the bivariate analysis remained in the age-adjusted regression, particularly for praxis, memory, and judgment. The total RUDAS score had an AUC of 98% (95% CI: 96-100%) for both MCI and dementia, by domains, judgment, verbal fluency, and memory AUC ranging from 0.7 to 0.8.

Conclusions: Our study showed the RUDAS domains of visuo-spatial orientation and memory had an excellent diagnostic performance for the detection of dementia. However, further research is needed to validate the use of individual RUDAS items for assessing specific cognitive domains.

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: 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: Neuropsychiatric symptoms (NPS) such as increased apathy, affective symptoms, psychosis and hyperactivity are common in Alzheimer's disease (AD) and are associated with increased disease severity and caregiver burden. In contrast to well-characterized associations between AD-related cognitive deficits and focal neuropathology (e.g., memory and hippocampal atrophy), fewer studies have focused on associations between NPS-brain associations in AD. Furthermore, studies focusing on magnetic resonance imaging measures of gray matter (GM) abnormalities associated with NPS in AD have not been systematically reviewed.

Methods: To address this gap, a systematic literature review was undertaken to identify articles that assessed structural brain differences associated with NPS in AD. This review identified 29 such articles that tested associations between NPS and gray matter loss (GML: reduced GM density, reduced GM volume, decreased cortical thickness, etc.).

Results: Across all NPS, most symptoms were associated with GML in the prefrontal cortex and medial temporal lobe, highlighting key limbic/limbic adjacent structures including orbitofrontal cortex and parahippocampal regions. Other regions exhibiting associations included the superior and middle temporal gyri as well as anterior and posterior cingulate cortex.

Conclusion: Understanding how GM changes in the brain relate to NPS in AD may not only improve our understanding of NPS and AD but may also provide help identify homologies/correspondence with brain changes in psychiatric diseases.

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: Given the elevated dementia risk in underrepresented demographic groups in the USA - particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals - it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library, and CINAHL. We explored the percent White participants for trials using versus not using a specific eligibility criterion or recruitment strategy using Hodges-Lehmann median difference estimation.

Results: Of forty-four studies meeting the inclusion criteria, twenty-seven reported on racial/ethnic diversity. Analyses demonstrated that criteria regarding cardiovascular disease, pulmonary disease, hearing impairment, and sedentary lifestyle were associated with relatively high participant diversity, while gastro-intestinal/liver disease, motivation to participate, and language proficiency criteria were associated with relatively little diversity. Information on recruitment strategies was often lacking. Three studies described recruitment efforts explicitly aimed at increasing diversity. Recruitment strategies associated with relatively high racial/ethnic diversity included recruitment via referral/word-of-mouth, television/radio advertising, and recruitment at church.

Conclusion: Eligibility criteria could be improved by revisiting and revising how they are defined (e.g., motivation to participate). Regarding recruitment, several recommendations are provided, including (1) lifting barriers to study participation (e.g., through reimbursement), (2) collaborating with community partners, and (3) formally studying the effectiveness of recruitment strategies.

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.