Validation of the Thai version of the short Boston Naming Test (T-BNT) in patients with Alzheimer's dementia and mild cognitive impairment: clinical and biomarker correlates

Development and validation of the Chinese Naming Test (CNT): Diagnostic efficacy and correlation with Alzheimer's disease biomarkers

BackgroundNeuropsychological assessments are essential tools for the screening and diagnosis of patients with cognitive impairments. Cultural background differences significantly affect cognitive test performance. For China, which is rapidly aging, a culturally adaptive picture naming test is urgently needed.ObjectiveThis study aims to develop a Chinese naming test (CNT) adapted to the cultural background of Chinese people and to explore its correlation with Alzheimer's disease (AD) biomarkers.MethodsA total of 1459 participants were recruited, including 744 with normal cognition (NC), 492 with mild cognitive impairment (MCI), and 223 with dementia. All participants underwent a comprehensive neuropsychological assessment. The diagnostic capability of CNT was determined using Receiver Operating Characteristic curves. Part of participants underwent amyloid-β (Aβ) PET scans, tau-PET scans, and MRI scans. The relationships between CNT scores and Aβ and tau deposition, as well as brain structural changes, were analyzed.ResultsThe diagnostic capability of CNT for MCI showed a sensitivity of 68.7%, specificity of 75.6%, and AUC of 0.81; for dementia, the sensitivity was 72.7%, specificity was 89.5%, and AUC was 0.89. The correlation coefficient between CNT scores and brain Aβ burden was -0.11 (p = 0.024). CNT scores correlated with tau burden in different Braak stages (p < 0.05). The correlation coefficient between CNT scores and hippocampus atrophy was -0.15 (p = 0.003).ConclusionsThe CNT has good diagnostic performance in detecting MCI and dementia in Chinese population. There is a correlation between CNT scores and AD imaging markers, indicating that the CNT might has potential value in predicting cognitive changes and disease progression.

Quality of Assessment Tools for Aphasia: A Systematic Review

Background/Objectives: Aphasia is a neurological condition affecting the ability to understand and/or express language fluently and accurately, and can occur following stroke, traumatic injuries, or other brain pathologies. The aim of the following study was to provide clinicians and researchers information regarding the existing assessment tools to assess aphasia. Methods: For this Systematic Review, PubMed, CINAHL, Web of Science, and Scopus were searched for articles published up to August 2024. Authors independently identified eligible studies based on predefined inclusion criteria and extracted data. The study quality and risk of bias were assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Of the 1278 publications identified and screened, 238 studies fell within the inclusion criteria and were critically reviewed, and 164 assessment tools were found and divided into 8 main domains; the most used tools were the Language Screening Test (LAST), the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39), the Oxford Cognitive Screen (OCS), and the Token test. Conclusions: This review has emphasized the need for agreement among researchers as to which tool must be studied or adapted to other national contexts to develop universal norms and standards.

Boston Naming Test as a Screening Tool for Early Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery

PURPOSE

The Boston naming test (BNT), as a simple, fast, and easily administered neuropsychological test, was demonstrated to be useful in detecting language function. In this study, BNT was investigated whether it could be a screening tool for early postoperative cognitive dysfunction (POCD).

METHODS

This prospective observational cohort study included 132 major noncardiac surgery patients and 81 nonsurgical controls. All participants underwent a mini-mental state examination (MMSE) and BNT 1 day before and 7 days after surgery. Early POCD was assessed by reliable change index and control group results.

RESULTS

Seven days after surgery, among 132 patients, POCD was detected in 30 (22.7%) patients (95% CI, 15.5%-30.0%) based on MMSE, and 45 (34.1%) patients (95% CI, 26.3%-41.9%) were found with postoperative language function decline based on BNT and MMSE. Agreement between the BNT spontaneous naming and MMSE total scoring was moderate (Kappa .523), and the sensitivity of BNT spontaneous naming for detecting early POCD was .767. Further analysis showed that areas under receiver operating characteristics curves (AUC) did not show statistically significant differences when BNT spontaneous naming (AUC .862) was compared with MMSE language functional subtests (AUC .889), or non-language functional subtests (AUC .933).

CONCLUSION

This study indicates the feasibility of implementing the BNT spontaneous naming test to screen early POCD in elderly patients after major noncardiac surgery.

Biomarkers of neurodegeneration across the Global South

Research on neurodegenerative diseases has predominantly focused on high-income countries in the Global North. This Series paper describes the state of biomarker evidence for neurodegeneration in the Global South, including Latin America, Africa, and countries in south, east, and southeast Asia. Latin America shows growth in fluid biomarker and neuroimaging research, with notable advancements in genetics. Research in Africa focuses on genetics and cognition but there is a paucity of data on fluid and neuroimaging biomarkers. South and east Asia, particularly India and China, has achieved substantial progress in plasma, neuroimaging, and genetic studies. However, all three regions face several challenges in the form of a lack of harmonisation, insufficient funding, and few comparative studies both within the Global South, and between the Global North and Global South. Other barriers include scarce infrastructure, lack of knowledge centralisation, genetic and cultural diversity, sociocultural stigmas, and restricted access to tools such as PET scans. However, the diverse ethnic, genetic, economic, and cultural backgrounds in the Global South present unique opportunities for bidirectional learning, underscoring the need for global collaboration to enhance the understanding of dementia and brain health.

Circuit-based neuromodulation enhances delayed recall in amnestic mild cognitive impairment

BACKGROUND

This study aimed to investigate the efficacy of circuits-based paired associative stimulation (PAS) in adults with amnestic mild cognitive impairment (aMCI).

METHODS

We conducted a parallel-group, randomised, controlled clinical trial. Initially, a cohort of healthy subjects was recruited to establish the cortical-hippocampal circuits by tracking white matter fibre connections using diffusion tensor imaging. Subsequently, patients diagnosed with aMCI, matched for age and education, were randomly allocated in a 1:1 ratio to undergo a 2-week intervention, either circuit-based PAS or sham PAS. Additionally, we explored the relationship between changes in cognitive performance and the functional connectivity (FC) of cortical-hippocampal circuits.

RESULTS

FCs between hippocampus and precuneus and between hippocampus and superior frontal gyrus (orbital part) were most closely associated with the Auditory Verbal Learning Test (AVLT)_N5 score in 42 aMCI patients, thus designated as target circuits. The AVLT_N5 score improved from 2.43 (1.43) to 5.29 (1.98) in the circuit-based PAS group, compared with 2.52 (1.44) to 3.86 (2.39) in the sham PAS group (p=0.003; Cohen's d=0.97). A significant decrease was noted in FC between the left hippocampus and left precuneus in the circuit-based PAS group from baseline to postintervention (p=0.013). Using a generalised linear model, significant group×FC interaction effects for the improvements in AVLT_N5 scores were found within the circuit-based PAS group (B=3.4, p=0.017).

CONCLUSIONS

Circuit-based PAS effectively enhances long-term delayed recall in adults diagnosed with aMCI, which includes individuals aged 50-80 years. This enhancement is potentially linked to the decreased functional connectivity between the left hippocampus and left precuneus.

TRIAL REGISTRATION NUMBER

ChiCTR2100053315; Chinese Clinical Trial Registry.

CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Neuropsychology Assessment Battery: 35 Years and Counting

BACKGROUND

In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations.

OBJECTIVE

Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments.

METHODS

Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches.

RESULTS

CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years.

CONCLUSION

CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.

Removing the noose item from the Boston naming test: A step toward antiracist neuropsychological assessment

Objective: The Boston Naming Test-Second Edition (BNT-2), the "gold-standard" assessment of confrontation naming used to diagnosis disorders such as dementia, includes aculturally insensitive item, the noose. Given calls to stop structural racism in psychology, this study examined changes in scores and performance classification if the noose item were omitted from the BNT-2. Methods: Participants were 291 Black, White, and Latinx adults who were administered the BNT-2 within a comprehensive neuropsychological evaluation. Ethnoracial differences in BNT-2 scores with and without the noose item and percentages of participants answering the noose item incorrectly were investigated. Results: Significant differences were found between ethnoracial groups in BNT-2 raw scores, T-scores, and percentage of participants incorrectly answering the noose item. Follow-up analyses revealed White participants obtained significantly higher raw scores and had significantly fewer participants answer the noose item incorrectly than Black and Latinx groups, who did not differ significantly. For T-scores, Black participants obtained significantly higher scores than White participants who obtained significantly higher scores than Latinx participants. Despite these differences, giving credit for the omitted noose item changed performance classification for only 10 participants (3.4%). Conclusions: Performance classification did not change significantly for the vast majority of a large ethnoculturally diverse sample when giving credit for the noose item as if it were not administered. Therefore, the non-noose BNT-2remains accurate while reducing cultural insensitivity towards Black populations, emphasizing a step in working towards anti-racism and fostering culturally-competent services within psychology.

Peripheral Blood Biomarkers Coupled with the Apolipoprotein E4 Genotype Are Strongly Associated with Semantic and Episodic Memory Impairments in Elderly Subjects with Amnestic Mild Cognitive Impairment and Alzheimer's Disease

BACKGROUND

The Apolipoprotein E4 (ApoE4) genotype is strongly associated with Alzheimer's disease (AD), although the presence of the ApoE4 allele alone is not sufficient to explain AD. The pathophysiology of amnestic mild cognitive impairment (aMCI) remains unclear.

OBJECTIVE

This study aims to examine associations between peripheral blood biomarkers coupled with ApoE4 and episodic and semantic memory.

METHODS

The CERAD battery was completed and various biomarkers were assayed in 60 subjects with aMCI, 60 with AD, and 62 healthy controls.

RESULTS

Deficits in semantic and episodic memory were significantly predicted by anion gap and bicarbonate, albumin, and glucose coupled with ApoE4. Furthermore, these peripheral biomarkers interacted with ApoE to predict greater memory impairments.

CONCLUSIONS

Peripheral blood biomarkers may interact with pathways related to ApoE4 to predict greater semantic and episodic memory impairments, thus contributing to the pathophysiology of aMCI and AD. Our data suggest that the transition from aMCI to AD could at least in some cases be associated with significant interactions between ApoE4 and those peripheral blood biomarkers.

Identification of potential blood biomarkers for early diagnosis of Alzheimer's disease through RNA sequencing analysis

Background

With demographic shifts toward older populations, the number of people with dementia is steadily increasing. Alzheimer’s disease (AD) is the most common cause of dementia, and no curative treatment is available. The current best strategy is to delay disease progression and to practice early intervention to reduce the number of patients that ultimately develop AD. Therefore, promising novel biomarkers for early diagnosis are urgently required.

Methods

To identify blood-based biomarkers for early diagnosis of AD, we performed RNA sequencing (RNA-seq) analysis of 610 blood samples, representing 271 patients with AD, 91 cognitively normal (CN) adults, and 248 subjects with mild cognitive impairment (MCI). We first estimated cell-type proportions among AD, MCI, and CN samples from the bulk RNA-seq data using CIBERSORT and then examined the differentially expressed genes (DEGs) between AD and CN samples. To gain further insight into the biological functions of the DEGs, we performed gene set enrichment analysis (GSEA) and network-based meta-analysis.

Results

In the cell-type distribution analysis, we found a significant association between the proportion of neutrophils and AD prognosis at a false discovery rate (FDR) < 0.05. Furthermore, a similar trend emerged in the results of routine blood tests from a large number of samples (n = 3,099: AD, 1,605; MCI, 994; CN, 500). In addition, GSEA and network-based meta-analysis based on DEGs between AD and CN samples revealed functional modules and important hub genes associated with the pathogenesis of AD. The risk prediction model constructed by using the proportion of neutrophils and the most important hub genes (EEF2 and RPL7) achieved a high AUC of 0.878 in a validation cohort; when further applied to a prospective cohort, the model achieved a high accuracy of 0.727.

Conclusions

Our model was demonstrated to be effective in prospective AD risk prediction. These findings indicate the discovery of potential biomarkers for early diagnosis of AD, and their further improvement may lead to future practical clinical use.