Dementia and Geriatric Cognitive Disorders Extra最新文献

Introduction: Due to the ongoing outbreak of the coronavirus disease 2019 (COVID-19), it is currently difficult to conduct in-person exercise classes. We thus started the program of an online physical exercise with musical accompaniment. Several interesting differences were found in the characteristics of the online participants compared with our previous in-person interventions.

Participants and methods: The total number of subjects was 88 (71.2 ± 4.9 years old; male 42, female 46). The questionnaire included the attributes of the participants, the perceived advantages of the exercise classes, and the presence or absence of noticeable changes in cognitive and physical function after participating in the classes.

Results: The personal computers used to attend the online classes were operated by the participants themselves. About 42% of the participants felt that their sense of day of the week and volition were improved by attending the exercise classes for 3 months. The most frequent answer to the reason for participation was because it was free (81.8%). The second most frequent answer was because the classes were held online (75.0%). Almost half of the participants answered that they would not participate if it was held in person because of the risk of COVID-19 infection (75.0%) and the difficulty getting to the site where the exercise classes were held (59.1%).

Conclusion: Online physical exercise with musical accompaniment improved the perceived orientation, volition, activity, exercise habits, and health condition in 30-40% of the participants and also stimulated greater participation by males compared to classes held in person.

Introduction: Early detection and intervention are important to prevent dementia. Gait parameters have been recognized as a potentially easy screening tool for mild cognitive impairment (MCI); however, differences in gait parameters between cognitive healthy individuals (CHI) and MCI are small. Daily life gait change may be used to detect cognitive decline earlier. In the present study, we aimed to clarify the relationship between cognitive decline and daily life gait.

Methods: We performed 5-Cog function tests and daily life and laboratory-based gait assessments on 155 community-dwelling elderly people (75.5 ± 5.4 years old). Daily life gait was measured for 6 days using an iPod-touch with an accelerometer. Laboratory-based 10-m gait (fast pace) was measured using an electronic portable walkway.

Results: The subjects consisted of 98 CHI (63.2%) and 57 cognitive decline individuals (CDI; 36.8%). Daily life maximum gait velocity in the CDI group (113.7 [97.0-128.5] cm/s) was significantly slower than that in the CHI group (121.2 [105.8-134.3] cm/s) (p = 0.032). In the laboratory-based gait, the stride length variability in the CDI group (2.6 [1.8-4.1]) was significantly higher than that in the CHI group (1.8 [1.2-2.7]) (p < 0.001). The maximum gait velocity in daily life gait was weakly but significantly correlated with stride length variability in laboratory-based gait (ρ = -0.260, p = 0.001).

Conclusion: We found an association between cognitive decline and slower daily life gait velocity among community-dwelling elderly people.

Introduction: Case managers can guide caregivers during their search for care for relatives with neurocognitive disorders. The present study aimed to evaluate the effects of this procedure on caregiver burden and quality of life.

Methods: Family caregivers searching for care at a memory clinic before the first consultation were provided written information and they provided verbal consent to participate in this pre-post intervention study. Intervention was a structured pre-consultation phone call interview given by the case manager to inform and organize individualize pathway of care. The mini-Zarit Burden Interview and the EuroQol five-dimensional questionnaire quality of life scores were recorded by an independent assessor before the intervention and 1 month thereafter. An expectation questionnaire was also completed during the assessments. The pre and post scores were compared using the Wilcoxon signed-rank test.

Results: In total, 45 participants were enrolled and 35 were assessed twice. There was no significant change in the total mini-Zarit Burden Interview score; however, the levels of stress due to caring and meeting familial responsibilities (p = 0.025), and the fear of what the future holds for the participants' relative (p = 0.01) was lower at 1 month. The need for information about the pathways of care decreased, but no change in support satisfaction was observed. Quality of life was good and did not change.

Conclusions: During the pre-consultation intervention, the case manager may fulfill several needs of caregivers, particularly to obtain personalized information, which should be implemented in memory clinics.

Aim: We aimed to investigate differences in the awareness of instrumental activities of daily living (IADL) disability between elderly patients with and without dementia requiring care.

Methods: We assessed 25 elderly individuals requiring care and their primary caregivers using the Lawton IADL scale, with score differences between the patients and their caregivers representing the level of impaired awareness of IADL disability.

Results: Among the participants, 80% exhibited impaired awareness of IADL disability. In terms of total score on the Lawton scale, there was no between-group difference in the occurrence of impaired awareness of IADL disability (p = 0.274, φ = 0.31). Contrastingly, regarding the subitems of the Lawton scale, the dementia group had a significantly higher number of participants with impaired awareness of responsibility for their own medications than the nondementia group (p = 0.030, φ = 0.47). Further, there were no significant between-group differences in the ability to use telephone, shopping, mode of transportation, or ability to handle finances.

Conclusions: It is important for caregivers to notice the emergence of impaired awareness among the elderly as soon as possible to ensure early diagnosis and treatment. The results of this study suggest the need for caregivers to take care of the elderly patients with the perspective that they may develop impaired awareness of responsibility for their own medications.

Introduction: Alzheimer's disease (AD) and cerebral small vessel disease (CVSD) both contribute to age-related cognitive decline but can be difficult to clinically distinguish at early stages. At mild cognitive impairment (MCI), we investigated brain MRI volumetric differences in white matter hyperintensities (WMH), frontal and temporal lobe volumes between neuropathologically defined groups of cerebral arteriolosclerosis alone (pARTE), AD alone (pAD), and mixed (ADARTE).

Methods: From the National Alzheimer's Coordinating Center, we defined neuropathology groups of pARTE (n = 18), pAD (n = 36), and ADARTE (n = 55) who had MRI brain volumetrics within 1 year of clinical evaluation with Clinical Dementia Rating score of 0.5, corresponding to MCI. We included moderate-to-severe arteriolosclerosis and/or ABC score 2-3 for AD, after excluding other major neuropathologies. We compared WMH and frontal and temporal lobe volumes between neuropathology groups using regression analysis.

Results: Adjusted regression models show AD-related groups associated with less WMH when compared to pARTE (pAD adjusted odds ratio (aOR) (95% confidence interval [CI]): 0.94 (0.90-0.98); ADARTE aOR (95% CI): 0.96 (0.93-0.99)). The mixed pathology group, but not pAD, had smaller right temporal lobe volumes than pARTE (pAD aOR [95% CI]: 0.86 [0.74-1.00]; ADARTE aOR [95% CI]: 0.83 [0.72-0.96]). There were no differences in frontal lobe volumes.

Discussion/conclusions: Findings from this neuropathologically confirmed cohort suggest volumetric differences in WMH and temporal lobe volumes between AD- and CVSD-related MCI. Moreover, our results suggest a differential atrophy susceptibility of the right versus left temporal lobe to the additive effect of AD and vascular pathologies.

Background: Cognitive aging is a complex phenomenon, which comprises various cognitive skills, broadly categorized into fluid and crystallized intelligence. Crystallized intelligence (gc) tends to be maintained, as opposed to fluid intelligence (gf), which tends to decline rapidly with age. The association of the two with cognitive decline remains a matter of conjecture requiring further research.

Aim: The aim of the study was to identify the variables of gc and gf from a population data of Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study and investigate its relationship with the onset of cognitive impairment using discrepancy analysis against neuropsychological tests.

Methods: This analysis of data from LASI-DAD study was carried out on a sample of 3,223 participants. They were assessed on extensive thirteen cognitive tests and one subjective test of cognition. Standardized score was used for discrepancy analysis. Fluid ability minus crystallized ability was used to assess the cognitive impairment. Any statistical significance with the score difference >0.99 SD was defined as a presence of cognitive decline. Hindi Mental Status Examination (HMSE) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used as gold standard.

Results: With increased discrepancy score, each cognitive parameter score declined which was found to be statistically significant. In HMSE (Normal = 25.81 ± 3.39; Impaired = 23.17 ± 3.54; p = <0.001), there was a drop of 2 point scores in identifying cognitive impairment in the population sample as per the gold standard. A similar trend was evident in other neurocognitive domains as well.

Conclusion: Crystallized-fluid intelligence discrepancy analysis has a strong potential in predicting the onset of cognitive decline ahead of time, facilitating early intervention.