Dementia and Geriatric Cognitive Disorders最新文献

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.

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: Elderly individuals with depressive symptoms often show increased susceptibility to mild cognitive impairment (MCI). This study explores the association between depressive symptoms and MCI among older adults in China.

Methods: Data from the Shanghai Brain Aging Study (SBAS) were used in this cross-sectional study. MCI was diagnosed through clinical assessments and Montreal Cognitive Assessment (MoCA) scores (≤23). Depressive symptoms were defined as a Geriatric Depression Scale (GDS) score of >10. Binary logistic regression and restricted cubic spline (RCS) analyses were conducted to evaluate the associations between depressive symptoms and MCI, adjusting for potential covariates.

Results: The study included 1,506 participants, with 43.6% diagnosed with MCI. Logistic regression analysis revealed a significant association between depressive symptoms and MCI. In the fully adjusted model, depressive symptoms were associated with a 65% higher likelihood of MCI (odds ratio: 1.65, 95% confidence interval: 1.17-2.34). RCS analysis indicated a significant non-linear relationship between depressive symptoms and MCI (p for non-linear = 0.029). Participants with depressive symptoms scored significantly lower on the MoCA subscores for visuospatial and executive function, as well as language abilities (all p < 0.05).

Conclusion: Our findings demonstrate a significant association between depressive symptoms and MCI, with depressive symptoms being linked to a higher prevalence of MCI. Early identification and intervention of depressive symptoms, including community screening, psychological therapies, or pharmacological treatments for older adults, may potentially mitigate cognitive decline. However, the cross-sectional design limits causal conclusions, and generalizability may be affected by self-reported depression measures and regional sampling.

Introduction: Studies have shown that quantitative EEG is useful in predicting conversion from mild cognitive impairment (MCI) to Alzheimer's disease dementia (ADD) and dementia with Lewy bodies (DLBs). As subcortical pathology is present and executive impairment is common in DLB, we hypothesized that EEG could predict conversion in patients with impaired executive function and any subcortical pathology.

Methods: We included 113 patients with MCI from 5 Nordic memory clinics, 80 (71%) with amnestic MCI, 17 (15%) with dysexecutive MCI (deMCI), 3 (3%) with aphasic, 2 (2%) with visuospatial, and 11 (10%) with unspecific MCI. Patients were examined with EEG in a resting state applying the statistical pattern recognition (SPR) method and followed up for 5 years. Eleven drop-outs were assessed after baseline. Receiver operating characteristic (ROC) analyses were used to examine the ability of EEG to predict conversion.

Results: Sixty patients converted to dementia, 47 to ADD, 8 to vascular dementia, 2 to DLB, 1 to frontotemporal dementia, and 2 to unspecific dementia. Eight (11%) recovered, and 45 (40%) remained MCI stable. ROC analyses revealed that EEG predicted conversion from deMCI to dementia with area under the curve of 0.92 (95% CI 0.76-100), sensitivity of 89%, and specificity of 100%. Subcortical pathology was present in 89% of the deMCI converters. EEG did not predict conversion from amnestic MCI to dementia.

Conclusion: This study demonstrates that quantitative EEG using the SPR method predicts conversion from deMCI to dementia disorders with subcortical pathology with high sensitivity and specificity.

Introduction: Cognitive function is key to aging and independence. Our aim was to evaluate the associations of domain-specific cognitive performance with disability and frailty. Understanding these associations can improve clinical decision-making and patient outcomes in aging populations.

Methods: This retrospective study was conducted at the Geriatric Outpatient Clinic at a tertiary hospital. Domains of the Standardized Mini-Mental State Examination and the clock drawing test were used for cognitive assessment. Clinical frailty scale (CFS), mini nutritional assessment short form (MNA), geriatric depression scale short form (GDS), activities of daily living (ADL), and instrumental activities of daily living (IADL) were used for geriatric assessment.

Results: Of the 274 patients, 65.3% (179) were women, and the mean age of patients was 77.9 (±7.3). While 32.8% of patients were frail according to CFS, 44.9% had IADL disability. The orientation and calculation-attention domains were associated with frailty and IADL disability, regardless of age, sex, education level, number of medications, number of diseases, MNA score, and GDS. On the other hand, the recall and executive function domains were not found to be associated with frailty or IADL disability While language domain was associated with both ADL and IADL scores in linear regression, it was only associated with ADL disability in binary regression analysis in all models.

Conclusion: Routine screening of language, orientation, and calculation-attention domains may help identify older adults at risk for frailty and disability, allowing for timely interventions.

Introduction: Previous studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. This study investigated the relationship between perceived stress and MCR in a community-based population.

Methods: The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of subjective memory complaints (SMCs) and slow gait speed.

Results: The average age of the study participants is 79.84 ± 4.34 years. The mean score of PSS-10 among participants is 10.32 (range = 0-33; [SD] = 5.71), with a median score of 10.00 (6.00, 14.00). The prevalence of MCR is 9.3%. In the logistic regression analysis, for each 1-SD (5.71) increase in the global PSS-10 score, the risk of MCR increased by 40% (95% CI 1.09-1.80). Additionally, in the aspect of two components of MCR, with a 1-SD increase (5.71) in the global PSS-10 score, there was a 50% (95% CI 1.29-1.75) increase in the risk of SMCs and a 27% (95% CI 1.04-1.55) increase in the risk of slow gait speed. In terms of specific walking speed, there was a reverse correlation between the global PSS-10 score and walking speed (r = -0.14, p < 0.001).

Conclusions: This study provided preliminary evidence that high levels of perceived stress were associated with the risk of MCR in a community-dwelling population.

Introduction: Recent introductions of disease-modifying treatments for Alzheimer's disease have re-invigorated the cause of early dementia detection. Cognitive "paper and pencil" tests represent the bedrock of clinical assessment, because they are cheap, easy to perform, and do not require brain imaging or biological testing. Cognitive tests vary greatly in duration, complexity, sociolinguistic biases, probed cognitive domains, and their specificity and sensitivity of detecting cognitive impairment (CI). Consequently, an ecologically valid head-to-head comparison seems essential for evidence-based dementia screening.

Method: We compared five tests: Montreal cognitive assessment (MoCA), Alzheimer's disease assessment scale-cognitive subscale (ADAS), Addenbrooke's cognitive examination (ACE-III), euro-coin handling test (Eurotest), and image identification test (Phototest) on a large sample of seniors (N = 456, 77.9 ± 8 years, 71% females). Their specificity and sensitivity were estimated in a novel way by contrasting each test's outcome to the majority outcome across the remaining tests (comparative specificity and sensitivity calculation [CSSC]). This obviates the need for an a priori gold standard such as a clinically clear-cut sample of dementia/MCI/controls. We posit that the CSSC results in a more ecologically valid estimation of clinical performance while precluding biases resulting from different dementia/MCI diagnostic criteria and the proficiency in detecting these conditions.

Results: There exists a stark trade-off between behavioral test specificity and sensitivity. The test with the highest specificity had the lowest sensitivity, and vice versa. The comparative specificities and sensitivities were, respectively: Phototest (97%, 47%), Eurotest (94%, 55%), ADAS (90%, 68%), ACE-III (72%, 77%), MoCA (55%, 95%).

Conclusion: Assuming a CI prevalence of 10%, the shortest (∼3 min) and the simplest instrument, the Phototest, was shown to have the best overall performance (accuracy 92%, PPV 66%, NPV 94%).

Introduction: This study aimed to investigate the influence of case management and its corresponding computer-assisted assessment system on the quality improvement of dementia care.

Methods: This observational study enrolled 2029 patients and their caregivers at Changhua Christian Hospital in Taiwan. Physicians who made the diagnosis of dementia would introduce the patient and caregiver dyad to the case manager-centered collaborative care team after obtaining agreement. The achievement rates of 11 quality indicators (QIs) comprising timely diagnostic evaluations, regular screens of cognition and neuropsychiatric symptoms, caregiver support, and proper medication prescriptions were counted. Different timeframes (≤4 months, 4 months-1 year, 1-2 years, 2-3 years, or ≥3 years) from diagnosis of dementia to collaborative care intervention were compared.

Results: A significantly higher attainment rate was achieved for patients with earlier entry into the collaborative team model, including QIs about timely diagnosis and regular screening, and caregiver support. The QIs regarding dementia medication prescriptions and documentation of the risk of antipsychotics remained similar regardless of the time of entry into the model. The completion rates of QIs also improved after the information system was launched.

Conclusions: Physician-case manager co-management in the setting of a collaborative care model with a computer-assisted assessment system helps improve QI achievement for dementia care.

Introduction: The safety and therapeutic effects of Gingko biloba extract EGb 761® to treat cognitive decline have been demonstrated in numerous clinical trials. However, trials in Indian populations have been lacking.

Methods: This open-label, multicenter, single-arm, phase IV trial enrolled 150 patients aged ≥50 years with major neurocognitive disorder due to Alzheimer's disease, major vascular neurocognitive disorder, or mixed forms of both according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and a Mini-Mental State Examination (MMSE) score of 12-24. Patients took 120 mg EGb 761® twice daily for 18 weeks. Therapeutic effects were assessed by CERAD constructional praxis and recall of constructional praxis (CERAD CP, CERAD recall of CP), Trail-Making Test (TMT), Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD), Clinical Global Impressions (CGI) scale, and 11-point box scales for tinnitus and vertigo. Safety assessment was based on the occurrence of adverse events as well as changes in clinical, laboratory, and functional parameters.

Results: After 18 weeks, significant improvements compared to baseline were found in constructional praxis (CERAD CP, p < 0.0001), memory (CERAD recall of CP, p < 0.0001), speed and executive functioning (TMT A, p < 0.0001; TMT B, p < 0.0001), and behavioral symptoms (BEHAVE-AD, p < 0.0001). Forty-five adverse events were reported in 33 (22.0%) patients in total, including ten presumed adverse drug reactions in 9 (6.0%) patients. Headache and diarrhea of mild-to-moderate severity were the most frequent events. Two serious adverse events, both considered unrelated to the study drug, occurred in 2 (1.3%) patients.

Conclusion: This study confirmed the favorable safety profile and suggested therapeutic benefits of EGb 761® in Indian patients with major neurocognitive disorder.