Clinical utility of mild cognitive impairment subtypes and number of impaired cognitive domains at predicting progression to dementia: A 20-year retrospective study

OBJECTIVE

To determine the utility of mild cognitive impairment (MCI) subtypes and number of impaired cognitive domains on initial assessment at predicting progression to dementia in a sample of memory clinic patients over a 20-year period.

METHODS

A retrospective analysis was conducted of those presenting to a memory clinic with MCI from 1 January 1999 to 31 December 2018 inclusive. Those with MCI were broken down into one of the four subtypes using recommended cut-off scores on the Cambridge Cognitive Assessment (CAMCOG). Binomial logistic regression analysis was used to determine the utility of MCI subtypes and number of impaired cognitive domains as predictors for dementia.

RESULTS

Overall 1188 individuals with MCI diagnosis were identified, with 378 (32%) progressing to dementia, with median [range] time to diagnosis of 2 years [1-8.4]. Six hundred and forty-nine (55%) were identified as amnestic MCI and 539 (45%) as non-amnestic MCI. Amnestic MCI was a significant predictor of progression compared to non-amnestic MCI (OR = 1.85, df = 1, P < .001). Number of cognitive domains impaired was also a significant predictor of progression to dementia (OR = 1.07, df = 1, P = .01) but the single-/multi-domain distinction was not (OR = 1.29, df = 1, P = .36).

CONCLUSION

This study shows that approximately 32% of those diagnosed with MCI in a memory clinic progressed to dementia, with a median time to progression of 2 years. Those with amnestic MCI are almost twice as likely to progress to dementia than non-amnestic MCI and that therefore this is a useful distinction. However, the utility of the single- and multi-domain MCI distinction is called into question by our findings.

Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) patients are at increased risk of developing dementia. There is a conflict if cognitive interventions can improve cognitive and functional performances in order to delay the development of dementia.

OBJECTIVES

This study aimed to examine the effectiveness of a holistic cognitive rehabilitation program on patients with MCI.

METHODS

The participants, 176 MCI patients with Mini-Mental State Examination = 27.89 (1.73), were classified into 2 groups matched for age, gender, education and cognitive abilities: (1) patients (104) on nonpharmacological therapy and (2) patients (72) on no therapy at all. The effectiveness of the interventions was assessed by neuropsychological evaluation performed at baseline and at the end of the interventions.

RESULTS

Between-group difference in benefit of the experimental group was demonstrated in abilities of executive function (p = 0.004), verbal memory (p = 0.003), praxis (p ≤ 0.012), daily function (p = 0.001) and general cognitive ability (p ≤ 0.005). The experimental patients improved cognitive and functional performances, while the control patients demonstrated deterioration in daily function (p = 0.004).

CONCLUSIONS

Our findings indicate that nonpharmacological therapy of the holistic approach can improve MCI patients' cognitive and functional performances.

The diagnostic accuracy of dementia-screening instruments with an administration time of 10 to 45 minutes for use in secondary care: a systematic review

Early screening for dementia is crucial for identifying reversible causes as well as managing, counseling, and other therapeutic interventions. Many reviews have compared the suitability of very brief screening instruments for use in primary care, but reviews on more extensive instruments in secondary care are scarce. In addition, results on diagnostic accuracy are often biased due to methodological shortcomings, differences in the spectrum of patients or reporting. This systematic review reports the diagnostic accuracy of dementia-screening instruments with an administration time of 10 to 45 minutes, validated in secondary care, restricted to mild dementia and validation studies of ''high quality.'' Characteristics such as cognitive domains and reliability figures are also highlighted.

Neuropsychological testing of culturally and linguistically diverse individuals: the case of Greek-speaking individuals

PURPOSE OF REVIEW

The aim of this review is to update clinicians and researchers regarding neuropsychological tools that have been normed in Greece, thereby assisting them to improve diagnostic accuracy when undertaking neuropsychological assessment of Greek-speaking individuals.

RECENT FINDINGS

A growing number of neuropsychological tests of cognition have been normed in the healthy Greek adult population and the findings reported in the English-language literature. Neuropsychological Greek normative studies have revealed performance differences in Greek speakers. In general, research findings indicate that population-specific norms are required for accurate neuropsychological assessment of the Greek adult population.

SUMMARY

Validating neuropsychological tests of cognition in healthy Greek adults improves clinicians' and researchers' ability to accurately assess, diagnose and manage Greek individuals with cognitive disorders. Normative studies in Greek-speaking clinical populations and studies examining performance differences between native Greek speakers and the Greek diaspora are directions for future research.

Severely stressful events and dementia: a study of an elderly Greek demented population

There is evidence that proneness to experience psychological distress is a risk factor for Alzheimer's disease (AD). In the present study, an attempt is made to examine the possible association between stressful events and cognitive impairment of the elderly, based on a sample of 1271 patients (500 male, 771 female) diagnosed with dementia according to the DSM-IV criteria and 140 age- and gender-matched cognitive healthy subjects. All patients were recruited from the Memory and Dementia Outpatient Clinic of the 3rd University Department of Neurology in "G. Papanikolaou" General Hospital, Thessaloniki, and examined over a period of 7 years. The majority of patients reported a history of a stressful event before the onset of dementia (n=990, 77.9%), while fewer patients reported insidious onset (n=281, 22.1%). The most frequently reported event was the announcement of a life threatening disease (n=472, 37.1%), followed by problems within the family (n=157, 12.4%), spouse death (n = 100, 7.9%), death of a sibling or other beloved person (n=77, 6.1%). Only 55% of the control subjects encountered stressful events, which is significantly different from the percentage of the study group. Our results demonstrate that a stressful event in the elderly could potentially trigger a cognitive decline.

Correlations between the Functional-Cognitive Assessment Scale and the Alzheimer's Disease Assessment Scale when administered to patients with dementia residing in long-term care

The Alzheimer Disease Assessment Scale (ADAS) and the Functional Cognitive Assessment Scale (FUCAS) examine the cognitive performance of patients with dementia. ADAS has been widely used as a clinical instrument, mainly in clinical trials. FUCAS is a useful tool in diagnosing early dementia since it examines executive skills. Moreover, it is sensitive to the subtle changes that occur during the progress of the disease. The aim of this study was to examine the possible correlations between FUCAS and ADAS. The 2 neuropsychological scales were administered to 32 patients with dementia residing in long-term care. They were 12 men and 20 women, 65 to 90 years old, with 4 to 12 years of education. Twenty-four patients were reassessed 3 months after the first assessment, with the same scales. Pearson's correlation showed that the total score of FUCAS correlated significantly with the total score of ADAS: r = 0.80 (P < .01). The t test showed that changes over the 3 months for FUCAS were more significant than ADAS, suggesting that FUCAS is a more sensitive tool.

Functional cognitive assessment scale (FUCAS): a new scale to assess executive cognitive function in daily life activities in patients with dementia and mild cognitive impairment

BACKGROUND

Several tests have been developed to examine performance of demented patients in daily life activities. However, most of them are based either on the subjective evaluation of performance by the patient him/herself, or on the reports of relatives. Functional Cognitive Assessment Scale (FUCAS) is a new reliable (alpha > 0.89 - 0.92) cognitive-behavioral scale that assesses executive function in daily life activities directly in patients with dementia.

AIMS

This study aimed at testing FUCAS' internal consistency of items, criterion-related validity, interrater reliability, discriminative ability, and effect of age, sex, and education on FUCAS scores.

RESULTS

Criterion-related validity was supported by significant correlations between FUCAS, CAMCOG, MMSE, and FRSSD. The interrater reliability of FUCAS' total score for two raters was r 0.997 and we found no significant effect of age, sex, or education on FUCAS' total performance. Discriminant analysis has identified that FUCAS was able to sufficiently discriminate the patients with MCI from those with moderate-severe dementia.

CONCLUSION

FUCAS is a useful and reliable diagnostic tool for MCI. Cognitive-behavioral assessment such as that provided by FUCAS can provide objective information that can serve to enhance the quality of clinical decision-making.

Performance and normative values of a concise neuropsychological test (CAMCOG) in an elderly population sample

BACKGROUND

CAMCOG is a widely used brief neuropsychological test. To date no normative values are available for English speaking individuals representative of the general population.

OBJECTIVES

The aims of the study were to describe the population distribution of performance on CAMCOG, and to provide normative data derived from a representative population sample.

METHODS

CAMCOG was administered at the assessment stage of the MRC Cognitive Function and Ageing Study. MRC CFAS is a multi-centre population-based study in England and Wales in respondents aged 65 years and older. Initial screening provided provisional identification of cognitive impairment. The subsequent assessment interview provided an algorithmic diagnosis of dementia, or other disorders, in a 20% sub-sample.

RESULTS

There were large differences between demented and non-demented groups on the CAMCOG total score and on all CAMCOG subscales. Charts of normative values for CAMCOG are presented by age group, sex and education for the non-demented population (n = 1 914, representing 11 008 individuals screened).

CONCLUSIONS

Population-derived normative data are valuable for comparing an individual's score to the score which would be expected of the general population, given the individual's specific demographic characteristics.

Special characteristics affecting the neuropsychologic assessment of the elderly in Greece

An important element in the diagnostic approach to psychogeriatric patients is the neuropsychologic assessment. Most instruments have been developed in the United States or the United Kingdom, but their appropriateness for culturally different populations is still an open question. Validation studies in Greece revealed certain difficulties both for the Mini-Mental State Examination and the Cambridge Cognitive Examination for the Elderly. These results were probably due to the functional illiteracy of elderly people in Greece, the coexistence of mood disorders, restricted access to news over past decades, and low levels of cooperation between the subject and the examiner The need for a more suitable diagnostic instrument for this kind of population led to the development of the Epidemiological Dementia Index. Data from developing countries support the possibility that research results from Europe and the United States are not directly applicable to the whole world; thus, the need for data from non-English speaking countries is evergrowing. Our understanding of psychogeriatric disorders in the developing world is like an iceberg: The larger portion is hidden because of the lack of relevant data.