[Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)]

Preoperative Electroencephalography-Based Machine Learning Predicts Cognitive Deterioration after Subthalamic Deep Brain Stimulation

Background

Subthalamic deep brain stimulation (STN DBS) may relieve refractory motor complications in Parkinson's disease (PD) patients. Despite careful screening, it remains difficult to determine severity of alpha‐synucleinopathy involvement which influences the risk of postoperative complications including cognitive deterioration. Quantitative electroencephalography (qEEG) reflects cognitive dysfunction in PD and may provide biomarkers of postoperative cognitive decline.

Objective

To develop an automated machine learning model based on preoperative EEG data to predict cognitive deterioration 1 year after STN DBS.

Methods

Sixty DBS candidates were included; 42 patients had available preoperative EEGs to compute a fully automated machine learning model. Movement Disorder Society criteria classified patients as cognitively stable or deteriorated at 1‐year follow‐up. A total of 16,674 EEG‐features were extracted per patient; a Boruta algorithm selected EEG‐features to reflect representative neurophysiological signatures for each class. A random forest classifier with 10‐fold cross‐validation with Bayesian optimization provided class‐differentiation.

Results

Tweny‐five patients were classified as cognitively stable and 17 patients demonstrated cognitive decline. The model differentiated classes with a mean (SD) accuracy of 0.88 (0.05), with a positive predictive value of 91.4% (95% CI 82.9, 95.9) and negative predictive value of 85.0% (95% CI 81.9, 91.4). Predicted probabilities between classes were highly differential (hazard ratio 11.14 [95% CI 7.25, 17.12]); the risk of cognitive decline in patients with high probabilities of being prognosticated as cognitively stable (>0.5) was very limited.

Conclusions

Preoperative EEGs can predict cognitive deterioration after STN DBS with high accuracy. Cortical neurophysiological alterations may indicate future cognitive decline and can be used as biomarkers during the DBS screening. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Performance of Mattis dementia rating scale-Chinese version in patients with mild cognitive impairment and Alzheimer's disease

Background

To identify the applicability of the Chinese Version of Mattis Dementia Rating Scale (DRS-CV).

Methods

The DRS-CV was administered to 483 participants, including 136 normal controls, 167 patients with mild cognition impairment (MCI), and 180 patients with Alzheimer’s disease (AD). Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the scale.

Results

The scores of DRS-CV were ranked in the order of NC > MCI > mild AD > moderate AD group. Memory was the sensitive function affected at a relatively earlier stage of AD. ROC curve analysis indicated the DRS-CV total score and memory subscale showed excellent sensitivity and specificity in the discrimination between MCI from mild AD and mild AD from moderate AD, but poor sensitivity and specificity in the discrimination between MCI and NC.

Conclusion

The DRS-CV is useful to the early diagnosis and severity of AD, not to the early identification of MCI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02173-0.

Normative data for middle-aged Brazilians in the Mattis Dementia Rating Scale

Despite the advances in the diagnosis of dementia, neuropsychological assessment remains an important tool. The Mattis Dementia Rating Scale (DRS) was designed to evaluate people with suspected dementia and allows for the analysis of different cognitive domains. Considering the numerous cases of early-onset dementia, specific reference standards aimed at the middle-aged population are necessary.

Anatomic and neuropsychological findings in low-educated cognitively intact elderly from a Brazilian cohort

In elderly individuals, low educational level may represent a risk factor for the development of dementia and a proxy of cognitive reserve. Objective: This study examined the cognitive and neuroanatomic correlates of high versus low educational levels in cognitively healthy community-dwelling older adults in Brazil. Methods: Fifty-three older adults (mean age: 68±5.3 years) were divided into a “low education” group [LE; 1-4 years of education (N=33)] and “high education” group [HE; >11 years of education (N=20)]. Both groups completed a comprehensive neuropsychological battery and underwent in vivo structural MRI close to the time of testing. Results: Higher educational level increased the chance of having better scores on neuropsychological tests, including verbal and visual delayed recall of information, verbal learning, category fluency, global cognition, and vocabulary. Better scores on these tests were observed in the HE group relative to the LE group. Despite this, there were no group differences between MRI measures. Conclusion: Older adults with higher educational levels showed better scores on neuropsychological measures of cognition, highlighting the need for education-adjusted norms in developing countries. Given the absence of differences in structural anatomy between the groups, these findings appear to be best explained by theories of cognitive reserve.

The influence of education on performance of adults on the Clock Drawing Test

The Clock Drawing Test (CDT) is an important instrument for screening individuals suspected of having cognitive impairment.

Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level

INTRODUCTION

A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level.

OBJECTIVES

The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country.

SAMPLE

The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro.

RESULTS

Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors.

CONCLUSIONS

These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.

Mattis dementia rating scale (DRS) normative data for the brazilian middle-age and elderly populations

OBJECTIVE

To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations.

METHODS

The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over).

RESULTS

Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores.

CONCLUSION

As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

Reliability of cognitive tests of ELSA-Brasil, the brazilian longitudinal study of adult health

Cognitive function evaluation entails the use of neuropsychological tests, applied exclusively or in sequence. The results of these tests may be influenced by factors related to the environment, the interviewer or the interviewee.

Is the Cambridge Cognitive Examination - revised a good tool for detection of dementia in illiterate Brazilian older adults?

AIMS

Few studies have been published on the use of the Cambridge Cognitive Examination Test - Revised (CAMCOG-R) for cognitive assessment of low educational level older adults. The aim of the present study was to determine the accuracy of the Brazilian version of the CAMCOG-R (Br-CAMCOG-R) within a sample of low educational level and illiterate older adults.

METHODS

The Br-CAMCOG-R was administered to outpatients in a public geriatric clinic. The diagnosis of dementia was based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria. The receiving operator characteristic curves were plotted, and the best trade-offs between sensitivities and specificities were calculated.

RESULTS

A total of 189 participants were evaluated. The mean age was 77 ± 6.9 years. The mean educational level was 3.1 ± 2.2 years. The mean test score was 66.5 ± 13.1 points; there were 56 (29.6%) participants with dementia. The best cut-off score for illiterate participants was 50/51; sensitivity, specificity and area under the curve (AUC) were 69%, 69% and 0.75, respectively; for participants with a low educational level, the best cut-off point was 60/61; the sensitivity, specificity and AUC were 83%, 85%, and 0.93, respectively; for participants with a middle educational level, the best cut-off point was 69/70; the sensitivity, specificity and AUC were 90%, 76% and 0.91, respectively.

CONCLUSIONS

The Br-CAMCOG-R was useful for identifying cases of dementia among older adults with middle and low levels of literacy, but inadequate for the illiterate individuals.

Contribuições de um treino cognitivo para a memória de idosos institucionalizados

Este estudo investigou a influência de diferentes treinos cognitivos na memória de idosos institucionalizados e em medidas neuropsicológicas e de humor. Dezesseis idosos participaram do programa que incluiu dois tipos de treinamentos que variavam quanto à semelhança com as atividades e o ambiente dos idosos na instituição. Os treinos tinham a duração de 60 minutos e ocorreram duas vezes por semana durante quase quatro semanas. Os resultados mostraram que ARFC foi influenciado pelo tipo de treinamento, e que a recordação livre para palavras foi melhor após o treinamento somente para o grupo de idosos alfabetizados, independentemente do tipo de treinamento. Não foram detectados efeitos no teste de reconhecimento de imagem e as sessões de treinamento afetaram positivamente os escores EDG.

Comparison of Neuropsychological Performance between Students from Public and Private Brazilian Schools

Neuropsychological assessment reveals that certain cognitive changes that take place during the neural development process may be associated with biopsychosocial issues. A substantial body of research has focused on cognitive development in children and adults, but few such studies have been carried out on adolescents. Therefore, research into the processing of neuropsychological functions in adolescents, taking into account the role of major socio-cultural factors such as school type (public vs. private), is highly relevant. The present study sought to assess whether differences in neuropsychological development exist between adolescent students of public (government-funded) and private schools. A total of 373 grade-matched students between the ages of 12 and 18, 190 from public schools and 183 from private schools, took part in the study. All subjects had no self-reported neurologic or psychiatric conditions and sensory disorders. The NEUPSILIN Brazilian Brief Neuropsychological Assessment Battery was administered to this sample. Comparison of mean scores (one-way ANCOVA with socioeconomic score and age as covariates) showed that adolescents attending private schools generally outperformed their public-school peers in tasks involving sustained attention, memory (working and visual), dictated writing, and constructional and reflective abilities. We conclude that school type should be taken into account during standardization of neuropsychological assessment instruments for adolescent and, probably, child populations.

Diferenças quanto à escolaridade em adultos no desempenho no teste de cancelamento dos sinos

O papel de variáveis sociodemográficas na cognição humana, em especial da escolaridade, vem sendo estudado em indivíduos saudáveis. Esta pesquisa objetivou verificar se há diferenças entre grupos de diferentes níveis educacionais no processamento atencional visual avaliado pelo Teste de Cancelamento dos Sinos. Participaram 124 adultos jovens, distribuídos em três grupos, 5-8, 9-11 e 12 ou mais anos de educação formal, emparelhados por idade. As variáveis de acurácia e tempo, assim como os resultados qualitativos de estratégias utilizadas, foram comparados entre grupos (ANCOVA One-Way e Qui-quadrado). Observou-se uma discrepância entre dados quantitativos e qualitativos. Os grupos de diferentes escolaridades não se diferenciaram entre si quanto a acurácia e tempo; houve, porém, diferenças significativas quanto à distribuição de participantes por coluna em que o primeiro sino foi cancelado e pelas estratégias de cancelamento utilizadas. Novos estudos são relevantes com grupos de diferentes idades e com populações clínicas neurológicas e/ou psiquiátricas.

Cognitive assessment instruments in Parkinson's disease patients undergoing deep brain stimulation

Deep Brain Stimulation (DBS) is a widely used surgical technique in individuals with Parkinson's disease (PD) that can lead to significant reductions in motor symptoms.

Low educational level effects on the performance of healthy adults on a Neuropsychological Protocol suggested by the Commission on Neuropsychology of the Liga Brasileira de Epilepsia

OBJECTIVE: To assess cognitive measures and impact of education on cognitive performance (CP) of low educational levels healthy adults (LELHA) on a Neuropsychological Protocol (NP) suggested by the Liga Brasileira de Epilepsia. METHOD: 138 subjects from an Education Program for Adults divided into two, age and gender matched groups of 69 subjects, answered the NP: Group 1 (mean of 6.9±2.95 months of formal education) and Group 2, 47.8±10 months. Data were compared as z-scores. RESULTS: The mean IQ was 77.1±5.50 and 79.4±3.30 in Groups 1 and 2, respectively (p=0.001). Both performed below the normal curve and Group 1 worse than 2. CP correlated with schooling, especially executive functions (54.1% vs 36.2%) and language (52.9% vs 25.7%). CONCLUSION: LELHA showed significant cognitive impairment in verbal and visuospatial areas. If these results had been obtained in epilepsy patients they would be interpreted as global cognitive impairment.

Sintomas depressivos e déficit cognitivo na população de 60 anos e mais em um município de médio porte do interior paulista*

Introdução: a população mundial está envelhecendo e o Brasil segue essa tendência, o que demanda uma reorganização da sociedade para o cuidado desses idosos. Observa-se, nesta tendência, um aumento do número de casos de depressão e demência, além da vinculação destas com outras doenças crônico-degenerativas. Objetivo: estimar a prevalência dos sintomas depressivos e déficits cognitivos em uma população de 60 anos e mais, moradora de um município de médio porte do interior do estado de São Paulo, e sua associação com outras doenças crônico-degenerativas mais prevalentes. Métodos: estudo transversal, com 364 idosos, utilizando: instrumentos sociodemográficos e de morbidade; o Mini Exame do Estado Mental (MEEM), a Escala de Yesavage, a Escala de Atividades de Vida Diária e a Escala de Atividades Instrumentais de Vida Diária (AIVD). Foram realizadas: análises estatísticas de frequências dos escores dos instrumentos; apresentação da sumarização das variáveis e as possíveis associações entre depressão/demência, aplicando-se o teste do X2 seguido do ajuste de um modelo de regressão logística para dados ordinais. Resultados: a suspeita de depressão foi encontrada em 44% (160) e o déficit cognitivo foi identificado em 38,7% (141) dos idosos. Aproximadamente 75% dos idosos, com suspeita de depressão ou déficit cognitivo, eram portadores de pelo menos mais uma patologia crônica. Foi possível estabelecer associações estatisticamente significativas entre: suspeita de depressão e AIVD (p<0,0001; OR=7,59; IC=3,361-7,139) e déficit cognitivo e AIVD (p=0,0007; OR=3,967; IC=1,788-8,799). Não foram encontradas associações entre idade, situação conjugal, escolaridade, inserção no mercado de trabalho, aposentadoria ou renda. Conclusão: idosos de ambos os sexos estão vulneráveis a doenças como depressão e demência. Por outro lado, sintomas depressivos e déficit cognitivo foram associados ao escore dos idosos comprometidos, segundo as AIVD.*Parte da Dissertação de Mestrado apresentada à Faculdade de Medicina de Botucatu para a obtenção do Título de Mestre em Saúde Pública.

A influência do gênero e da escolaridade no diagnóstico de demência

Um problema no diagnóstico das demências é a ausência de informação prévia sobre o nível cognitivo dos pacientes, anterior às manifestações atuais. A análise das discrepâncias nos testes cognitivos torna-se assim uma referência para o diagnóstico. A relação entre gênero, nível de escolaridade, experiência profissional e resultados da avaliação neuropsicológica foi analisada a partir de prontuários clínicos de pacientes idosos. A amostra masculina de nível superior apresentou médias significativamente menores nas subescalas de execução em relação às verbais. Apesar do nível de escolaridade e da atividade intelectual ocultarem a perda de performance nos quadros demenciais, a análise das discrepâncias evidencia as quedas de rendimento. Na amostra feminina, com menor nível de escolaridade, embora os resultados mostrassem deficiência cognitiva, não ocorreram diferenças significativas entre os subtestes verbais e de execução. A análise da covariância indicou que o nível de escolaridade, e não o gênero, foi o fator responsável pela diferença.

The influence of schooling on performance in the Mattis Dementia Rating Scale (DRS)

Studies have shown the influence of schooling on performance in the Dementia Rating Scale (DRS), suggesting that a single cut-off score is not appropriate for all groups of elderly people.

[Cognitive function in menopausal women evaluated with the Mini-Mental State Examination and Word-List Memory Test]

There is little research in Brazil on cognition and menopause, despite the high frequency of neuropsychiatric complaints in this phase of women's life. The authors present a cross-sectional study aimed at describing the scores by 156 menopausal women on the Mini-Mental State Examination (MMSE) and the Word-List Memory Test (WLMT). The mean score on the MMSE was 25.86 points (SD = 2.67), similar to other studies, except for better performance by illiterate women; scores on the sub-items 'attention and calculation' and 'immediate recall' showed lower values. In the WLMT, the mean was also consistent with the literature (M = 18.83 words; SD = 3.82). The only significant associations with score were for schooling in both tests and arterial hypertension in the WLMT. The authors conclude that cognitive performance in these menopausal women is similar to that of other Brazilian samples, corroborating the wider range of scores among individuals with lower schooling. Complaints pertaining to memory in middle-aged women may be related to decreased attention.

Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities.

Objective

To compare different tests used to examine visuospatial functions in patients with PD.

Methods

Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2).

Results

The mean MMSE score was 24.8±3.03and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42).

Discussion

Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

Cognitive and functional dementia assessment tools: review of Brazilian literature

The diagnosis of dementia is based on cognitive and functional evaluation. One of the difficulties in ascertaining the number of people with dementia in developing countries is the population's lack of formal education. Independent effects of age, sex and education have been identified on scores for most but not all cognitive tests.

OBJECTIVES

Identify the most-used cognitive and functional assessment tools in Brazil, related to dementia diagnosis and treatment outcome; and identify adaptations or normative data, when available.

METHODS

Data were generated from PubMed, LILACS and Portal Periodicos CAPES (thesis database) databases using the search terms 'dementia' and 'Alzheimer'. Data collection criteria were a. Articles with abstract; b. Brazilian abstracts, related to adult Brazilian population; c. Clear mention of assessment tool in the abstract text. A total of 108 abstracts were selected for the main analysis: a. to identify the instruments used b. to determine how many of the selected abstracts mentioned each tool and c. to search in the mentioned databases for respective test adaptations or normative data.

RESULTS

Some 52 different assessment tools, 41 cognitive instruments and 11 functional instruments were identified. The most cited assessment tests were the Mini Mental State Examination (64 abstracts) and Pfeffer Functional Activities Questionnaire (4 abstracts).

DISCUSSION

Many of the instruments used only have the description of the translation process into Portuguese, along with some suggestions of validation or normative data. Few of these followed the recommended procedures of validation, replication, normalization or transcultural adaptation.