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Galvin JE, Chrisphonte S, Chang LC. Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults. J Alzheimers Dis 2021; 84:1563-1576. [PMID: 34690143 PMCID: PMC10731581 DOI: 10.3233/jad-215020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer's disease and related disorders (ADRD) health disparities. OBJECTIVE Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program. METHODS We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes. RESULTS African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel SES. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants. CONCLUSION SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lun-Ching Chang
- Department of Mathematical Sciences, Florida Atlantic University, Boca Raton, FL, USA
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Geier DA, Kern JK, Homme KG, Geier MR. A Cross-Sectional Study of Blood Ethylmercury Levels and Cognitive Decline Among Older Adults and the Elderly in the United States. J Alzheimers Dis 2020; 72:901-910. [PMID: 31658062 PMCID: PMC6918911 DOI: 10.3233/jad-190894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cognitive health is an emerging public health concern for the aging American population. Mercury (Hg) is a toxic element that can cause nervous system damage. This hypothesis-testing study evaluated the relationship between blood ethyl-Hg levels and cognitive decline in an older adult and elderly American population. A total of 1,821,663 weighted-persons between 60-80 years old with detectable blood ethyl-Hg levels within the 2011-2012 National Health and Nutritional Examination Survey were examined. Those persons with blood ethyl-Hg levels greater than the median were deemed the higher ethyl-Hg exposure group and those with ethyl-Hg levels less than the median were deemed the lower ethyl-Hg exposure group. Three tests were utilized to measure cognitive function: 1) Consortium to Establish a Registry for Alzheimer's Disease - Word List Learning (CERAD W-L) delayed recall test, 2) animal fluency test, and 3) Digit Symbol Substitution Test. Each cognitive test score was categorized as higher for those with scores greater than the median and lower for those with scores less than the median. Survey logistic regression modeling with covariates was used to analyze the data for the relationship between blood ethyl-Hg levels and cognitive function scores. Significantly increased risks for lower animal fluency test (odds ratio (OR) = 13.652, p = 0.0029) and CERAD W-L delayed recall test (OR = 6.401, p = 0.0433) scores were observed among the higher ethyl-Hg exposure group as compared to the lower ethyl-Hg exposure group. This study supports the hypothesis that increased ethyl-Hg exposure is associated with significant cognitive decline in older adult and elderly Americans.
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Affiliation(s)
- David A Geier
- Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA.,CoMeD, Inc., Silver Spring, MD, USA
| | - Janet K Kern
- Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA.,CoMeD, Inc., Silver Spring, MD, USA.,CONEM US Autism Research Group, Allen, TX, USA
| | - Kristin G Homme
- International Academy of Oral Medicine and Toxicology, ChampionsGate, FL, USA
| | - Mark R Geier
- Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA.,CoMeD, Inc., Silver Spring, MD, USA
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ELbedewy RMS, ELOKL M. Can a combination of two neuropsychological tests screen for mild neurocognitive disorder better than each test alone? A cross-sectional study. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00048-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Early symptoms of dementia may not be apparent and are sometimes even concealed during short office visits initiated for other complaints. The aim of the study is to find out if the combined use of VF/CDT, VF/BNT, or CDT/BNT could improve the accuracy of detecting mild NCD in an outpatient setting, compared with either test used alone.
Participants
Community-dwelling older adults, attending the outpatient Geriatrics Clinic at Ain Shams University hospitals between June 1, 2017 and January 31, 2018. All participants received a comprehensive geriatric assessment (CGA) which included the mini-mental state examination test. Participants with a score of less than 24 and fulfil DSM5 criteria for mild neurocognitive disorder (NCD) are considered cognitively impaired otherwise are considered normal. Then participants were further examined by the Arabic versions of CDT, BNT, and VF animal category.
Results
We recruited 143 male and female participants mean age 67.17 ± 5.41, females are 56.6%, and 48.9% of all participants have mild NCD according to DSM5 criteria. AUC for individual neurocognitive tests in illiterates is 0.893 for clock drawing test, 0.907 for verbal fluency animal category, and 0.904 for Boston naming test, while AUC for neurocognitive test combinations in illiterates is 0.932 for VF + CDT, 0.917 for VF + BNT, and 0.932 for BNT + CDT. On the other hand, AUC for individual neurocognitive tests in educated participants is 0.925 for clock drawing test, 0.921 for verbal fluency animal category, and 0.907 for Boston naming test, whereas AUC for neurocognitive test combinations in educated participants is 0.958 for VF + CDT, 0.963 for VF + BNT, and 0.953 for BNT + CDT.
Conclusion
From the current study, we can conclude that any of the studied combinations have better diagnostic accuracy (although small) than individual test in both literate and illiterate older adults.
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Cichosz SL, Jensen MH, Hejlesen O. Cognitive impairment in elderly people with prediabetes or diabetes: A cross-sectional study of the NHANES population. Prim Care Diabetes 2020; 14:455-459. [PMID: 31831376 DOI: 10.1016/j.pcd.2019.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 12/24/2022]
Abstract
AIM To investigate the cognitive function in people without diabetes, with prediabetes and with diabetes. METHODS/DESIGN The study design used was a cross-sectional analysis of data in people above 60 years registered in NHANES from 2011 to 2014.Three assessments were used to characterize cognitive function: (a) CERAD Word Learning subtest assessing immediate and delayed learning ability, (b) The Animal Fluency test assesing categorical verbal fluency, and (c) The Digit Symbol Substitution test assessing processing speed, sustained attention, and working memory. RESULTS (A) Memory recall (-0.19, [-0.34; -0.039], p = 0.014) and Delayed memory recall decline was associated with diabetes (-0.285, [-0.503; -0.067], p = 0.01), but not in an adjusted analysis. (B) Animal Fluency score decline was associated with diabetes (-1.185, [-1.688; -0.682], p < 0.001). (C) Digit Symbol score decline was associated with diabetes (-6.897, [-8.491; -5.302], p < 0.001). Prediabetes was not associated with cognitive function. CONCLUSIONS This study demonstrates an association between cognitive dysfunction and diabetes. Results may also indicate that cognitive decline is not yet present in people with mild impairments of glucose homeostasis.
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Affiliation(s)
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Denmark
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Booker S, Herr K, Tripp-Reimer T. Patterns and Perceptions of Self-Management for Osteoarthritis Pain in African American Older Adults. PAIN MEDICINE 2020; 20:1489-1499. [PMID: 30541043 DOI: 10.1093/pm/pny260] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore and describe older African Americans' patterns and perceptions of managing chronic osteoarthritis pain. METHODS A convergent parallel mixed-methods design incorporating cross-sectional surveys and individual, semistructured interviews. SETTING One hundred ten African Americans (≥50 years of age) with clinical osteoarthritis (OA) or provider-diagnosed OA from communities in northern Louisiana were enrolled. RESULTS Although frequency varied depending on the severity of pain, older African Americans actively used an average of seven to eight self-management strategies over the course of a month to control pain. The average number of self-management strategies between high and low education and literacy groups was not statistically different, but higher-educated adults used approximately one additional strategy than those with high school or less. To achieve pain relief, African Americans relied on 10 self-management strategies that were inexpensive, easy to use and access, and generally perceived as helpful: over-the-counter (OTC) topicals, thermal modalities, land-based exercise, spiritual activities, OTC and prescribed analgesics, orthotic and assistive devices, joint injections, rest, and massage and vitamins. CONCLUSIONS This is one of the first studies to quantitatively and qualitatively investigate the self-management of chronic OA pain in an older African American population that happened to be a predominantly higher-educated and health-literate sample. Findings indicate that Southern-dwelling African Americans are highly engaged in a range of different self-management strategies, many of which are self-initiated. Although still an important component of chronic pain self-management, spirituality was used by less than half of African Americans, but use of oral nonsteroidal anti-inflammatory drugs and opioids was relatively high.
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Affiliation(s)
- Staja Booker
- Pain Research and Intervention Center of Excellence, The University of Florida, Gainesville, Florida
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Rofes A, de Aguiar V, Ficek B, Wendt H, Webster K, Tsapkini K. The Role of Word Properties in Performance on Fluency Tasks in People with Primary Progressive Aphasia. J Alzheimers Dis 2020; 68:1521-1534. [PMID: 30909222 DOI: 10.3233/jad-180990] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People with primary progressive aphasia (PPA) present language difficulties that require lengthy assessments and follow-ups. Despite individual differences, people with PPA are often classified into three variants that present some distinctive language difficulties. We analyzed the data of 6 fluency tasks (i.e., "F", "A", "S", "Fruits", "Animals", "Vegetables"). We used random forests to pinpoint relevant word properties and error types in the classification of the three PPA variants, conditional inference trees to indicate how relevant variables may interact with one another and ANOVAs to cross-validate the results. Results indicate that total word count helps distinguish healthy individuals (N = 10) from people with PPA (N = 29). Furthermore, mean familiarity differentiates people with svPPA (N = 8) from people with lvPPA (N = 10) and nfvPPA (N = 11). No other word property or error type was relevant in the classification. These results relate to previous literature, as familiarity effects have been reported in people with svPPA in naming and spontaneous speech. Also, they strengthen the relevance of using familiarity to identify a specific group of people with PPA. This paper enhances our understanding of what determines word retrieval in people with PPA, complementing and extending data from naming studies.
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Affiliation(s)
- Adrià Rofes
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Vânia de Aguiar
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Haley Wendt
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kimberly Webster
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
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Hajjar I, Okafor M, McDaniel D, Obideen M, Dee E, Shokouhi M, Quyyumi AA, Levey A, Goldstein F. Effects of Candesartan vs Lisinopril on Neurocognitive Function in Older Adults With Executive Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2012252. [PMID: 32761160 PMCID: PMC7411539 DOI: 10.1001/jamanetworkopen.2020.12252] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Observational studies have suggested that angiotensin receptor blockers are associated with a unique cognitive protection. It is unclear if this is due to reduced blood pressure (BP) or angiotensin receptors type 1 blockade. OBJECTIVE To determine neurocognitive effects of candesartan vs lisinopril in older adults with mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included participants aged 55 years or older with MCI and hypertension. Individuals were withdrawn from prior antihypertensive therapy and randomized in a 1 to 1 ratio to candesartan or lisinopril from June 2014 to December 2018. Participants underwent cognitive assessments at baseline and at 6 and 12 months. Brain magnetic resonance images were obtained at baseline and 12 months. This intent-to-treat study was double-blind and powered for a sample size accounting for 20% dropout. Data were analyzed from May to October 2019. INTERVENTIONS Escalating doses of oral candesartan (up to 32 mg) or lisinopril (up to 40 mg) once daily. Open-label antihypertensive drug treatments were added as needed to achieve BP less than 140/90 mm Hg. MAIN OUTCOMES AND MEASURES The primary outcome was executive function (measured using the Trail Making Test, Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research tool) and secondary outcomes were episodic memory (measured using the Hopkins Verbal Learning Test-Revised) and microvascular brain injury reflected by magnetic resonance images of white matter lesions. RESULTS Among 176 randomized participants (mean [SD] age, 66.0 [7.8] years; 101 [57.4%] women; 113 [64.2%] African American), 87 were assigned to candesartan and 89 were assigned to lisinopril. Among these, 141 participants completed the trial, including 77 in the candesartan group and 64 in the lisinopril group. Although the lisinopril vs candesartan groups achieved similar BP (12-month mean [SD] systolic BP: 130 [17] mm Hg vs 134 [20] mm Hg; P = .20; 12-month mean [SD] diastolic BP: 77 [10] mm Hg vs 78 [11] mm Hg; P = .52), candesartan was superior to lisinopril on the primary outcome of executive function measured by Trail Making Test Part B (effect size [ES] = -12.8 [95% CI, -22.5 to -3.1]) but not Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research score (ES = -0.03 [95% CI, -0.08 to 0.03]). Candesartan was also superior to lisinopril on the secondary outcome of Hopkins Verbal Learning Test-Revised delayed recall (ES = 0.4 [95% CI, 0.02 to 0.8]) and retention (ES = 5.1 [95% CI, 0.7 to 9.5]). CONCLUSIONS AND RELEVANCE These findings suggest that in older adults with MCI, 1-year treatment with candesartan had superior neurocognitive outcomes compared with lisinopril. These effects are likely independent of the BP-lowering effect of candesartan. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01984164.
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Affiliation(s)
- Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Maureen Okafor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Darius McDaniel
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Malik Obideen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth Dee
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Mahsa Shokouhi
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Allan Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Felicia Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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Parikh NS, Kumar S, Rosenblatt R, Zhao C, Cohen DE, Iadecola C, Kamel H. Association between liver fibrosis and cognition in a nationally representative sample of older adults. Eur J Neurol 2020; 27:1895-1903. [DOI: 10.1111/ene.14384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Affiliation(s)
- N. S. Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY USA
| | - S. Kumar
- Division of Gastroenterology and Hepatology Weill Cornell Medicine New York NY USA
| | - R. Rosenblatt
- Division of Gastroenterology and Hepatology Weill Cornell Medicine New York NY USA
| | - C. Zhao
- Department of Neurology, Penn State Milton S. Hershey Medical Center, and Department of Public Health Sciences Pennsylvania State University College of Medicine Hershey PA USA
| | - D. E. Cohen
- Division of Gastroenterology and Hepatology Weill Cornell Medicine New York NY USA
| | - C. Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY USA
| | - H. Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY USA
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Galvin JE, Tolea MI, Chrisphonte S. What older adults do with the results of dementia screening programs. PLoS One 2020; 15:e0235534. [PMID: 32609745 PMCID: PMC7329076 DOI: 10.1371/journal.pone.0235534] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful. Methods A community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models. Results Participants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19–2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09–6.83), and mobility issues (OR = 2.43;95%CI: 1.93–5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06–0.59) and better physical function (OR = 0.38; 95%CI: 0.17–0.81). Discussion MCI/ADRD screening was well-received by a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did not always act on screening results, 25% ordered further testing and evaluation. Efforts need to be directed toward (1) increasing self-efficacy of older adults to discuss screening results with their HCPs, and (2) educating HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making.
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Affiliation(s)
- James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - Magdalena I. Tolea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Stephanie Chrisphonte
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Reduced suprathreshold auditory nerve responses are associated with slower processing speed and thinner temporal and parietal cortex in presbycusis. PLoS One 2020; 15:e0233224. [PMID: 32428025 PMCID: PMC7237004 DOI: 10.1371/journal.pone.0233224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/30/2020] [Indexed: 01/27/2023] Open
Abstract
Epidemiological evidence shows an association between hearing loss and dementia in elderly people. However, the mechanisms that connect hearing impairments and cognitive decline are still unknown. Here we propose that a suprathreshold auditory-nerve impairment is associated with cognitive decline and brain atrophy. Methods: audiological, neuropsychological, and brain structural 3-Tesla MRI data were obtained from elders with different levels of hearing loss recruited in the ANDES cohort. The amplitude of waves I (auditory nerve) and V (midbrain) from auditory brainstem responses were measured at 80 dB nHL. We also calculated the ratio between wave V and I as a proxy of suprathreshold brainstem function. Results: we included a total of 101 subjects (age: 73.5 ± 5.2 years (mean ± SD), mean education: 9.5 ± 4.2 years, and mean audiogram thresholds (0.5–4 kHz): 25.5 ± 12.0 dB HL). We obtained reliable suprathreshold waves V in all subjects (n = 101), while replicable waves I were obtained in 92 subjects (91.1%). Partial Spearman correlations (corrected by age, gender, education and hearing thresholds) showed that reduced suprathreshold wave I responses were associated with thinner temporal and parietal cortices, and with slower processing speed as evidenced by the Trail-Making Test-A and digit symbol performance. Non-significant correlations were obtained between wave I amplitudes and other cognitive domains. Conclusions: These results evidence that reduced suprathreshold auditory nerve responses in presbycusis are associated with slower processing speed and brain structural changes in temporal and parietal regions.
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Hemmy LS, Linskens EJ, Silverman PC, Miller MA, Talley KMC, Taylor BC, Ouellette JM, Greer NL, Wilt TJ, Butler M, Fink HA. Brief Cognitive Tests for Distinguishing Clinical Alzheimer-Type Dementia From Mild Cognitive Impairment or Normal Cognition in Older Adults With Suspected Cognitive Impairment. Ann Intern Med 2020; 172:678-687. [PMID: 32340040 DOI: 10.7326/m19-3889] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The accuracy and harms of brief cognitive tests for identifying clinical Alzheimer-type dementia (CATD) are uncertain. PURPOSE To summarize evidence on accuracy and harms of brief cognitive tests for CATD in older adults with suspected cognitive impairment. DATA SOURCES Electronic bibliographic databases (from inception to November 2019) and systematic review bibliographies. STUDY SELECTION English-language, controlled observational studies in older adults that evaluated the accuracy of brief cognitive tests (standalone tests; memory, executive function, and language tests; and brief multidomain batteries) for distinguishing CATD from mild cognitive impairment (MCI) or normal cognition as defined by established diagnostic criteria. Studies with low or medium risk of bias (ROB) were analyzed. DATA EXTRACTION Two reviewers rated ROB. One reviewer extracted data; the other verified extraction accuracy. DATA SYNTHESIS Fifty-seven studies met analysis criteria. Many brief, single cognitive tests were highly sensitive and specific for distinguishing CATD from normal cognition. These included standalone tests (clock-drawing test, median sensitivity 0.79 and specificity 0.88 [8 studies]; Mini-Mental State Examination, 0.88 and 0.94 [7 studies]; Montreal Cognitive Assessment, 0.94 and 0.94 [2 studies]; and Brief Alzheimer Screen, 0.92 and 0.97 [1 study]), memory tests (list delayed recall, 0.89 and 0.94 [5 studies]), and language tests (category fluency, 0.92 and 0.89 [9 studies]). Accuracy was lower in distinguishing mild CATD from normal cognition and distinguishing CATD from MCI. No studies reported on testing harms. LIMITATIONS Studies were small. Few test metrics were evaluated by multiple studies. Few studies directly compared different tests, scores, cut points, or test combinations. CONCLUSION Many brief, single cognitive tests accurately distinguish CATD from normal cognition in older adults but are less accurate in distinguishing mild CATD from normal cognition or CATD from MCI. No studies reported on testing harms. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897).
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Affiliation(s)
- Laura S Hemmy
- Minneapolis Veterans Affairs Health Care System and University of Minnesota, Minneapolis, Minnesota (L.S.H., B.C.T., T.J.W., H.A.F.)
| | - Eric J Linskens
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (E.J.L., P.C.S., M.A.M., N.L.G.)
| | - Pombie C Silverman
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (E.J.L., P.C.S., M.A.M., N.L.G.)
| | - Margaret A Miller
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (E.J.L., P.C.S., M.A.M., N.L.G.)
| | | | - Brent C Taylor
- Minneapolis Veterans Affairs Health Care System and University of Minnesota, Minneapolis, Minnesota (L.S.H., B.C.T., T.J.W., H.A.F.)
| | | | - Nancy L Greer
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (E.J.L., P.C.S., M.A.M., N.L.G.)
| | - Timothy J Wilt
- Minneapolis Veterans Affairs Health Care System and University of Minnesota, Minneapolis, Minnesota (L.S.H., B.C.T., T.J.W., H.A.F.)
| | - Mary Butler
- University of Minnesota, Minneapolis, Minnesota (K.M.T., J.M.O., M.B.)
| | - Howard A Fink
- Minneapolis Veterans Affairs Health Care System and University of Minnesota, Minneapolis, Minnesota (L.S.H., B.C.T., T.J.W., H.A.F.)
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Spies CD, Krampe H, Paul N, Denke C, Kiselev J, Piper SK, Kruppa J, Grunow JJ, Steinecke K, Gülmez T, Scholtz K, Rosseau S, Hartog C, Busse R, Caumanns J, Marschall U, Gersch M, Apfelbacher C, Weber-Carstens S, Weiss B. Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings - Results of an expert consensus and feasibility field test. J Intensive Care Soc 2020; 22:159-174. [PMID: 34025756 DOI: 10.1177/1751143720923597] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. Results We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale - revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). Conclusions We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).
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Affiliation(s)
- Claudia D Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jörn Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Jochen Kruppa
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Steinecke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tuba Gülmez
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simone Rosseau
- Klinikum Ernst von Bergmann, Pneumologisches Beatmungszentrum, Bad Belzig, Germany
| | - Christiane Hartog
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Klinik Bavaria, Kreischa, Germany
| | - Reinhard Busse
- Department for Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Jörg Caumanns
- Innovation Center Telehealth Technologies, Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | | | - Martin Gersch
- Department of Information Systems, School of Business & Economics, Freie Universität Berlin, Berlin, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Devora PV, Beevers S, Kiselica AM, Benge JF. Normative Data for Derived Measures and Discrepancy Scores for the Uniform Data Set 3.0 Neuropsychological Battery. Arch Clin Neuropsychol 2020; 35:75-89. [PMID: 31236576 DOI: 10.1093/arclin/acz025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The Uniform Data Set 3.0 (UDS 3.0) neuropsychological battery is a recently published battery intended for clinical research with older adult populations. While normative data for the core measures has been published, several additional discrepancy and derived scores can also be calculated. We present normative data for Trail Making Test (TMT) A & B discrepancy and ratio scores, semantic and phonemic fluency discrepancy scores, Craft Story percent retention score, Benson Figure percent retention score, difference between verbal and visual percent retention, and an error index. METHOD Cross-Sectional data from 1803 English speaking, cognitively normal control participants were obtained from the NACC central data repository. RESULTS Descriptive information for derived indices is presented. Demographic variables, most commonly age, demonstrated small but significant associations with the measures. Regression values were used to create a normative calculator, made available in a downloadable supplement. Statistically abnormal values (i.e., raw scores corresponding to the 5th, 10th, 90th, and 95th percentiles) were calculated to assist in practical application of normative findings to individual cases. Preliminary validity of the indices are demonstrated by a case study and group comparisons between a sample of individuals with Alzheimer's (N = 81) and Dementia with Lewy Bodies (DLB; N = 100). CONCLUSIONS Clinically useful normative data of such derived indices from the UDS 3.0 neuropsychological battery are presented to help researchers and clinicians interpret these scores, accounting for demographic factors. Preliminary validity data is presented as well along with limitations and future directions.
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Affiliation(s)
- Paulina V Devora
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA
| | - Samantha Beevers
- Baylor Scott and White Research Institute, Temple, TX 76508, USA
| | - Andrew M Kiselica
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA
| | - Jared F Benge
- Division of Neuropsychology, Department of Neurology, Baylor Scott and White Health, Temple, TX 76508, USA.,Texas A&M Health Science Center, Temple, TX 76508, USA.,Plummer Movement Disorders Center, Temple, TX 76508, USA
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64
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Booker SQ, Content VG. Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis. J Clin Nurs 2020; 29:2675-2690. [PMID: 32301200 DOI: 10.1111/jocn.15292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 01/01/2023]
Abstract
AIM AND OBJECTIVES To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use. BACKGROUND African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. DESIGN A descriptive, secondary mixed-methods analysis. METHODS A convenience sample of 110 African American adults (50-94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis. RESULTS Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension. CONCLUSIONS There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. RELEVANCE TO CLINICAL PRACTICE Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, The University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence (PRICE), The University of Florida, Gainesville, FL, USA
| | - Virginia G Content
- Pain Research and Intervention Center of Excellence (PRICE), The University of Florida, Gainesville, FL, USA
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Association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in older adults: National Health and nutrition examination Survey (NHANES) 2011-2014. Nutr J 2020; 19:25. [PMID: 32222145 PMCID: PMC7103069 DOI: 10.1186/s12937-020-00547-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Current evidence on the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance is inconsistent. Therefore, the aim is to explore the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in the U.S. noninstitutionalized population of older adults. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Intakes of ω-3 and ω-6 fatty acids were obtained through two 24-h dietary recalls and were adjusted by energy. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer’s disease (CERAD) Word Learning sub-test, Animal Fluency test and Digit Symbol Substitution Test (DSST). For each cognitive test, people who scored lower than the lowest quartile in each age group were defined as having low cognitive performance. Binary logistic regression and restricted cubic spline models were applied to evaluate the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance. Results A total of 2496 participants aged 60 years or older were included. In the full-adjusted model, the odds ratios (ORs) with 95% confidence interval (CI) of CERAD test score, Animal Fluency test score and DSST test score were 0.58 (0.38–0.88), 0.68 (0.47–0.99) and 0.59 (0.37–0.92) for the highest versus lowest tertile of dietary ω-3 fatty acids intake, respectively; the ORs with 95% CI of CERAD test score, Animal Fluency test score and DSST test score were 0.48 (0.31–0.75), 0.60 (0.40–0.92) and 0.50 (0.34–0.75) for the highest versus lowest tertile of dietary ω-6 fatty acids intake, respectively. The association between ω-6: ω-3 ratio and cognitive performance was not statistically significant in three tests. In dose-response relationship analysis, L-shaped associations were apparent for ω-3 and ω-6 fatty acids intake with CERAD test score, Animal Fluency test score and DSST test score. Conclusions Dietary ω-3 and ω-6 fatty acids intake might be inversely associated with low cognitive performance.
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66
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Dong X, Li S, Sun J, Li Y, Zhang D. Association of Coffee, Decaffeinated Coffee and Caffeine Intake from Coffee with Cognitive Performance in Older Adults: National Health and Nutrition Examination Survey (NHANES) 2011-2014. Nutrients 2020; 12:nu12030840. [PMID: 32245123 PMCID: PMC7146118 DOI: 10.3390/nu12030840] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to examine the association of coffee, caffeinated coffee, decaffeinated coffee and caffeine intake from coffee with cognitive performance in older adults. we used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Coffee and caffeine intake were obtained through two 24-hour dietary recalls. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test, Animal Fluency test and Digit Symbol Substitution Test (DSST). Binary logistic regression and restricted cubic spline models were applied to evaluate the association of coffee and caffeine intake with cognitive performance. A total of 2513 participants aged 60 years or older were included. In the fully adjusted model, compared to those reporting no coffee consumption, those who reported 266.4–495 (g/day) had a multivariate adjusted odd ratio (OR) with 95% confidence interval (CI) of 0.56(0.35–0.89) for DSST test score, compared to those reporting no caffeinated coffee consumption, those who reported ≥384.8 (g/day) had a multivariate-adjusted OR (95% CI) of 0.68(0.48–0.97) for DSST test score, compared to the lowest quartile of caffeine intake from coffee, the multivariate adjusted OR (95% CI) of the quartile (Q) three was 0.62(0.38–0.98) for the CERAD test score. L-shaped associations were apparent for coffee, caffeinated coffee and caffeine from coffee with the DSST test score and CERAD test score. No significant association was observed between decaffeinated coffee and different dimensions of cognitive performance. Our study suggests that coffee, caffeinated coffee and caffeine from coffee were associated with cognitive performance, while decaffeinated coffee was not associated with cognitive performance.
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Loughrey DG, Pakhomov SVS, Lawlor BA. Altered verbal fluency processes in older adults with age-related hearing loss. Exp Gerontol 2019; 130:110794. [PMID: 31790801 DOI: 10.1016/j.exger.2019.110794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/27/2019] [Accepted: 11/24/2019] [Indexed: 11/28/2022]
Abstract
Epidemiological studies have linked age-related hearing loss (ARHL) with an increased risk of neurocognitive decline. Difficulties in speech perception with subsequent changes in brain morphometry, including regions important for lexical-semantic memory, are thought to be a possible mechanism for this relationship. This study investigated differences in automatic and executive lexical-semantic processes on verbal fluency tasks in individuals with acquired hearing loss. The primary outcomes were indices of automatic (clustering/word retrieval at start of task) and executive (switching/word retrieval after start of the task) processes from semantic and phonemic fluency tasks. To extract indices of clustering and switching, we used both manual and computerised methods. There were no differences between groups on indices of executive fluency processes or on any indices from the semantic fluency task. The hearing loss group demonstrated weaker automatic processes on the phonemic fluency task. Further research into differences in lexical-semantic processes with ARHL is warranted.
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Affiliation(s)
- David G Loughrey
- Global Brain Health Institute, Trinity College Dublin, Ireland; Global Brain Health Institute, University of California, San Francisco, USA; Trinity College Institute of Neuroscience, Trinity College Dublin.
| | | | - Brian A Lawlor
- Global Brain Health Institute, Trinity College Dublin, Ireland; Global Brain Health Institute, University of California, San Francisco, USA; Mercer's Institute for Successful Ageing, St James Hospital, Dublin, Ireland
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Association of Physical Activity on Memory and Executive Function: Population-Based National Sample of Older Adults. JOURNAL OF COGNITIVE ENHANCEMENT 2019. [DOI: 10.1007/s41465-019-00127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014. Eur J Nutr 2019; 59:3133-3148. [DOI: 10.1007/s00394-019-02152-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
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Abstract
BACKGROUND Understanding contributions of different brain pathologies to domain-specific cognitive trajectories in the oldest old is crucial to guide future intervention studies. METHODS Two-hundred-twenty Oregon Alzheimer's Disease Center research participants who were cognitively intact at entry were followed on average for 7.3 years with annual neuropsychological testing until death (mean age, 93.7 y) and autopsy. Mixed effects models examined the relationship between trajectories in memory, verbal fluency, and mini-mental state examination (MMSE) and pathology (neurofibrillary tangles, neuritic plaques, gross infarcts, hippocampal sclerosis, Lewy bodies, APOE genotype, age at death, and years of education). The association between the MMSE trajectory and pathologic variables were examined using a Poisson model with MMSE errors as outcomes given the nonlinear distribution of MMSE scores. RESULTS Memory trajectory was associated with the APOε4 allele (P=0.006). Verbal fluency trajectory was associated with gross infarcts (P=0.008). MMSE trajectory was associated with high Braak scores (P=0.03), gross infarcts (P<0.0001), hippocampal sclerosis (P=0.003), moderate neuritic plaques (P=0.04), and the APOε4 allele (P=0.02). CONCLUSIONS The association between trajectory of decline in global cognitive scores and multiple brain pathologies highlights the importance of accounting for comorbid pathologies in therapeutic trials aimed at one specific pathology in the oldest old. Only the APOε4 allele showed an association with memory decline, despite accounting for Alzheimer's disease pathology, suggesting that APOE may be involved in mechanisms beyond amyloid metabolism in its role in memory. Further studies are needed to examine the role of APOE in brain aging.
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71
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Hudak EM, Bugos J, Andel R, Lister JJ, Ji M, Edwards JD. Keys to staying sharp: A randomized clinical trial of piano training among older adults with and without mild cognitive impairment. Contemp Clin Trials 2019; 84:105789. [PMID: 31226405 PMCID: PMC6945489 DOI: 10.1016/j.cct.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevalence of dementia, the most expensive medical condition (Kirschstein, 2000 and Hurd et al., 2013 [1,2]), and its precursor, mild cognitive impairment (MCI) are increasing [3]. Finding effective intervention strategies to prevent or delay dementia is imperative to public health. Prior research provides compelling evidence that central auditory processing (CAP) deficits are a risk factor for dementia [4-6]. Grounded in the information degradation theory [7, 8], we hypothesize that improving brain function at early perceptual levels (i.e., CAP) may be optimal to attenuate cognitive and functional decline and potentially curb dementia prevalence. Piano training is one avenue to enhance cognition [9-13] by facilitating CAP at initial perceptual stages [14-18]. OBJECTIVES The Keys To Staying Sharp study is a two arm, randomized clinical trial examining the efficacy of piano training relative to music listening instruction to improve CAP, cognition, and everyday function among older adults. In addition, the moderating effects of MCI status on piano training efficacy will be examined and potential mediators of intervention effects will be explored. HYPOTHESES We hypothesize that piano training will improve CAP and cognitive performance, leading to functional improvements. We expect that enhanced CAP will mediate cognitive gains. We further hypothesize that cognitive gains will mediate functional improvements. METHOD We plan to enroll 360 adults aged 60 years and older who will be randomized to piano training or an active control condition of music listening instruction and complete pre- and immediate post- assessments of CAP, cognition, and everyday function.
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Affiliation(s)
- Elizabeth M Hudak
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida.
| | | | - Ross Andel
- School of Aging Studies, University of South Florida; Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jennifer J Lister
- Department of Communication Sciences and Disorders, University of South Florida
| | - Ming Ji
- College of Nursing, University of South Florida
| | - Jerri D Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida; Department of Communication Sciences and Disorders, University of South Florida
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Kiselica AM, Benge JF. Quantitative and qualitative features of executive dysfunction in frontotemporal and Alzheimer's dementia. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:449-463. [PMID: 31424275 DOI: 10.1080/23279095.2019.1652175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Behavioral variant fronto-temporal degeneration (bvFTD) is typically distinguished from Alzheimer's disease (AD) by early, prominent dysexecutive findings, in addition to other clinical features. However, differences in executive functioning between these groups are not consistently found. The current study sought to investigate quantitative and qualitative differences in executive functioning between those with bvFTD and AD in a large sample, while controlling for dementia severity and demographic variables. Secondary data analyses were completed on a subset of cases from the National Alzheimer's Coordinating Center collected from 36 Alzheimer's Disease Research Centers and consisting of 1,577 individuals with AD and 406 individuals with bvFTD. Groups were compared on 1) ability to complete three commonly administered executive tasks (letter fluency, Trail Making Test Part B [TMTB], and digits backward); 2) quantitative test performance; and 3) errors on these tasks. Findings suggested that individuals with bvFTD were less likely to complete letter fluency, χ2(2) = 178.62, p < .001, and number span tasks, χ2(1) = 11.49, p < .001), whereas individuals with AD were less likely to complete TMTB, χ2(2) = 460.38, p < .001. Individuals with bvFTD performed more poorly on letter fluency, F(1) = 28.06, p = .013, but there were not group differences in TMTB lines per second or number span backwards. Errors generally did not differentiate the diagnostic groups. In summary, there is substantial overlap in executive dysfunction between those with bvFTD and AD, though individuals with bvFTD tend to demonstrate worse letter fluency performance.
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Affiliation(s)
- Andrew M Kiselica
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA
| | - Jared F Benge
- Division of Neuropsychology, Baylor Scott and White Health, Dallas, TX, USA.,Plummer Movement Disorders Center, Baylor Scott and White Health, Dallas, TX, USA.,Texas A&M College of Medicine, Bryan, TX, USA
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van Loon IN, Goto NA, Boereboom FTJ, Bots ML, Hoogeveen EK, Gamadia L, van Bommel EFH, van de Ven PJG, Douma CE, Vincent HH, Schrama YC, Lips J, Siezenga MA, Abrahams AC, Verhaar MC, Hamaker ME. Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis. Nephron Clin Pract 2019; 143:108-119. [PMID: 31408861 DOI: 10.1159/000501277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A geriatric assessment (GA) is a structural method for identifying frail patients. The relation of GA findings and risk of death in end-stage kidney disease (ESKD) is not known. The objective of the GA in OLder patients starting Dialysis Study was to assess the association of GA at dialysis initiation with early mortality and hospitalization. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Patients ≥65 years old were included just prior to dialysis initiation. All participants underwent a GA, including assessment of (instrumental) activities of daily living (ADL), mobility, cognition, mood, nutrition, and comorbidity. In addition, a frailty screening (Fried Frailty Index, [FFI]) was applied. Outcome measures were 6- and 12-month mortality, and 6-month hospitalization. Associations with mortality were assessed with cox-regression adjusting for age, sex, comorbidity burden, smoking, residual kidney function and dialysis modality. Associations with hospitalization were assessed with logistic regression, adjusting for relevant confounders. RESULTS In all, 192 patients were included, mean age 75 ± 7 years, of whom 48% had ≥3 geriatric impairments and were considered frail. The FFI screening resulted in 46% frail patients. Mortality rate was 8 and 15% at 6- and 12-months after enrolment, and transplantation rate was 2 and 4% respectively. Twelve-month mortality risk was higher in patients with ≥3 impairments (hazard ratio [HR] 2.97 [95% CI 1.19-7.45]) compared to less impaired patients. FFI frail patients had a higher risk of 12-month mortality (HR 7.22 [95% CI 2.47-21.13]) and hospitalization (OR 1.93 [95% CI 1.00-3.72]) compared to fit patients. Malnutrition was associated with 12-month mortality, while impaired ADL and depressive symptoms were associated with 12-month mortality and hospitalization. CONCLUSIONS Frailty as assessed by a GA is related to mortality in elderly patients with ESKD. Individual components of the GA are related to both mortality and hospitalization. As the GA allows for distinguishing between frail and fit patients initiating dialysis, it is potentially of added value in the decision-making process concerning dialysis initiation.
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Affiliation(s)
- Ismay N van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands, .,Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands, .,Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Namiko A Goto
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Franciscus T J Boereboom
- Dianet Dialysis Center, Utrecht, The Netherlands.,Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen K Hoogeveen
- Department of Internal Medicine Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Laila Gamadia
- Department of Internal Medicine Tergooi Hospital, Hilversum, The Netherlands
| | - E F H van Bommel
- Department of Internal Medicine Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P J G van de Ven
- Department of Internal Medicine Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline E Douma
- Department of Internal Medicine Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - H H Vincent
- Department of Internal Medicine Antonius Hospital, Nieuwegein, The Netherlands
| | - Yvonne C Schrama
- Department of Internal Medicine St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Joy Lips
- Department of Internal Medicine Bernhoven Hospital, Uden, The Netherlands
| | - Machiel A Siezenga
- Department of Internal Medicine Gelderse Vallei Hospital, Ede, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije E Hamaker
- Department of Geriatrics University Medical Center Utrecht, Utrecht, The Netherlands
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Auampradit N, Vapattanawong P, Punpuing S, Sunpuwan M, Jirapramukpitak T. A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System. Gerontol Geriatr Med 2019; 5:2333721419862885. [PMID: 31321256 PMCID: PMC6628515 DOI: 10.1177/2333721419862885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: To examine the impacts of changes in social determinants of
health (SDH) toward changes in cognition. Methods: Longitudinal data came
from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011.
Cognitive impairment was measured by category fluency and delayed recall. Generalized
estimating equation (GEE) was used to investigate changes in cognition by taking SDH and
other variables including age, gender, marital status, education, and depression into the
model. Results: GEE revealed longitudinal effects of wealth index and working
status against cognition. Older Thais living with richest wealth index (odds ratio [OR] =
0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95%
CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion:
Poorer wealth index and being unemployed were served as a risk factor for cognitive
impairment over time. Increasing age was still the major risk for cognitive
impairment.
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Affiliation(s)
| | - Patama Vapattanawong
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
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Suskind AM, Kowalik C, Quanstrom K, Boscardin J, Zhao S, Reynolds WS, Mishra K, Finlayson E. The impact of frailty on treatment for overactive bladder in older adults. Neurourol Urodyn 2019; 38:1915-1923. [PMID: 31286561 DOI: 10.1002/nau.24093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/17/2019] [Indexed: 01/17/2023]
Abstract
AIMS To examine the impact of frailty on treatment outcomes for overactive bladder (OAB) in older adults starting pharmacotherapy, onabotulinumtoxinA, and sacral neuromodulation. METHODS This is a prospective study of men and women age ≥60 years starting pharmacotherapy, onabotulinumtoxinA, or sacral neuromodulation. Subjects were administered questionnaires at baseline and again at 1- and 3-months. Frailty was assessed at baseline using the timed up and go test (TUGT), whereby a TUGT time of ≥12 seconds was considered to be slow, or frail. Response to treatment was assessed using the overactive bladder symptom score (OABSS) and the OAB-q SF (both Bother and HRQOL subscales). Information on side effects/adverse events was also collected. Mixed effects linear modeling was used to model changes in outcomes over time both within and between groups. RESULTS A total of 45 subjects enrolled in the study, 40% (N = 18) of whom had a TUGT ≥12 seconds. Both TUGT groups demonstrated improvement in OAB symptoms over time and there were no statistically significant differences in these responses per group (all P-values >.05). Similar trends were found for both OAB-q SF Bother and OAB-q SF HRQOL questionnaire responses. Side effects and adverse events were not significantly different between groups (all P's >.05). CONCLUSIONS Adults ≥60 years of age starting second- and third-line treatments for OAB, regardless of TUGT time, demonstrated improvement in OAB symptoms at 3 months. These findings suggest that frail older adults may receive comparable benefit and similar rates of side effects compared with less frail older individuals.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, California
| | - Casey Kowalik
- Department of Urology, University of Kansas Medical Center, Kansas City, Missouri
| | - Kathryn Quanstrom
- Department of Urology, University of California, San Francisco, California
| | - John Boscardin
- Department of Biostatistics, Uinversity of California, San Francisco, California
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, California
| | | | - Kavita Mishra
- Department of Obstetrics and Gynecology, Standford University, California
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, California
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Marceaux JC, Prosje MA, McClure LA, Kana B, Crowe M, Kissela B, Manly J, Howard G, Tam JW, Unverzagt FW, Wadley VG. Verbal fluency in a national sample: Telephone administration methods. Int J Geriatr Psychiatry 2019; 34:578-587. [PMID: 30588700 PMCID: PMC6420356 DOI: 10.1002/gps.5054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 12/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Describe novel methods for ascertaining verbal fluency in a large national sample of adults, examine demographic factors influencing performance, and compare scores to studies using in-person assessment. METHODS/DESIGN Participants were from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study of stroke in adults aged 45 years and older. Letter and semantic fluency were gathered, using Letter "F" and Animal Naming, via a telephone-based assessment with computer-assisted scoring of digital recordings. RESULTS Initial letter and semantic fluency scores were obtained on 18 505 and 18 072 participants, respectively. For both fluency tests, scores were normally distributed. Younger age and more years of education were associated with better performances (p < 0.0001). The mean and standard deviation for matched subgroups, based on age, gender, and education, were quite comparable with scores reported out of samples using an in-person administration format. Telephone-based assessment also allowed for a level of quality control not available via in-person measurement. CONCLUSIONS Telephone-based assessment of verbal fluency and computer-assisted scoring programs designed for this study facilitated large-scale data acquisition, storage, and scoring of protocols. The resulting scores have similar characteristics to those obtained by traditional methods. These findings extend validation of cognitive assessment methods, using survey research staff and computer-assisted technology for test administration.
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Affiliation(s)
- Janice C Marceaux
- Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX
| | | | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA
| | - Bhumika Kana
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Brett Kissela
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Jennifer Manly
- Department of Neurology, Columbia University, New York, NY
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Joyce W Tam
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | | | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Ranson JM, Kuźma E, Hamilton W, Muniz-Terrera G, Langa KM, Llewellyn DJ. Predictors of dementia misclassification when using brief cognitive assessments. Neurol Clin Pract 2019; 9:109-117. [PMID: 31041124 PMCID: PMC6461420 DOI: 10.1212/cpj.0000000000000566] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brief cognitive assessments can result in false-positive and false-negative dementia misclassification. We aimed to identify predictors of misclassification by 3 brief cognitive assessments; the Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS) and animal naming (AN). METHODS Participants were 824 older adults in the population-based US Aging, Demographics and Memory Study with adjudicated dementia diagnosis (DSM-III-R and DSM-IV criteria) as the reference standard. Predictors of false-negative, false-positive and overall misclassification by the MMSE (cut-point <24), MIS (cut-point <5) and AN (cut-point <9) were analysed separately in multivariate bootstrapped fractional polynomial regression models. Twenty-two candidate predictors included sociodemographics, dementia risk factors and potential sources of test bias. RESULTS Misclassification by at least one assessment occurred in 301 (35.7%) participants, whereas only 14 (1.7%) were misclassified by all 3 assessments. There were different patterns of predictors for misclassification by each assessment. Years of education predicts higher false-negatives (odds ratio [OR] 1.23, 95% confidence interval [95% CI] 1.07-1.40) and lower false-positives (OR 0.77, 95% CI 0.70-0.83) by the MMSE. Nursing home residency predicts lower false-negatives (OR 0.15, 95% CI 0.03-0.63) and higher false-positives (OR 4.85, 95% CI 1.27-18.45) by AN. Across the assessments, false-negatives were most consistently predicted by absence of informant-rated poor memory. False-positives were most consistently predicted by age, nursing home residency and non-Caucasian ethnicity (all p < 0.05 in at least 2 models). The only consistent predictor of overall misclassification across all assessments was absence of informant-rated poor memory. CONCLUSIONS Dementia is often misclassified when using brief cognitive assessments, largely due to test specific biases.
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Affiliation(s)
- Janice M Ranson
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Elżbieta Kuźma
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - William Hamilton
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Graciela Muniz-Terrera
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Kenneth M Langa
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - David J Llewellyn
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
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Vogel A, Stokholm J, Jørgensen K. Normative data for eight verbal fluency measures in older Danish adults. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:114-124. [DOI: 10.1080/13825585.2019.1593935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jette Stokholm
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Labenz C, Beul L, Toenges G, Schattenberg JM, Nagel M, Sprinzl MF, Nguyen-Tat M, Zimmermann T, Huber Y, Marquardt JU, Galle PR, Wörns MA. Validation of the simplified Animal Naming Test as primary screening tool for the diagnosis of covert hepatic encephalopathy. Eur J Intern Med 2019; 60:96-100. [PMID: 30131209 DOI: 10.1016/j.ejim.2018.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre. METHODS 143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1. RESULTS 58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youden's index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%. CONCLUSIONS S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.
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Affiliation(s)
- Christian Labenz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Larissa Beul
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Nagel
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Nguyen-Tat
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Tim Zimmermann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Yvonne Huber
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens U Marquardt
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
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80
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Churnin I, Qazi J, Fermin CR, Wilson JH, Payne SC, Mattos JL. Association Between Olfactory and Gustatory Dysfunction and Cognition in Older Adults. Am J Rhinol Allergy 2019; 33:170-177. [DOI: 10.1177/1945892418824451] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The association between olfactory dysfunction (OD) and cognitive decline is becoming apparent in the emerging literature. However, the literature demonstrating a similar effect between gustatory dysfunction (GD) and cognition is not well established. Objective To determine whether OD and GD are independently associated with cognitive impairment. Methods The 2013–2014 National Health and Nutrition Examination Survey was queried for 1376 older adults, corresponding to a weighted population sample of 50 816 529, to assess olfactory and gustatory status and cognition using univariate and multivariate regression analyses. OD and GD were determined using objective measurements with validated protocols. Participants were stratified as normal or abnormal cognition status using accepted cutoff values as indicated for the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological test, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Results OD was associated with both mild cognitive impairment (odds ratio [OR] 1.809, P = .004) and dementia (OR 3.173, P < .001) with CERAD testing, abnormal AFT (OR 2.424, P < .001), and abnormal DSST (OR 4.028, P < .001). GD based on 1M NaCl whole mouth taste testing was associated with dementia on CERAD testing (OR 2.217, P = .004). When smell and taste parameters were included together in the regression model, both OD and GD remained significant independent predictors of dementia status based on CERAD testing (OR 3.133, P < .001, OR 1.904, P = .015). Conclusions OD and severe GD represent independent predictors of cognitive impairment in a nationally representative sample of older adults.
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Affiliation(s)
- Ian Churnin
- Department of Otolaryngology – Head & Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Jamiluddin Qazi
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Cyrelle R. Fermin
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - James H. Wilson
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Spencer C. Payne
- Department of Otolaryngology – Head & Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Jose L. Mattos
- Department of Otolaryngology – Head & Neck Surgery, University of Virginia, Charlottesville, Virginia
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König A, Linz N, Tröger J, Wolters M, Alexandersson J, Robert P. Fully Automatic Speech-Based Analysis of the Semantic Verbal Fluency Task. Dement Geriatr Cogn Disord 2018; 45:198-209. [PMID: 29886493 DOI: 10.1159/000487852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Semantic verbal fluency (SVF) tests are routinely used in screening for mild cognitive impairment (MCI). In this task, participants name as many items as possible of a semantic category under a time constraint. Clinicians measure task performance manually by summing the number of correct words and errors. More fine-grained variables add valuable information to clinical assessment, but are time-consuming. Therefore, the aim of this study is to investigate whether automatic analysis of the SVF could provide these as accurate as manual and thus, support qualitative screening of neurocognitive impairment. METHODS SVF data were collected from 95 older people with MCI (n = 47), Alzheimer's or related dementias (ADRD; n = 24), and healthy controls (HC; n = 24). All data were annotated manually and automatically with clusters and switches. The obtained metrics were validated using a classifier to distinguish HC, MCI, and ADRD. RESULTS Automatically extracted clusters and switches were highly correlated (r = 0.9) with manually established values, and performed as well on the classification task separating HC from persons with ADRD (area under curve [AUC] = 0.939) and MCI (AUC = 0.758). CONCLUSION The results show that it is possible to automate fine-grained analyses of SVF data for the assessment of cognitive decline.
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Affiliation(s)
- Alexandra König
- Memory Clinic, Association IA, CoBTek Lab, CHU Université Côte d'Azur, Nice, France
| | - Nicklas Linz
- German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany
| | - Johannes Tröger
- German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany
| | - Maria Wolters
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Jan Alexandersson
- German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany
| | - Phillipe Robert
- Memory Clinic, Association IA, CoBTek Lab, CHU Université Côte d'Azur, Nice, France
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Pantsiou K, Sfakianaki O, Papaliagkas V, Savvoulidou D, Costa V, Papantoniou G, Moraitou D. Inhibitory Control, Task/Rule Switching, and Cognitive Planning in Vascular Dementia: Are There Any Differences From Vascular Aging? Front Aging Neurosci 2018; 10:330. [PMID: 30410439 PMCID: PMC6211074 DOI: 10.3389/fnagi.2018.00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 09/28/2018] [Indexed: 01/06/2023] Open
Abstract
Recent studies have shown that patients diagnosed with Vascular Dementia (VaD) exhibit deficits in executive functions. According to “vascular hypothesis of cognitive aging,” community-dwelling older adults having risk factors for vascular disease development (RVD) may suffer from cognitive decline of the same type. The aim of the study was to assess the level of specific executive functions (EF) that have been revealed as most affected by vascular abnormalities, in older adults with incipient VaD and RVD. Subsequently specific ways of EF measuring could be suggested for more accurate diagnosis of early stage VaD. The study compared three adult groups (N = 60): (a) patients diagnosed with incipient VaD, according to DSM-5 criteria (n = 20); (b) community-dwelling older adults presenting cardiovascular risk factors (RVD; n = 20); (c) healthy young adult controls (n = 20). Three types of executive functions were examined: inhibitory control, cognitive flexibility as rule/task switching, and planning. The following D-KEFS subtests were administered for their evaluation: The ‘Color-Word Interference Test,’ the ‘Verbal Fluency Test,’ and the ‘Tower Test.’ Mixed-measures ANOVA, MANOVA, and one-way ANOVA as well as Scheffe post hoc test were applied to the data of the scores in each condition of each test. The results showed that VaD patients had significantly lower performance in test conditions requiring switching and planning, compared to RVD group and young controls. The specific deficits of VaD patients, compared to older adults presenting RVD according to multiple-group path analyses were: more uncorrected errors in inhibition, the use of semantic knowledge primarily instead of switching ability to switch between semantic categories, as well as a lower level of movement precision in planning.
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Affiliation(s)
- Krystallia Pantsiou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ourania Sfakianaki
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Savvoulidou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Costa
- 1st Neurology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Papantoniou
- Department of Early Childhood Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Despina Moraitou
- Lab of Psychology, Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Eliassen CF, Reinvang I, Selnes P, Fladby T, Hessen E. Convergent Results from Neuropsychology and from Neuroimaging in Patients with Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2018; 43:144-154. [PMID: 28152536 DOI: 10.1159/000455832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To investigate the correspondence between neuropsychological single measures and variation in fludeoxyglucose positron emission tomography (FDG PET) glucose metabolism and magnetic resonance imaging (MRI) cortical thickness in mild cognitive impairment (MCI) patients. METHODS Forty-two elderly controls and 73 MCI subjects underwent FDG PET and MRI scanning. Backward regression analyses with PET and MRI regions were used as dependent variables, while Rey Auditory Verbal Memory Test (RAVLT) recall, Trail Making Test B (TMT B), and a composite test score (RAVLT learning and immediate recall, TMT A, COWAT, and letter-number sequencing) were used as predictor variables. RESULTS The composite score predicted variation in cortical metabolism; supplementary analyses showed that TMT B was significantly correlated with PET metabolism as well. RAVLT and TMT B were significant predictors of variation in MRI cortical thickness. CONCLUSION Our results indicate that RAVLT and TMT B are sensitive to variation in Alzheimer disease neuroimaging markers.
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Kinuhata S, Takemoto Y, Senda M, Nakai S, Tsumura E, Otoshi T, Hiratani S, Fukumoto K, Namikawa H, Tochino Y, Morimura M, Shuto T, Uchimoto S. The 1-min animal test as a mental status screening examination in patients with diabetes. ASIA PACIFIC FAMILY MEDICINE 2018; 17:6. [PMID: 29930481 PMCID: PMC5992673 DOI: 10.1186/s12930-018-0043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Detecting and treating dementia at an early stage are important. Although the Revised Hasegawa Dementia Scale (HDS-R) is commonly used to detect dementia, it takes about 10 min to complete. In contrast, the 1-min animal test (OMAT) takes only 1 min to complete and may be a helpful screening test for general practitioners in deciding whether to proceed with administering further diagnostic tests such as the HDS-R. We sought to examine the relationship between the OMAT and HDS-R scores, and determine the cut-off OMAT score that balanced the sensitivity and specificity in identifying HDS-R-positive patients. METHODS A total of 122 consecutive patients with diabetes who visited the outpatient clinic at the Fujiidera Municipal Hospital were enrolled. The patients underwent the OMAT and HDS-R on the same day. Tests were conducted in a single-blinded manner. The relationship between the OMAT and HDS-R scores was examined using Spearman's rank correlation. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off score of OMAT that will determine whether to proceed with further diagnostic tests. RESULTS A strong positive correlation between the OMAT and HDS-R scores was observed (r = 0.70). The sensitivity and specificity of OMAT using cut-off scores of 12/13, 13/14, and 14/15 for HDS-R-positive patients were 0.87 and 0.66, 1.00 and 0.51, and 1.00 and 0.40, respectively among all the subjects. Similar results were obtained in a subgroup of subjects aged ≥ 65 years. CONCLUSIONS A cut-off score of 13/14 on the OMAT balanced the sensitivity closest to 1.00 and allowed for the highest specificity for the HDS-R not only among all the patients, but also among just the patients aged ≥ 65 years. The OMAT may be an optimal screening test to determine whether to proceed with further diagnosis using HDS-R.Trial registration UMIN UMIN000025260. This study is retrospectively registered on December 13th, 2016.
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Affiliation(s)
- Shigeki Kinuhata
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Yasuhiko Takemoto
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | | | - Shiho Nakai
- Fujiidera Municipal Hospital, Fujiidera, Japan
| | | | | | | | - Kazuo Fukumoto
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Hiroki Namikawa
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Yoshihiro Tochino
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Mina Morimura
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Taichi Shuto
- Department of Medical Education and General Practice, Osaka City University Graduate School and Faculty of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
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Frith E, Loprinzi PD. 15-Year Secular Trends in Cognitive Function Among Older Adults in the United States. Psychol Rep 2018; 122:841-852. [PMID: 29566595 DOI: 10.1177/0033294118765227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is associated with various chronic diseases, including mobility limitation and early mortality. Thus, evaluating changes in cognition is of paramount public health interest. The purpose of this study was to evaluate secular trends in cognitive function among a representative sample of the U.S. older adult population. Data from the 1999-2000, 2001-2002, 2011-2012, and 2013-2014 National Health and Nutrition Examination Survey were utilized to identify an aggregate sample of adults 60+ years of age. The sample size across the four respective cycles was 1417, 1558, 1422, and 1592. Three cognitive assessments were employed, including the CERAD Word Learning subset (Consortium to Establish a Registry for Alzheimer's disease), the Animal Fluency test, and the Digit Symbol Substitution Test (DSST). For the entire sample and several subpopulations, DSST scores increased from 1999 to 2012 and then decreased in the 2013 to 2014 cycle. For all CERAD trials, there was evidence of increased CERAD performance from 2011-2012 to 2013-2014. No secular trends were observed for the Animal Fluency task across these cycles. Select cognitive parameters appear to be improving among U.S. older adults. Future work is needed to further explore secular trends in cognitive sustainability, and, as evidenced by our present study, cognitive enrichment over time.
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Affiliation(s)
| | - Paul D Loprinzi
- Physical Activity Epidemiology Laboratory, Exercise Psychology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS, USA
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Vaughan RM, Coen RF, Kenny R, Lawlor BA. Semantic and Phonemic Verbal Fluency Discrepancy in Mild Cognitive Impairment: Potential Predictor of Progression to Alzheimer's Disease. J Am Geriatr Soc 2018; 66:755-759. [DOI: 10.1111/jgs.15294] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Roisin M. Vaughan
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - Robert F. Coen
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - RoseAnne Kenny
- The Irish Longitudinal Study on Ageing; Trinity College; Dublin Ireland
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
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Pakhomov SVS, Eberly LE, Knopman DS. Recurrent perseverations on semantic verbal fluency tasks as an early marker of cognitive impairment. J Clin Exp Neuropsychol 2018; 40:832-840. [PMID: 29502483 DOI: 10.1080/13803395.2018.1438372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Our objective was to examine the association between perseverations produced on the semantic verbal fluency (SVF) task in asymptomatic individuals and the future diagnosis of cognitive impairment (CI). METHOD Participants were individuals participating in the Mayo Clinic Study of Aging (N = 1269, Mage = 79.3 years, SD = 5.1; 51% men). All were cognitively normal at baseline and were followed in 15-month intervals for up to 6 visits. Each neurocognitive assessment included SVF tasks ("animals," "fruits," and "vegetables"). Cox modeling was used to test for associations between perseverations and time to CI diagnosis. RESULTS Perseverations on the "animals" SVF task were associated with incident CI (hazard ratio = 1.35; 95% confidence interval, CI [1.10, 1.66]). No significant association was found with perseverations on the "fruits" or "vegetables" SVF tasks. Mixed-effects modeling in cognitively normal participants revealed that the number of perseverations at baseline is significantly associated with decline in memory and visuospatial cognitive domains but is not associated with decline in attention. CONCLUSIONS Assessing perseverations together with standard SVF scores on the "animals" SVF task can help in early identification of asymptomatic individuals at an increased risk for CI. Perseverations are not associated with attention, but rather visual and verbal working memory mechanisms. In longitudinal settings aimed at early detection of signs of CI in presymptomatic individuals, SVF testing with scoring that includes counting of perseverations may potentially serve as a practical alternative to the more cumbersome memory tests.
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Affiliation(s)
| | - Lynn E Eberly
- b Division of Biostatistics , University of Minnesota , Minneapolis , MN , USA
| | - David S Knopman
- c Department of Neurology , Mayo Clinic , Rochester , MN , USA
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Dietary inflammatory index and memory function: population-based national sample of elderly Americans. Br J Nutr 2018; 119:552-558. [PMID: 29361990 DOI: 10.1017/s0007114517003804] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The objective of this study was to examine the association between dietary inflammatory potential and memory and cognitive functioning among a representative sample of the US older adult population. Cross-sectional data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey were utilised to identify an aggregate sample of adults 60-85 years of age (n 1723). Dietary inflammatory index (DII®) scores were calculated using 24-h dietary recall interviews. Three memory-related assessments were employed, including the Consortium to Establish a Registry for Alzheimer's disease (CERAD) Word Learning subset, the Animal Fluency test and the Digit Symbol Substitution Test (DSST). Inverse associations were observed between DII scores and the different memory parameters. Episodic memory (CERAD) (b adjusted=-0·39; 95 % CI -0·79, 0·00), semantic-based memory (Animal Fluency Test) (b adjusted=-1·18; 95 % CI -2·17, -0·20) and executive function and working-memory (DSST) (b adjusted=-2·80; 95 % CI -5·58, -0·02) performances were lowest among those with the highest mean DII score. Though inverse relationships were observed between DII scores and memory and cognitive functioning, future work is needed to further explore the neurobiological mechanisms underlying the complex relationship between inflammation-related dietary behaviour and memory and cognition.
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Hsu YH, Huang CF, Lo CP, Wang TL, Yang CC, Tu MC. Frontal Assessment Battery as a Useful Tool to Differentiate Mild Cognitive Impairment due to Subcortical Ischemic Vascular Disease from Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 42:331-341. [PMID: 27866203 DOI: 10.1159/000452762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prominent executive dysfunction can differentiate vascular dementia from Alzheimer disease (AD). However, it is unclear whether the Frontal Assessment Battery (FAB) screening tool can differentiate subcortical ischemic vascular disease (SIVD) from AD at the pre-dementia stage. In addition, the neural correlates of FAB performance have yet to be clarified. METHODS Patients with mild cognitive impairment (MCI) due to SIVD (MCI-V), MCI due to AD (MCI-A), and demographically matched controls completed the Mini-Mental State Examination, Taiwanese FAB (TFAB), Category Fluency, and Chinese Version of the Verbal Learning Test, and underwent magnetic resonance imaging. White matter hyperintensities were rated according to the Scheltens scale. RESULTS TFAB total scale and its Orthographical Fluency subtest were the only measures that could differentiate MCI-V from MCI-A. Discriminative analysis showed that Orthographical Fluency scores successfully identified 73.2% of the cases with MCI-V, with 85.0% sensitivity. Orthographical Fluency scores were specifically associated with lesion load within frontal periventricular, frontal deep white matter, and basal ganglia regions. CONCLUSION The TFAB, and especially its 1-min Orthographical Fluency subtest, is a useful screening procedure to differentiate MCI due to SIVD from MCI due to AD. The discriminative ability is probably due to frontosubcortical white matter pathologies disproportionately involved in the two disease entities.
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Affiliation(s)
- Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan, ROC
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van Loon IN, Goto NA, Boereboom FT, Bots ML, Verhaar MC, Hamaker ME. Frailty Screening Tools for Elderly Patients Incident to Dialysis. Clin J Am Soc Nephrol 2017; 12:1480-1488. [PMID: 28716855 PMCID: PMC5586582 DOI: 10.2215/cjn.11801116] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES A geriatric assessment is an appropriate method for identifying frail elderly patients. In CKD, it may contribute to optimize personalized care. However, a geriatric assessment is time consuming. The purpose of our study was to compare easy to apply frailty screening tools with the geriatric assessment in patients eligible for dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A total of 123 patients on incident dialysis ≥65 years old were included <3 weeks before to ≤2 weeks after dialysis initiation, and all underwent a geriatric assessment. Patients with impairment in two or more geriatric domains on the geriatric assessment were considered frail. The diagnostic abilities of six frailty screening tools were compared with the geriatric assessment: the Fried Frailty Index, the Groningen Frailty Indicator, Geriatric8, the Identification of Seniors at Risk, the Hospital Safety Program, and the clinical judgment of the nephrologist. Outcome measures were sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS In total, 75% of patients were frail according to the geriatric assessment. Sensitivity of frailty screening tools ranged from 48% (Fried Frailty Index) to 88% (Geriatric8). The discriminating features of the clinical judgment were comparable with the other screening tools. The Identification of Seniors at Risk screening tool had the best discriminating abilities, with a sensitivity of 74%, a specificity of 80%, a positive predictive value of 91%, and a negative predictive value of 52%. The negative predictive value was poor for all tools, which means that almost one half of the patients screened as fit (nonfrail) had two or more geriatric impairments on the geriatric assessment. CONCLUSIONS All frailty screening tools are able to detect geriatric impairment in elderly patients eligible for dialysis. However, all applied screening tools, including the judgment of the nephrologist, lack the discriminating abilities to adequately rule out frailty compared with a geriatric assessment.
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Affiliation(s)
- Ismay N. van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands
- Departments of Internal Medicine and
- Departments of Nephrology and Hypertension and
| | | | | | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
OBJECTIVE The aim of the study was to determine the relationship of lifestyle factors and neurocognitive functioning in older adults with vascular risk factors and cognitive impairment, no dementia (CIND). METHODS One hundred sixty adults (M [SD] = 65.4 [6.8] years) with CIND completed neurocognitive assessments of executive function, processing speed, and memory. Objective measures of physical activity using accelerometry, aerobic capacity determined by exercise testing, and dietary habits quantified by the Food Frequency Questionnaire and 4-Day Food Diary to assess adherence to the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets were obtained to assess direct effects with neurocognition. Potential indirect associations of high-sensitivity C-reactive protein and the Framingham Stroke Risk Profile also were examined. RESULTS Greater aerobic capacity (β = 0.24) and daily physical activity (β = 0.15) were associated with better executive functioning/processing speed and verbal memory (βs = 0.24; 0.16). Adherence to the DASH diet was associated with better verbal memory (β = 0.17). Greater high-sensitivity C-reactive protein (βs = -0.14; -0.21) and Framingham Stroke Risk Profile (β = -0.18; -0.18) were associated with poorer executive functioning/processing speed and verbal memory. Greater stroke risk partially mediated the association of aerobic capacity with executive functioning/processing speed, and verbal memory and greater inflammation partially mediated the association of physical activity and aerobic fitness, with verbal memory. CONCLUSIONS Higher levels of physical activity, aerobic fitness, and adherence to the DASH diet are associated with better neurocognitive performance in adults with CIND. These findings suggest that the adoption of healthy lifestyle habits could reduce the risk of neurocognitive decline in vulnerable older adults. CLINICAL TRIAL REGISTRATION NCT01573546.
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Huang SF, Liu CK, Chang CC, Su CY. Sensitivity and specificity of executive function tests for Alzheimer's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:493-504. [PMID: 27420924 DOI: 10.1080/23279095.2016.1204301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Decline in executive function (EF) occurs early in Alzheimer's disease (AD) and can interfere with daily functioning. Unfortunately, little is known about the relative ability of traditional EF tests to detect these cognitive changes. Given that timely diagnosis and intervention are essential to improving functional outcome in this population, our aim was to identify the specific EF measures that best differentiated mild dementia from normal aging. Thirty-one patients with mild AD and 31 controls were administered 7 EF tests. Findings indicated significant between-group differences on all measures except Wisconsin Card Sorting Test. The remaining 6 tests displayed fair to good accuracy discriminating between AD cases and controls. Only category fluency and Tower of London test remained in the final regression model that yielded the highest AUC of 0.90, which was not statistically different from that of either test alone. Overall, most of the tests employed were valid for assessing mild EF disturbances. Specifically, the two measures can be used in isolation for quick screening or in combination to facilitate a more in-depth evaluation of EF performance. This study contributes to clinical field by testifying to the validity of various EF tests to identify AD-related compromises in this cognitive domain.
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Affiliation(s)
- Shu-Fen Huang
- a Department of Rehabilitation Medicine, Ministry of Health and Welfare Pingtung Hospital , Pingtung , Taiwan
| | - Ching-Kuan Liu
- b Department of Neurology, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chiung-Chih Chang
- c Department of Neurology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chwen-Yng Su
- d Occupational Therapy, Kaohsiung Medical University , Kaohsiung , Taiwan
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Characterizing cognitive performance in a large longitudinal study of aging with computerized semantic indices of verbal fluency. Neuropsychologia 2016; 89:42-56. [PMID: 27245645 DOI: 10.1016/j.neuropsychologia.2016.05.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/22/2022]
Abstract
A computational approach for estimating several indices of performance on the animal category verbal fluency task was validated, and examined in a large longitudinal study of aging. The performance indices included the traditional verbal fluency score, size of semantic clusters, density of repeated words, as well as measures of semantic and lexical diversity. Change over time in these measures was modeled using mixed effects regression in several groups of participants, including those that remained cognitively normal throughout the study (CN) and those that were diagnosed with mild cognitive impairment (MCI) or Alzheimer's disease (AD) dementia at some point subsequent to the baseline visit. The results of the study show that, with the exception of mean cluster size, the indices showed significantly greater declines in the MCI and AD dementia groups as compared to CN participants. Examination of associations between the indices and cognitive domains of memory, attention and visuospatial functioning showed that the traditional verbal fluency scores were associated with declines in all three domains, whereas semantic and lexical diversity measures were associated with declines only in the visuospatial domain. Baseline repetition density was associated with declines in memory and visuospatial domains. Examination of lexical and semantic diversity measures in subgroups with high vs. low attention scores (but normal functioning in other domains) showed that the performance of individuals with low attention was influenced more by word frequency rather than strength of semantic relatedness between words. These findings suggest that various automatically semantic indices may be used to examine various aspects of cognitive performance affected by dementia.
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Preservation of the Semantic Verbal Fluency Advantage in a Large Population-Based Sample: Normative Data from the TILDA Study. J Int Neuropsychol Soc 2016; 22:570-6. [PMID: 27055803 DOI: 10.1017/s1355617716000291] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES It is widely believed that phonemic fluency is more difficult than naming exemplars from a semantic category. Normative data in this regard are scarce, and there is considerable disagreement in the literature regarding the pattern in normal ageing and neurodegenerative conditions. Our objective was to provide normative data for semantic phonemic discrepancy scores from a large sample of older adults. METHODS A total of 5780 community-dwelling older adults were included in this prospective, longitudinal study. Discrepancy scores were calculated by subtracting phonemic fluency score from semantic fluency score for each participant. Quantile regression was used to estimate normative values stratified for age. RESULTS Subjects did better on testing of semantic fluency. The average discrepancy score was 9.18±6.89 words, (range, -20 to 37; n=5780). At the fiftieth percentile, those in their fifth decade produced 10 more "animals" than "letter F" words. Subjects scored one word less per decade, with an average of seven more "animal" words produced by those in their eighth decade. CONCLUSIONS Our study is the first to provide normative data and confirms that, for animal versus letter F fluency, the semantic advantage persists into later life in a population-based sample of community-dwelling older adults. Given that a majority of clinical samples have confirmed a reverse of this pattern in Alzheimer's dementia (i.e., loss of semantic advantage in Alzheimer's disease, yielding a phonemic advantage), our findings support the clinical utility of brief fluency tests and encourage further research into their use in diagnosis and prediction of progression to dementia.
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Clark DG, McLaughlin PM, Woo E, Hwang K, Hurtz S, Ramirez L, Eastman J, Dukes RM, Kapur P, DeRamus TP, Apostolova LG. Novel verbal fluency scores and structural brain imaging for prediction of cognitive outcome in mild cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 2:113-22. [PMID: 27239542 PMCID: PMC4879664 DOI: 10.1016/j.dadm.2016.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The objective of this study was to assess the utility of novel verbal fluency scores for predicting conversion from mild cognitive impairment (MCI) to clinical Alzheimer's disease (AD). METHOD Verbal fluency lists (animals, vegetables, F, A, and S) from 107 MCI patients and 51 cognitively normal controls were transcribed into electronic text files and automatically scored with traditional raw scores and five types of novel scores computed using methods from machine learning and natural language processing. Additional scores were derived from structural MRI scans: region of interest measures of hippocampal and ventricular volumes and gray matter scores derived from performing ICA on measures of cortical thickness. Over 4 years of follow-up, 24 MCI patients converted to AD. Using conversion as the outcome variable, ensemble classifiers were constructed by training classifiers on the individual groups of scores and then entering predictions from the primary classifiers into regularized logistic regression models. Receiver operating characteristic curves were plotted, and the area under the curve (AUC) was measured for classifiers trained with five groups of available variables. RESULTS Classifiers trained with novel scores outperformed those trained with raw scores (AUC 0.872 vs 0.735; P < .05 by DeLong test). Addition of structural brain measurements did not improve performance based on novel scores alone. CONCLUSION The brevity and cost profile of verbal fluency tasks recommends their use for clinical decision making. The word lists generated are a rich source of information for predicting outcomes in MCI. Further work is needed to assess the utility of verbal fluency for early AD.
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Affiliation(s)
- David Glenn Clark
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- Department of Neurology, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Paula M. McLaughlin
- Ontario Neurodegenerative Disease Research Initiative, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ellen Woo
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kristy Hwang
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sona Hurtz
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Leslie Ramirez
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jennifer Eastman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reshil-Marie Dukes
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Puneet Kapur
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Thomas P. DeRamus
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Appels BA, van Campen JPCM, Schmand B. [Validation of the Seven Minute Screen for use in a memory clinic]. Tijdschr Gerontol Geriatr 2016; 47:68-77. [PMID: 26860596 DOI: 10.1007/s12439-015-0166-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive tests play a crucial part in the assessment of dementia. In 1998 the Seven Minute Screen was developed by Solomon and colleagues. The test was originally designed to distinguish between Alzheimer's disease (AD) and normal ageing, and research showed that the instrument is highly sensitive to AD. Subsequent research also proved the diagnostic accuracy of the Seven Minute Screen in the detection of other common types of dementia, such as vascular dementia, frontotemporal dementia and dementia with Lewy bodies. This article reports new research on the predictive validity of the Seven Minute Screen using 289 cognitively intact subjects, 175 patients with MCI and 563 patients with dementia in the setting of a memory clinic. In addition, a comparison is made with the Mini Mental State Examination (MMSE). The study demonstrates that the Seven Minute Screen is a valuable screening instrument for all common types of dementia, and it has added value to the MMSE. The sensitivity for dementia is 96 % and the specificity 93 %, in comparison to 69 and 98 % for the MMSE (< 24). The sensitivity for the various types of dementia is consistently high, ranging from 92 % for a subcortical dementia to 97 % for AD. The Seven Minute Screen requires little training, and combines a short administration time with a high diagnostic accuracy. This makes the Seven Minute Screen useful for application in memory clinics.
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Affiliation(s)
- B A Appels
- afdeling Medische Psychologie en Ziekenhuispsychiatrie, Medisch Centrum Slotervaart, Amsterdam, Nederland.
| | - J P C M van Campen
- afdeling Klinische Geriatrie, Medisch Centrum Slotervaart, Amsterdam, Nederland
| | - B Schmand
- afdeling Medische Psychologie, Academisch Medisch Centrum, en Programmagroep Brain & Cognition, Faculteit der Maatschappij- en Gedragswetenschappen, Universiteit van Amsterdam, Amsterdam, Nederland
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Delgado C, Muñoz-Neira C, Soto A, Martínez M, Henríquez F, Flores P, Slachevsky A. Comparison of the Psychometric Properties of the “Word” and “Picture” Versions of the Free and Cued Selective Reminding Test in a Spanish-Speaking Cohort of Patients with Mild Alzheimer's Disease and Cognitively Healthy Controls. Arch Clin Neuropsychol 2016; 31:165-75. [DOI: 10.1093/arclin/acv107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 01/07/2023] Open
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Beckert M, Loureiro F, Menta C, Mello EF, Nogueira EL, von Gunten A, Gomes I. Performance of low-educated elders with depression on Addenbrooke's Cognitive Examination-Revised (ace-r) test. Dement Neuropsychol 2016; 10:19-25. [PMID: 29213426 PMCID: PMC5674909 DOI: 10.1590/s1980-57642016dn10100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Along with cognitive disorders, depression has been a concern for mental health services due to its highly debilitating effect on the functioning and quality of life of the elderly. However, there is still little understanding of the cognitive alterations resulting from depression or of the difficult differential diagnosis with mild cognitive impairment (MCI). It is known that performance on cognitive tests is strongly influenced by education but few studies have been conducted involving low-educated populations. Objective To evaluate the performance of elders with low education and no dementia on Addenbrooke's Cognitive Examination-Revised (ACE-R) test and its cognitive domains, and compare patients with Current Major Depressive Episode (CMDE) against those without depressive symptoms. Methods A retrospective, cross-sectional analytical study was conducted based on medical files of patients treated at the Cerebral Aging Clinic of the Hospital São Lucas of the PUCRS. The study included 116 individuals with low education (< 8 years of education) aged between 60 and 84 (69.6 ± 6.4) years, with MCDE (N = 41) and controls (N = 75). Results No significant difference was observed between control and MCDE groups in median scores on the ACE-R, Mini-Mental State Examination, and the five cognitive domains. There was also no difference between the groups on separate analyses of results on the clock drawing test, the categorical verbal and phonological fluency test, and the naming test. Conclusion The results of this study showed that depressive symptoms did not influence scores on the ACE-R tests conducted in elders with low education.
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Affiliation(s)
- Michele Beckert
- Psychologist, MD, Department of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
| | - Fernanda Loureiro
- Speech Therapist, MD, PhD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
| | - Caroline Menta
- Psychiatrist, MD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
| | - Elisa Fasolin Mello
- Psychiatrist, MD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
| | - Eduardo L Nogueira
- Psychiatrist, MD, PhD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
| | - Armin von Gunten
- Psychiatrist, MD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil, and Old-Age Psychiatric Service, Department of Psychiatry, Lausanne University Hospital, Switzerland
| | - Irênio Gomes
- Neurologist, MD, PhD, Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, RS, Brazil
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