Dementia and Geriatric Cognitive Disorders最新文献

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: 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: 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: 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.

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.