Dementia and neurocognitive disorders最新文献

Background and purpose: This clinical practice guideline provides evidence-based recommendations for treatment of dementia, focusing on cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists for Alzheimer's disease (AD) and other types of dementia.

Methods: Using the Population, Intervention, Comparison, Outcomes (PICO) framework, we developed key clinical questions and conducted systematic literature reviews. A multidisciplinary panel of experts, organized by the Korean Dementia Association, evaluated randomized controlled trials and observational studies. Recommendations were graded for evidence quality and strength using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.

Results: Three main recommendations are presented: (1) For AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) are strongly recommended for improving cognition and daily function based on moderate evidence; (2) Cholinesterase inhibitors are conditionally recommended for vascular dementia and Parkinson's disease dementia, with a strong recommendation for Lewy body dementia; (3) For moderate to severe AD, NMDA receptor antagonist (memantine) is strongly recommended, demonstrating significant cognitive and functional improvements. Both drug classes showed favorable safety profiles with manageable side effects.

Conclusions: This guideline offers standardized, evidence-based pharmacologic recommendations for dementia management, with specific guidance on cholinesterase inhibitors and NMDA receptor antagonists. It aims to support clinical decision-making and improve patient outcomes in dementia care. Further updates will address emerging treatments, including amyloid-targeting therapies, to reflect advances in dementia management.

Alzheimer's disease (AD), a leading cause of dementia, presents a formidable global health challenge intensified by the aging population. This review encapsulates the evolving landscape of AD diagnosis and treatment with a special focus on the innovative role of fluid biomarkers. Pathologically, AD is marked by amyloid beta (Aβ) plaques and neurofibrillary tangles of hyperphosphorylated tau, which lead to synaptic dysfunction, neuronal loss, and cognitive decline. These pathological changes, commencing decades before symptom onset, underscore the need for early detection and intervention. Diagnosis traditionally relies on clinical assessment, neuropsychological testing, and neuroimaging techniques. However, fluid biomarkers in cerebrospinal fluid and blood, such as various forms of Aβ, total tau, phosphorylated tau, and neurofilament light chain, are emerging as less invasive, cost-effective diagnostic tools. These biomarkers are pivotal for early diagnosis, differential diagnosis, disease progression monitoring, and treatment response evaluation. The treatment landscape is shifting toward personalized medicine, highlighted by advancements in Aβ immunotherapies, such as lecanemab and donanemab. Demonstrating efficacy in phase III clinical trials, these therapies hold promise as tailored treatment strategies based on individual biomarker profiles. The integration of fluid biomarkers into clinical practice represents a significant advance in AD management, providing the potential for early and precise diagnosis, coupled with personalized therapeutic approaches. This heralds a new era in combating this debilitating disease.

Background and purpose: Since the onset of the coronavirus disease 2019 pandemic, the Telephone-Montreal Cognitive Assessment (T-MoCA) has gained popularity as a remote cognitive screening tool. T-MoCA includes items from the original MoCA (MoCA-30), excluding those requiring visual stimuli, resulting in a maximum score of 22 points. This study aimed to assess whether the T-MoCA items (MoCA-22) demonstrate comparable discriminatory power to MoCA-30 and Mini-Mental State Examination (MMSE) in screening for mild cognitive impairment (MCI) and dementia.

Methods: Participants included 233 cognitively normal (CN) individuals, 175 with MCI, and 166 with dementia. All completed the Korean-MoCA-30 (K-MoCA-30) and Korean-MMSE (K-MMSE), with the Korean-MoCA-22 (K-MoCA-22) scores derived from the K-MoCA-30 responses. A receiver operating characteristic (ROC) curve analysis was conducted.

Results: K-MoCA-22 showed a strong correlation with K-MoCA-30 and a moderate correlation with K-MMSE. Scores decreased progressively from CN to MCI and dementia, with significant differences between groups, consistent with K-MoCA-30 and K-MMSE. The study also explored modified K-MoCA-22 index scores across 5 cognitive domains. ROC curve analysis revealed that the area under the curve (AUC) for K-MoCA-22 was significantly smaller than that for K-MoCA-30 in distinguishing both MCI and dementia from CN. However, no significant difference in AUC was found between K-MoCA-22 and K-MMSE, indicating similar discriminatory power. Additionally, the discriminability of K-MoCA-22 varied by education level.

Conclusions: These results indicate that K-MoCA-22, although slightly less effective than K-MoCA-30, still shows good to excellent discriminatory power and is comparable to K-MMSE in screening for MCI and dementia.

Background and purpose: Dementia, particularly Alzheimer's disease, is a significant global health concern, with early diagnosis and treatment development being critical goals. While numerous cohorts have advanced dementia research, there is a lack of comprehensive data on ethnic differences, particularly for the Korean population. The Korea-Registries to Overcome Dementia and Accelerate Dementia Research (K-ROAD) aims to establish a large-scale, hospital-based dementia cohort to address this gap, with a focus on understanding disease progression, developing early diagnostics, and supporting treatment advancements specific to the Korean population.

Methods: K-ROAD comprises multiple prospective cohorts. Participants underwent clinical evaluations, neuroimaging, and biomarker analysis, with data collected on a range of clinical and genomic markers.

Results: As of December 2023, K-ROAD has recruited over 5,800 participants, including individuals across the Alzheimer's clinical syndrome, subcortical vascular cognitive impairment, and frontotemporal dementia spectra. Preliminary findings highlight significant ethnic differences in amyloid positivity, cognitive decline, and biomarker profiles, compared to Western cohorts.

Conclusions: The K-ROAD cohort offers a unique and critical resource for dementia research, providing insights into ethnic-specific disease characteristics and biomarker profiles. These findings will contribute to the development of personalized diagnostic and therapeutic approaches to dementia, enhancing global understanding of the disease.

Lecanemab (product name Leqembi®) is an anti-amyloid monoclonal antibody treatment approved for use in Korea for patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease. The Korean Dementia Association has created recommendations for the appropriate use of lecanemab to assist clinicians. These recommendations include selecting patients for administration, necessary pre-administration tests and preparations, administration methods, monitoring for amyloid related imaging abnormalities (ARIA), and communication with patients and caregivers. Lecanemab is recommended for patients with MCI or mild dementia who confirmed positive amyloid biomarkers, and should not be administered to patients with severe hypersensitivity to lecanemab or those unable to undergo magnetic resonance imaging (MRI) evaluation. To predict the risk of ARIA before administration, apolipoprotein E genotyping is conducted, and regular brain MRI evaluations are recommended to monitor for ARIA during treatment. The most common adverse reactions are infusion-related reactions, which require appropriate management upon occurrence. Additional caution is needed when co-administering with anticoagulants or tissue plasminogen activator due to the risk of macrohemorrhage. Clinicians should consider the efficacy and necessary conditions for administration, as well as the safety of lecanemab, to make a comprehensive decision regarding its use.

Background and purpose: We aimed to develop the diagnostic matrix of the Seoul Cognitive Status Test (SCST) and compare its performance with traditional paper-and-pencil neuropsychological tests, including the Seoul Neuropsychological Screening Battery-II (SNSB-II) and the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K).

Methods: We recruited 197 participants from the head-to-head SCST-SNSB cohort, and 204 participants from the head-to-head SCST-CERAD cohort. They underwent either SNSB-II or CERAD-K, in addition to SCST. The diagnostic matrix was developed by combining cognitive function, determined by neuropsychological tests, and activities of daily living (ADL), determined by Instrumental-ADL scales.

Results: The diagnostic agreement between the SCST and the SNSB-II was 83.9% (weighted kappa=0.87). The agreement between the SCST and the CERAD-K was 84.3% (weighted kappa=0.88). In the SCST-SNSB cohort, all differences in SCST scores between the cognitively unimpaired (CU), mild cognitive impairment (MCI), and dementia diagnosed with the SNSB-II were significant in all cognitive domains (all p<0.01), except for the executive domain between CU and MCI (p=0.145). In the SCST-CERAD cohort, all differences in SCST scores between the 3 groups diagnosed with the CERAD-K were significant in all cognitive domains (all p<0.01), except for the language and visuospatial domains between MCI and dementia (p=0.169 and p=0.778, respectively).

Conclusions: Our findings suggest that the tablet-based SCST may be another option to traditional paper-and-pencil neuropsychological tests, especially in situations where time and space are relatively limited, and neuropsychological testing specialists are not available.

Background and purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer's disease dementia (ADD). However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM).

Methods: Patients who were diagnosed with MCI and were aged over 60 years were included. After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use.

Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59-1.26) or ADD (HR, 1.05; 95% CI, 0.51-1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use.

Conclusions: In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

Background and purpose: The Korean-Mini Mental State Examination, 2nd edition (K-MMSE~2) was recently released. This study aimed to determine whether the K-MMSE~2: Standard Version (K-MMSE~2:SV) had the same test characteristics as the K-MMSE.

Methods: A total of 1,514 healthy community-based participants aged 19 to 90 years were administered the K-MMSE~2:SV Blue Form along with the language items from the K-MMSE. The item and test characteristics and test information for the K-MMSE~2:SV and K-MMSE were compared using Item Response Theory analysis.

Results: Item discriminations for the K-MMSE~2:SV and K-MMSE were above the moderate range for all items except Recall. Most of the items on the K-MMSE~2:SV and K-MMSE had item category difficulty in the very easy or easy range. The test information curve (TIC) showed that the K-MMSE~2:SV and K-MMSE provide almost the same amount of information (27.86 vs. 28.44), with both tests providing the most information at an ability level of -1.57. The generalizability (G) coefficient for the K-MMSE~2:SV and K-MMSE was 0.99.

Conclusions: These results indicate that the K-MMSE~2:SV and K-MMSE are equally optimal tests for screening for mild cognitive impairment and early dementia. Given that the amount of test information provided by the two tests was almost identical, the shapes of the TICs were very similar, and the G coefficient was close to 1, we can conclude that the K-MMSE and K-MMSE~2:SV are equivalent tests.