The 5 Objects Test: a novel, minimal-language, memory screening test

The nonverbal BriefScreen: A cognitive screening method for patients with limited language and motor abilities

Dementia and significant cognitive decline are frequent sequelae of stroke, but are difficult to evaluate when aphasia and/or motor impairment are present. The linguistic and motor requirements of commonly employed screening tests render them problematic for use post-stroke. The present study examines the validity of the Nonverbal BriefScreen, a brief screening method with limited verbal and motor requirements, in groups of patients with known cognitive impairment using the MMSE as a gold standard. Participants were 137 healthy middle aged and older community dwellers, 21 patients with MCI/early dementia and 35 patients with different types of dementia. The sensitivity and specificity of the Nonverbal BriefScreen were calculated for various cutoff scores, with the MMSE as comparison. The Nonverbal BriefScreen was effective in discriminating between healthy controls and patients with dementia, as well as between healthy controls and all patients, with areas under the ROC curve similar to that of the MMSE. ROC analyses with a smaller sample of 35 age-matched healthy controls showed adequate discriminant ability to detect cognitive impairment. The Nonverbal BriefScreen was shown to be a valid method for screening for cognitive impairment that could be employed as a screening method for patients with limited language.

Binding objects to their spatiotemporal context: Age gradient and neuropsychological correlates of What-Where-When task performance

A number of recent studies have shown that the ability to accurately recall bound object and spatiotemporal aspects of an experienced event develops gradually in children and is greatly impaired in the elderly, reflecting developmental discontinuities in the integrity of the underlying medial temporal lobe network. Using a novel What-Where-When (WWW) visuospatial reconstruction task, the experiential memory performance of a group of healthy older adults (aged 60-80) was compared to that of a group of younger adults (aged 20-40). Both groups were equated on their general cognitive ability, their executive functioning, and on the presence of depression, anxiety, and stress symptomatology. As hypothesized, the performance of the older adults in the binding task was significantly lower, with younger participants recalling three times the amount of bound object and spatiotemporal triads than their older counterparts. Psychomotor speed was found to be lower in older adults and was the only neuropsychological index to significantly affect success on the WWW binding task. Based on this and other relevant studies, the selective associative memory impairment obtained using a non-verbal What-Where-When paradigm emerges as a marker for the detection of early pre-clinical signs of experiential memory pathology.

Prosopagnosia, Other Specific Cognitive Deficits, and Behavioral Symptoms: Comparison between Right Temporal and Behavioral Variant of Frontotemporal Dementia

Right temporal variant of frontotemporal dementia (rtv-FTD) represents an uncommon and recently described frontotemporal dementia (FTD) entity presenting with symptoms in many ways comparable to those of the frontal or behavioral variant of FTD (bv-FTD). The aims of this study were to explore the timing of cognitive and behavioral symptoms of rtv-FTD, and to compare the distinct cognitive deficits including prosopagnosia and behavioral symptoms of rtv-FTD patients with those observed in bv-FTD patients. We reviewed the records of 105 patients clinically diagnosed with FTD. A total of 7 patients (5 men/2 women) with FTD and marked right temporal atrophy in magnetic resonance imaging (MRI) were detected. Clinical features were compared with those observed in a group of 22 age-matched patients (16 men/6 women) with FTD and predominant frontal lobe atrophy. The main presenting symptoms of rtv-FTD were prosopagnosia, apathy, and episodic memory impairment. In contrast, social awkwardness and compulsive behaviors were dominant in later stages of the disease together with disinhibition and loss of insight with a marked personality change. Although the cognitive and behavioral profiles of patients with right temporal or frontal lobes atrophy present substantial similarities, each subtype has a number of distinct characteristics. It appears that prosopagnosia, obsessive behaviors, and psychotic symptoms are more prominent in rtv-FTD patients.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Montreal Cognitive Assessment in Older Adults

Objective: Cognitive screening instruments (CSIs) are essential for everyday practice. The Quick Mild Cognitive Impairment (Qmci) screen, a short instrument designed to identify mild cognitive impairment, was recently translated into Greek (Qmci-Gr). The present study compared its diagnostic value against the Montreal Cognitive Assessment (MoCA) screen and examined its optimal cutoffs. Method: We recruited consecutive patients aged ≥55 years that presented with cognitive complaints from two outpatient clinics in Greece. The Qmci-Gr and MoCA were completed by all patients. Furthermore, they were assessed independently with a comprehensive flexible neuropsychological battery to establish a diagnostic classification. Results: In the current study, we assessed a total of 145 patients, with a median age of 70 years; 44 were classified as having Subjective Memory Complaints (SMC) but normal cognition, 32 with MCI and 69 with dementia. The Qmci-Gr had a higher accuracy compared to the MoCA in discriminating MCI from dementia, area under the curve (AUC) of 0.81 versus 0.75, respectively; however, this finding was marginally significant (p = 0.08). Its accuracy was marginally higher for distinguishing SMC from dementia, AUC of 0.94 versus 0.89 (p = 0.03). However, Qmci-Gr presented a lower accuracy than MoCa in differentiating SMC from MCI, AUC of 0.76 versus 0.94 (p = 0.006). Conclusions: The Qmci-Gr has comparable diagnostic accuracy to the MoCA regarding MCI and dementia groups. Further research, with larger and more diverse samples, may be necessary to ensure generalizability.

Evolving Causes of Rapidly Progressive Dementia: A 5-Year Comparative Study

BACKGROUND

Rapidly progressive dementia (RPD) is a clinical syndrome developing in <1 to 2 years. Recent progress in RPD evaluation is significant, so RPD's prevalence may change over time. The aim of our new case series was to estimate the relative frequency of RPDs' causative entities, considering the recent advances in RPDs' diagnosis, and compare the results with those of our previous report.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 47 patients who were referred to Attikon University Hospital during a 5-year period for a suspected RPD.

RESULTS

Neurodegenerative diseases were the most frequent causes (38%), followed by prion disease (19%) and autoimmune encephalopathy (AE, 17%). AE cases were by far more common than in our previous report, while other than AE secondary causes were significantly decreased. Mean time to dementia was 9 months in neurodegenerative diseases and 5 months in non-neurodegenerative. Main clinical findings across all patients were memory impairment (66%) and behavioral-emotional disturbances (48%).

CONCLUSIONS

Neurodegenerative diseases are common causes of RPD and have a slower evolution than non-neurodegenerative. Diagnostic novelties enabled the recognition of AE, whereas more common secondary causes are probably now diagnosed in primary settings since the recognition of RPD as distinct clinical entity is continually increasing.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Standardised Mini-Mental State Examination

INTRODUCTION

Short cognitive screening instruments (CSIs) are widely used to stratify patients presenting with cognitive symptoms. The Quick Mild Cognitive Impairment (Qmci) screen is a new, brief (<5mins) CSI designed to identify mild cognitive impairment (MCI), which can be used across the spectrum of cognitive decline. Here we present the translation of the Qmci into Greek (Qmci-Gr) and its validation against the widely-used Standardised Mini-Mental State Examination (SMMSE).

METHODS

Consecutive patients aged ≥55 years presenting with cognitive complaints were recruited from two outpatient clinics in Greece. All patients completed the Qmci-Gr and SMMSE and underwent an independent detailed neuropsychological assessment to determine a diagnostic classification.

RESULTS

In total, 140 patients, median age 75 years, were included; 30 with mild dementia (median SMMSE 23/30), 76 with MCI and 34 with subjective memory complaints (SMC) but normal cognition. The Qmci-Gr had similar accuracy in differentiating SMC from cognitive impairment (MCI & mild dementia) compared with SMMSE, area under the curve (AUC) of 0.84 versus 0.79, respectively; while accuracy was higher for the Qmci-Gr, this finding was not significantly different, (p = .19). Similarly, the Qmci-Gr had similar accuracy in separating SMC from MCI, AUC of 0.79 versus 0.73 (p = .23).

CONCLUSIONS

The Qmci-Gr compared favorably with the SMMSE. Further research with larger samples and comparison with other instruments such as the Montreal Cognitive Assessment is needed to confirm these findings but given its established brevity, it may be a better choice in busy clinical practice in Greece.

Cognitive assessment tools for mild cognitive impairment screening

Mild cognitive impairment (MCI) is a clinical condition with a high risk of progression to dementia. Due to lack of effective disease-modifying therapies for advanced dementia, diagnosis and disease intervention at an early stage, particularly at MCI stage, has been widely accepted as a critical strategy in disease management that could potentially affect long-term outcome. However, there is currently no consensus on guidelines for routine screening of MCI, resulting in a considerable number of patients with undiagnosed MCI from community. In addition, the use of different screening guidelines leads to difficulties in comparing different studies. A variety of screening tools have been utilized; however, the sensitivity and specificity vary greatly among these tools. By summarizing the sensitivity, specificity and time efficiency for common MCI screening tools, which are key factors to be taken into consideration when making selections and combinations of screening tools, this review suggests the use of a combination of two self-administered highly sensitive tools, p-AD8 + IQCODE (informant questionnaire on cognitive decline in the elderly individuals) in initial screening, as well as a combination of two highly specific widely covered tools, DemTect + MoCA (Montreal cognitive assessment) or memory and executive screening (MES) + MoCA in secondary screening. In addition, this review also proposes a screening flowchart for MCI, aiming to build a sensitive and time efficient way for recruiting subjects for subsequent investigation and disease differentiation.

Validity of screening tools for dementia and mild cognitive impairment among the elderly in primary health care: a systematic review

OBJECTIVES

This systematic review aims to provide updated and comprehensive evidence on the validity and feasibility of screening tools for mild cognitive impairment (MCI) and dementia among the elderly at primary healthcare level.

STUDY DESIGN

A review of articles was performed.

METHODS

A search strategy was used by using electronic bibliographic databases including PubMed, Embase and CENTRAL for published studies and reference list of published studies. The articles were exported to a bibliographic database for further screening process. Two reviewers worked independently to screen results and extract data from the included studies. Any discrepancies were resolved and confirmed by the consensus of all authors.

RESULTS

There were three screening approaches for detecting MCI and dementia - screening by a healthcare provider, screening by a self-administered questionnaire and caretaker informant screening. Montreal Cognitive Assessment (MoCA) was the most common and preferable tool for MCI screening (sensitivity [Sn]: 81-97%; specificity [Sp]: 60-86%), whereas Addenbrooke's Cognitive Examination (ACE) was the preferable tool for dementia screening (Sn: 79-100%; Sp: 86%).

CONCLUSION

This systematic review found that there are three screening approaches for detecting early dementia and MCI at primary health care. ACE and MoCA are recommended tools for screening of dementia and MCI, respectively.

Cognitive functioning in chronic post-stroke aphasia

There is a minimal amount of knowledge regarding the cognitive abilities of people with aphasia. We evaluated the performance of individuals with chronic aphasia (AP) and control participants without aphasia (CP) with left hemisphere stroke in a battery of nonverbal cognitive tests and its relationship with aphasia severity, comprehension abilities, and speech fluency in a prospective cross-sectional study. Cognitive evaluation comprised 10 nonverbal tests. Scores were converted to age and education adjusted standard scores. Forty-eight AP and 32 CP were included. AP average scores were below normal range in three tests: Camel and Cactus Test, immediate recall of 5 Objects Test and Spatial Span. The mean test scores were significantly lower in AP than in CP, except in four tests. Aphasia severity and verbal comprehension ability correlated significantly with semantic memory, constructive abilities and attention/processing speed tests. Subjects with nonfluent aphasia had lower scores than CP in memory, executive functions and attention tests, while subjects with fluent aphasia showed lower scores in memory tests only. On average half of the individuals with aphasia exhibit results within the normal range. Nonetheless, their performance was worse than that of controls, despite the fact that many tests do not correlate with the severity of language disorder.

Normative Data of the Story and Six-Object Memory Recall Tests in Older Spanish Adults: NEDICES Population-Based Cohort

Objective

We provide normative data for the story and six-object recall tasks, stratified by age and education in a large population-based cohort of older Spanish adults.

Method

The sample consisted of 2,581 participants without dementia (age range: 67-98 years) from different socioeconomic areas of central Spain. Normative data are presented in percentile ranks and divided into four overlapping age tables with different midpoints.

Results

Spearman correlations and shared variances were calculated to evaluate the effects of sociodemographic variables on both tasks. Our findings showed that age and education influence the scores in the story and six-object recall tasks, whereas sex had null effect on story recall and an almost negligible on object recall, respectively.

Conclusion

The norms presented herein are important for the correct interpretation of scores in the story and six-object recall tasks when assessing older adults in Spain.

The need for harmonisation and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group

Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status.

Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a “big data” common data set.

We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe.

A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries.

Validation of TICS for detection of dementia and mild cognitive impairment among individuals characterized by low levels of education or illiteracy: a population-based study in rural Greece

OBJECTIVE

The efficacy of the most widely used tests for dementia screening is limited in populations characterized by low levels of education. This study aimed to validate the face-to-face administered Telephone Interview for Cognitive Status (TICS) for detection of dementia and mild cognitive impairment (MCI) in a population-based sample of community dwelling individuals characterized by low levels of education or illiteracy in rural Greece.

METHODS

The translated Greek version of TICS was administered through face-to-face interview in 133 elderly residents of Velestino of low educational level (<12 years). We assessed its internal consistency and test-retest reliability, its correlation with sociodemographic parameters, and its discriminant ability for cognitive impairment and dementia, as defined by a brief neurological evaluation, including assessment of cognitive status and level of independence.

RESULTS

TICS was characterized by adequate internal consistency (Cronbach's α: .72) and very high test-retest reliability (intra-class correlation coefficient: .93); it was positively correlated with age and educational years. MCI and dementia were diagnosed in 18 and 10.5% of the population, respectively. Its discriminant ability for detection of dementia was high (Area under the curve, AUC: .85), with a sensitivity and specificity of 86 and 82%, respectively, at a cut-off point of 24/25. TICS did not perform well in differentiating MCI from cognitively normal individuals though (AUC: .67).

CONCLUSION

The directly administered TICS questionnaire provides an easily applicable and brief option for detection of dementia in populations of low educational level and might be useful in the context of both clinical and research purposes.