Dementia and neurocognitive disorders最新文献

Background and purpose: The Seoul Cognitive Status Test (SCST) is a brief (~30 minutes), tablet-based battery that yields domain-specific and composite scores and uses automated scoring for rapid result generation, reduced examiner burden, and scalability for large or longitudinal assessments. We evaluated the SCST's psychometric and diagnostic performance against multidisciplinary final clinical diagnoses derived from a multidimensional workup.

Methods: We conducted a cross-sectional diagnostic study of 777 outpatients (SCST-Seoul Neuropsychological Screening Battery [SNSB] n=639; SCST-Consortium to Establish a Registry for Alzheimer's Disease [CERAD] n=138) who underwent standardized diagnostic evaluation; multidisciplinary final diagnoses served as the reference. Participants completed the SCST and either the Korean version of CERAD (CERAD-K) or SNSB-second edition (SNSB-II). We assessed convergent validity of SCST subtests with traditional measures and compared SCST composite scores and classifications with reference diagnoses.

Results: Pearson correlations between SCST subtests and corresponding CERAD-K/SNSB-II measures were all significant (p<0.001), with key domain correlations ≥0.7 (language, memory, executive). In the pooled sample, covariate-adjusted receiver operating characteristic area under the curves (AUCs) for the SCST composite ranged from 0.854 (cognitively unimpaired [CU] vs. mild cognitive impairment [MCI]) to 0.980 (CU vs. dementia); AUC for CU vs. cognitively impaired [CI] was 0.903. SCST-based classification sensitivity was 0.859 (CU vs. CI), 0.984 (CU vs. dementia), 0.758 (CU vs. MCI), 0.896 (MCI vs. dementia), and 0.882 (no dementia vs. dementia).

Conclusions: These findings support the SCST's clinical utility; further studies in broader community-based cohorts are warranted to confirm generalizability.

Background and purpose: Accurate and early diagnosis of Parkinson's disease (PD) remains challenging, as clinical assessments have notable limitations. Gait impairment, a hallmark motor symptom, appears in the early stages and is indicative of disease evolution. This study aimed to examine gait parameters and their associations with established clinical measures to assess their potential as diagnostic and monitoring biomarkers in a Korean PD cohort.

Methods: PD patients (n=18) and healthy controls (HCs, n=15) underwent gait assessments with MotionCore (JEIOS Inc.). Gait parameters were measured during both the 10-m walk (locomotion) and Timed Up and Go (TUG) tests, including stride length, cadence, single and double support time, toe-off time, and turning performance. Clinical assessments comprised the Hoehn & Yahr (H&Y) scale, Unified Parkinson's Disease Rating Scale Part III, Freezing of Gait Questionnaire, Korean version of the Mini-Mental State Examination, Geriatric Depression Scale, and Berg Balance Scale.

Results: Patients with PD demonstrated significantly shortened stride length and higher cadence. Reduced single support time, extended double support time, and delayed toe-off time were observed in the PD group. Integrating gait metrics from both the 10-m locomotion and TUG tests improved discrimination between PD patients and healthy controls, as well as among different H&Y stages. Turning-related measures were significantly higher in PD patients. Gait measures showed robust correlations with clinical indices, including motor severity, cognitive status, and balance scores.

Conclusions: Gait analysis identified prominent motor and balance deficits in PD patients that were strongly associated with clinical severity. Gait parameters hold considerable potential as objective digital biomarkers for the diagnosis and monitoring of PD progression.

Background and purpose: Prior research has indicated that changes in the amyloid-beta (Aβ) biomarker precede tau biomarker alterations in Alzheimer's disease (AD). However, establishing causality through temporal correlations remains contentious. This study aimed to explore the causal relationship between Aβ and tau using Mendelian randomization (MR) analysis.

Methods: We conducted two-sample MR analyses employing genome-wide association studies (GWASs) summary statistics for Aβ positron emission tomography (PET) and cerebrospinal fluid phosphorylated tau (CSF pTau). Additionally, to reinforce and validate the results of the two-sample MR, we performed two-sample MR using tau PET GWAS summary statistics and one-sample MR analysis using autopsy data. In the one-sample MR analysis, the exposure and outcome variables were neuritic plaque burden and neurofibrillary tangle burden, respectively, determined through neuropathological examination.

Results: The two-sample MR analysis unveiled a causal association between Aβ accumulation and CSF pTau level (BETA [standard error]=0.30 [0.10], p=0.004). The absence of heterogeneity and horizontal pleiotropy was confirmed. In contrast, there was no evidence causally relating CSF pTau level to Aβ accumulation (p=0.56). Our results were reinforced by consistently directional effects observed in the two-sample MR using tau PET GWAS and one-sample MR analysis, indicating a causal direction from Aβ burdens (measured by neuritic plaques) to tau burdens (measured by neurofibrillary tangles) (p=1.24×10^-13).

Conclusions: Our findings suggest a causal relationship between Aβ burdens and tau burdens in AD, reinforcing the notion of Aβ as a pivotal upstream factor in AD pathogenesis.

Background and purpose: Global population aging heightens concern about cognitive decline, underscoring the need for scalable interventions. While computerized cognitive training offers benefits, many seniors face device-related challenges that limit adherence, and facility-based programs pose logistical barriers. To address these, we evaluated a 12-week home-based Hybrid Analog-Digital Cognitive Training (HCT) program, which paired a sensor-embedded, pressure-sensitive paper workbook with a Bluetooth-linked television, to enhance usability and engagement among cognitively unimpaired (CU) older adults.

Methods: In this single-blind, randomized controlled trial, 66 CU adults aged ≥60 years were allocated to HCT or control (each n=33) groups. Participants had literacy and Korean Mini-Mental State Examination scores above -1.5 standard deviation. The HCT group performed 30-minute sessions 5 times weekly for 12 weeks, while controls continued usual activities. Primary outcomes were changes in composite Z-scores for frontal, attention, and memory domains, derived from the Cambridge Neuropsychological Testing Automated Battery. Z-scores were direction-weighted and aggregated by domain. Between-group differences were analyzed using linear mixed-effects models.

Results: Baseline characteristics were similar between groups. After 12 weeks, the HCT group showed a significant group × visit interaction in the frontal domain (estimate, 0.29; standard error, 0.13; p=0.03), indicating improved executive function. No significant differences were found in attention or memory domains. Also, the HCT group exhibited improvements in psychological profiles.

Conclusions: A home-based HCT program improved frontal executive function in CU older adults. The hybrid analog-digital design may help reduce digital barriers, support usability, and foster sustained participation. Larger trials with active controls, modality-specific comparators, and extended follow-up are warranted to confirm benefits and optimize delivery.

Trial registration: Clinical Research Information Service Identifier: KCT0007922.

Background and purpose: The quality of life (QoL) of individuals with dementia is influenced by their ability to perform activities of daily living (ADLs), social engagement, and emotional well-being. Instrumental ADLs (IADLs) decline even in early stages, while basic ADLs (BADLs) are significantly affected in advanced stages. This study examined whether a home-based occupational therapy intervention improves QoL in people with dementia, reduces caregiver burden, depression, and anxiety, and enhances BADL performance.

Methods: Forty-nine participants with moderate to severe dementia were assigned to an intervention group (n=26, mean age 83.5±5.0 years, t=2.63, p=0.011) or a control group (n=23, mean age 80.0±4.2 years). QoL was assessed using the QoL in Alzheimer's disease (QoL-AD) and QoL in late-stage dementia (QUALID) scales. The intervention group received a 3-month standardized home-based occupational therapy program (12 individualized sessions) focused on BADL training, in addition to ongoing support from the Greek Alzheimer's Disease Association. The control group received only standard support. Caregivers in both groups participated in counseling or standard support sessions, respectively.

Results: Significant improvements were observed in patients' QoL (QoL-AD, p=0.008; QUALID, p=0.009) and in caregivers' anxiety and depression (p<0.001). No significant effects were found for BADL performance (p=0.857) or caregiver burden (p=0.773).

Conclusions: Home-based standardized occupational therapy interventions enhance the quality of life and emotional well-being of individuals with moderate to severe dementia and improve caregiver mental health, highlighting their crucial role in community dementia care.

Background and purpose: Mild cognitive impairment (MCI), particularly due to Alzheimer's disease (AD), is an important stage for early intervention. We aim to assess awareness among the general population of MCI and AD, and evaluate their willingness to pay for treatment that delays the progression to dementia.

Methods: A nationwide cross-sectional telephone survey was conducted from August 29 to 31, 2022, targeting adults aged ≥18 years in the Republic of Korea. In toto, 1,006 respondents were randomly selected via a proportional allocation based on age, sex, and region. The survey consisted of 11 questions covering demographic information, awareness of MCI and AD, understanding of diagnostic procedures, such as amyloid positron emission tomography (PET), and willingness to pay for disease-modifying treatment.

Results: Among the respondents, 41.3% had heard of MCI, but only 12.0% were well informed. Some 77.0% stated that if they experienced cognitive decline, they would visit a hospital. Only 12.4% of respondents knew the important role of amyloid PET in diagnosing MCI due to AD. Regarding the treatment costs of disease-modifying drugs, 42.1% were willing to pay <600,000 KRW (approximately 420 USD) per month, while 18.4% were unwilling to pay. Older age and lower socioeconomic status were significantly associated with decreased willingness to pay (p<0.001).

Conclusions: Public awareness of MCI is limited, and willingness to pay decreases with older age and lower socioeconomic status. Targeted education and strategies are therefore required to increase awareness and reduce disparities.

Background and purpose: Virtual reality (VR)-based cognitive training programs represent an emerging intervention for cognitive impairment. This pilot study aimed to evaluate the feasibility of a VR-based cognitive training program in patients with mild cognitive impairment (MCI).

Methods: Thirty-two patients diagnosed with MCI according to Peterson's criteria participated in a 12-week VR training program, consisting of twice-weekly 50-minute sessions. Comprehensive assessments were conducted at baseline and after the intervention, including neuropsychological tests, questionnaires for depression, anxiety, quality of life, and dizziness severity. Caregivers evaluated patients' daily living activities and neurobehavioral symptoms.

Results: Twenty-eight patients completed the program (87.5% women, mean age 73.21 years). Post-intervention analyses revealed significant improvements in both total composite and memory-specific scores on neuropsychological tests. No significant changes were observed in depression, anxiety, dizziness severity, neuropsychiatric symptoms, or daily living activities. Importantly, functional neuroimaging demonstrated statistically significant increases in connectivity among the bilateral hippocampus, parahippocampal gyrus, and amygdala, regions essential for memory and emotional processing.

Conclusions: This pilot study demonstrates that VR-based cognitive training may be a feasible therapeutic approach for cognitive impairment. The observed improvements in neuropsychological test scores and enhanced brain connectivity in memory-related regions suggest potential benefits for MCI patients. Further research with control group and larger sample sizes is warranted to confirm these findings and distinguish intervention effects from natural learning or test-retest effects.

Background and purpose: The Telephone-Montreal Cognitive Assessment (T-MoCA) is a remote cognitive screening tool increasingly used in clinical and research contexts. However, its applicability in Korean populations remains underexplored.

Methods: This study examined the equivalence between the T-MoCA and the face-to-face Korean MoCA-22 (K-MoCA-22) in a community-based sample of 113 cognitively normal adults aged 21-91 years. The sample was stratified into 2 age groups (<60 and ≥60 years) for subgroup analyses. All participants completed both the T-MoCA and K-MoCA-22 in a counterbalanced order, with a one-month interval between assessments.

Results: Both T-MoCA and K-MoCA-22 scores were significantly associated with age and education, but not with sex in either age group. However, none of these variables significantly influenced the score differences between the 2 tests. Lin's concordance correlation coefficient indicated strong agreement between the 2 tests in the overall sample and in participants aged ≥60, with minimal systematic bias. Equivalence testing using the two one-sided tests procedure supported statistical equivalence in the total sample and the <60 group, but not in the ≥60 group. Subtest-level differences were observed in the ≥60 group, with higher repetition scores on the K-MoCA-22 and higher delayed recall scores on the T-MoCA, possibly reflecting absence of visual cues, reduced supervision, and lower anxiety during remote testing.

Conclusions: These findings support the T-MoCA as an equivalent and reliable alternative to the K-MoCA-22 for remote cognitive screening in Korean adults. Nonetheless, age-related and modality-specific factors should be considered when interpreting scores, particularly in older individuals.

Social cognition, including theory of mind, empathy, social perception, and behavior, is crucial for interpersonal relationships and social functioning. Impairments in social cognition have also been recognized in neurodegenerative disorders including frontotemporal dementia, Alzheimer's disease, and Parkinson's disease. This review defines social cognition components, summarizes assessment tools, and evaluates their clinical applicability in these disorders. Despite research, the incorporation of social cognition assessments into clinical practice remains limited. Developing standardized, validated tools and integrating them with current, conventional neuropsychological assessments is crucial for improving the diagnosis, prognosis, and management of neurodegenerative disorders. Emerging interventions targeting specific social cognitive domains or their neural systems hold promise in enhancing the social functioning and quality of life of affected individuals.