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Samson AD, Shen K, Grady CL, McIntosh AR. Exploration of salient risk factors involved in mild cognitive impairment. Eur J Neurosci 2022; 56:5368-5383. [PMID: 35388543 DOI: 10.1111/ejn.15665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022]
Abstract
Mild cognitive impairment (MCI) is a prevalent and complex condition among older adults that often progresses into Alzheimer's disease (AD). Although MCI affects individuals differently, there are specific indicators of risk commonly associated with the development of MCI. The present study explored the prevalence of seven established MCI risk categories within a large sample of older adults with and without MCI. We explored trends across the different diagnostic groups and extracted the most salient risk factors related to MCI using partial least squares. Neuropsychological risk categories showed the largest differences across groups, with the cognitively unimpaired groups outperforming the MCI groups on all measures. Apolipoprotein E4 (ApoE4) carriers were significantly more common among the more severe MCI group, whereas ApoE4 non-carriers were more common in the healthy controls. Participants with subjective and objective cognitive impairment were trending towards AD-like cerebral spinal fluid (CSF) biomarker levels. Increased age, being male and having fewer years of education were identified as important risk factors of MCI. Higher CSF tau levels were correlated with ApoE4 carrier status, age and a decrease in the ability to carry out daily activities across all diagnostic groups. Amyloid beta1-42 CSF concentration was positively correlated with cognitive and memory performance and non-ApoE4 carrier status regardless of diagnostic status. Unlike previous research, poor cardiovascular health or being female had no relation to MCI. Altogether, the results highlighted risk factors that were specific to persons with MCI, findings that will inform future research in healthy aging, MCI and AD.
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Affiliation(s)
- Alexandria D Samson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kelly Shen
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Institute for Neuroscience and Neurotechnology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Cheryl L Grady
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anthony R McIntosh
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Institute for Neuroscience and Neurotechnology, Simon Fraser University, Burnaby, British Columbia, Canada.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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Custodio N, Malaga M, Chambergo-Michilot D, Montesinos R, Moron E, Vences MA, Huilca JC, Lira D, Failoc-Rojas VE, Diaz MM. Combining visual rating scales to identify prodromal Alzheimer's disease and Alzheimer's disease dementia in a population from a low and middle-income country. Front Neurol 2022; 13:962192. [PMID: 36119675 PMCID: PMC9477244 DOI: 10.3389/fneur.2022.962192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many low- and middle-income countries, including Latin America, lack access to biomarkers for the diagnosis of prodromal Alzheimer's Disease (AD; mild cognitive impairment due to AD) and AD dementia. MRI visual rating scales may serve as an ancillary diagnostic tool for identifying prodromal AD or AD in Latin America. We investigated the ability of brain MRI visual rating scales to distinguish between cognitively healthy controls, prodromal AD and AD. Methods A cross-sectional study was conducted from a multidisciplinary neurology clinic in Lima, Peru using neuropsychological assessments, brain MRI and cerebrospinal fluid amyloid and tau levels. Medial temporal lobe atrophy (MTA), posterior atrophy (PA), white matter hyperintensity (WMH), and MTA+PA composite MRI scores were compared. Sensitivity, specificity, and area under the curve (AUC) were determined. Results Fifty-three patients with prodromal AD, 69 with AD, and 63 cognitively healthy elderly individuals were enrolled. The median age was 75 (8) and 42.7% were men. Neither sex, mean age, nor years of education were significantly different between groups. The MTA was higher in patients with AD (p < 0.0001) compared with prodromal AD and controls, and MTA scores adjusted by age range (p < 0.0001) and PA scores (p < 0.0001) were each significantly associated with AD diagnosis (p < 0.0001) but not the WMH score (p=0.426). The MTA had better performance among ages <75 years (AUC 0.90 [0.85–0.95]), while adjusted MTA+PA scores performed better among ages>75 years (AUC 0.85 [0.79–0.92]). For AD diagnosis, MTA+PA had the best performance (AUC 1.00) for all age groups. Conclusions Combining MTA and PA scores demonstrates greater discriminative ability to differentiate controls from prodromal AD and AD, highlighting the diagnostic value of visual rating scales in daily clinical practice, particularly in Latin America where access to advanced neuroimaging and CSF biomarkers is limited in the clinical setting.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
- *Correspondence: Nilton Custodio
| | - Marco Malaga
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- San Martin de Porres University, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Elizabeth Moron
- Departamento de Radiología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
- Servicio de Radiología, Centro de Diagnóstico por Imagen-DPI, Lima, Peru
| | - Miguel A. Vences
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
| | - José Carlos Huilca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neurología, Hospital Guillermo Kaelin de La Fuente, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Centro de Investigación en Medicina Traslacional, Universidad Privada Norbert Wiener, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Brief cognitive tests as a decision-making tool in primary care. A population and validation study. Neurologia 2022:S2173-5808(22)00082-7. [PMID: 35963538 DOI: 10.1016/j.nrleng.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.
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Affiliation(s)
- M Tainta
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain.
| | - A Iriondo
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Ecay-Torres
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Estanga
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M de Arriba
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Barandiaran
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Clerigue
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | | | - J Villanua
- Osatek SA, Hospital Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Izagirre
- Universidad del País Vasco (UPV-EHU), Facultad de Medicina y Enfermería, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Saldias
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Aramburu
- Osakidetza, Organización Sanitaria Integrada (OSI) Debabarrena, Spain
| | - J Taboada
- Osakidetza, Organización Sanitaria Integrada (OSI) Bilbao Basurto, Spain
| | - J Múgica
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain
| | - A Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain
| | - A Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain; Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Vizcaya, Spain
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Test cognitivos breves como herramienta de decisión en Atención Primaria. Estudio poblacional y de validación. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Montesinos R, Parodi JF, Diaz MM, Herrera-Perez E, Valeriano-Lorenzo E, Soto A, Delgado C, Slachevsky A, Custodio N. Validation of Picture Free and Cued Selective Reminding Test for Illiteracy in Lima, Peru. Am J Alzheimers Dis Other Demen 2022; 37:15333175221094396. [PMID: 35465730 PMCID: PMC10581140 DOI: 10.1177/15333175221094396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia in Latin America is a crucial public health problem. Identifying brief cognitive screening (BCS) tools for the primary care setting is crucial, particularly for illiterate individuals. We evaluated tool performance characteristics and validated the free and total recall sections of the Free and Cued Selective Reminding Test-Picture version (FCSRT-Picture) to discriminate between 63 patients with early Alzheimer's disease dementia (ADD), 60 amnestic mild cognitive impairment (aMCI) and 64 cognitively healthy Peruvian individuals with illiteracy from an urban area. Clinical, functional, and cognitive assessments were performed. FCSRT-Picture performance was assessed using receiver operating characteristic curve analyses. The mean ± standard deviation scores were 7.7 ± 1.0 in ADD, 11.8 ± 1.6 in aMCI, and 29.5 ± 1.8 in controls. The FCSRT-Picture had better performance characteristics for distinguishing controls from aMCI compared with several other BCS tools, but similar characteristics between controls and early ADD. The FCSRT-Picture is a reliable BCS tool for illiteracy in Peru.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Jose F. Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Elizabeth Valeriano-Lorenzo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Ambar Soto
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carolina Delgado
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de neurociencia, Facultad de medicina Universidad de Chile, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile
- Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
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Custodio N, Montesinos R, Alva-Diaz C, Pacheco-Barrios K, Rodriguez-Calienes A, Herrera-Pérez E, Becerra-Becerra Y, Castro-Suárez S, Pintado-Caipa M, Cruz Del Castillo R, Cuenca J, Lira D. Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru. Int J Geriatr Psychiatry 2022; 37. [PMID: 33682923 DOI: 10.1002/gps.5531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non-dementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru. MATERIALS AND METHODS A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI. RESULTS Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC = 0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC = 0.84 [95%CI 0.74-0.95]) and MMSE-Pe (0.92 [95%CI 0.86-0.99]). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (-LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and -LR = 0.03) than ACE-Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and -LR = 0.05) and MMSE-Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and -LR = 0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling. CONCLUSION The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Carlos Alva-Diaz
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú.,Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Kevin Pacheco-Barrios
- Red de Eficacia Clínica y Sanitaria, REDECS, Callao, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Aaron Rodriguez-Calienes
- Red de Eficacia Clínica y Sanitaria, REDECS, Callao, Perú.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú.,Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Facultad de Medicina Humana de la Universidad de San Martin de Porres, Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Yahaira Becerra-Becerra
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Geriatría, Hospital Geriátrico Militar, Lima, Perú
| | - Sheila Castro-Suárez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Neurología de la conducta y Neuro-inmunología clínica, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Rossana Cruz Del Castillo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Geriatría, Programa de Atención Domiciliaria-PADOMI, EsSalud, Lima, Perú
| | - José Cuenca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Perú.,Carrera de Psicología, Facultad de Ciencias de la Salud. Universidad Privada del Norte, Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
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Diaz MM, Custodio N, Montesinos R, Lira D, Herrera-Perez E, Pintado-Caipa M, Cuenca-Alfaro J, Gamboa C, Lanata S. Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru. Front Public Health 2021; 9:676518. [PMID: 34552900 PMCID: PMC8450418 DOI: 10.3389/fpubh.2021.676518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Reversible etiologies of cognitive impairment are common and treatable, yet the majority of mild cognitive impairment (MCI) and dementia research in Latin America has focused on irreversible, neurodegenerative etiologies. Objective: We sought to determine if thyroid dysfunction and vitamin B12 and folate deficiencies are associated with cognitive disorders among older adults with memory complaints in Lima, Peru. Methods: This was a retrospective review of patients who presented for cognitive evaluations to a multidisciplinary neurology clinic in Lima, Peru from January 2014 to February 2020. We included individuals aged ≥60 years, native Spanish-speakers, with at least a primary school educational level and a complete clinical assessment. Patients had either subjective cognitive decline (SCD), MCI, or dementia. One-way ANOVA and multiple logistic regression analyses were performed. Results: We included 720 patients (330 SCD, 154 MCI, and 236 dementia); the dementia group was significantly older [mean age SCD 69.7 ± 4.1, dementia 72.4 ± 3.7 (p = 0.000)] and had lower folate levels than SCD patients. The MCI group had higher free T3 levels compared with SCD patients. Those with lower TSH had greater dementia risk (OR = 2.91, 95%CI: 1.15-6.86) but not MCI risk in unadjusted models. B12 deficiency or borderline B12 deficiency was present in 34% of the dementia group, yet no clear correlation was seen between neuropsychological test results and B12 levels in our study. There was no association between MCI or dementia and thyroid hormone, B12 nor folate levels in adjusted models. Conclusion: Our findings do not support an association between metabolic and endocrine disorders and cognitive impairment in older Peruvians from Lima despite a high prevalence of B12 deficiency. Future work may determine if cognitive decline is associated with metabolic or endocrine changes in Latin America.
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Affiliation(s)
- Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Jose Cuenca-Alfaro
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Serggio Lanata
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
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8
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Custodio N, Montesinos R, Cruzado L, Herrera-Perez E, Failoc-Rojas VE, Pintado-Caipa M, Seminario G W, Cuenca J, Gamboa C, Diaz MM. Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels. Front Neurol 2021; 12:704109. [PMID: 34552551 PMCID: PMC8450322 DOI: 10.3389/fneur.2021.704109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The behavioral variant of frontotemporal dementia (bvFTD), characterized by early behavioral abnormalities and late memory impairment, is a neurodegenerative disorder with a detrimental impact on patients and their caregivers. bvFTD is often difficult to distinguish from other neurodegenerative diseases, such as Alzheimer's disease (AD), using brief cognitive tests. Combining brief socio-cognitive and behavioral evaluations with standard cognitive testing could better discriminate bvFTD from AD patients. We sought to evaluate the diagnostic accuracy of brief socio-cognitive tests that may differentiate bvFTD and AD patients with low educational levels. Methods: A prospective study was performed on 51 individuals over the age of 50 with low educational levels, with bvFTD or AD diagnosed using published criteria, and who were receiving neurological care at a multidisciplinary neurology clinic in Lima, Peru, between July 2017 and December 2020. All patients had a comprehensive neurological evaluation, including a full neurocognitive battery and brief tests of cognition (Addenbrooke's Cognitive Examination version III, ACE-III), social cognition (Mini-social Cognition and Emotional Assessment, Mini-SEA), and behavioral assessments (Frontal Behavioral Inventory, FBI; Interpersonal Reactivity Index-Emphatic Concern, IRI-EC; IRI-Perspective Taking, IRI-PT; and Self-Monitoring Scale-revised version, r-SMS). Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was performed to compare the brief screening tests individually and combined to the gold standard of bvFTD and AD diagnoses. Results: The AD group was significantly older than the bvFTD group (p < 0.001). An analysis of the discriminatory ability of the ACE-III to distinguish between patients with AD and bvFTD (AUC = 0.85) and the INECO Frontal Screening (IFS; AUC = 0.78) shows that the former has greater discriminatory ability. Social and behavioral cognition tasks were able to appropriately discriminate bvFTD from AD. The Mini-SEA had high sensitivity and high moderate specificity (83%) for discriminating bvFTD from AD, which increased when combined with the brief screening tests ACE-III and IFS. The FBI was ideal with high sensitivity (83%), as well as the IRI-EC and IRI-PT that also were adequate for distinguishing bvFTD from AD. Conclusions: Our study supports the integration of socio-behavioral measures to the standard global cognitive and social cognition measures utilized for screening for bvFTD in a population with low levels of education.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lizardo Cruzado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Instituto Nacional de Salud Mental “Honorio Delgado—Hideyo Noguchi”, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Wendy Seminario G
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - José Cuenca
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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9
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Ibanez A, Parra MA, Butler C. The Latin America and the Caribbean Consortium on Dementia (LAC-CD): From Networking to Research to Implementation Science. J Alzheimers Dis 2021; 82:S379-S394. [PMID: 33492297 PMCID: PMC8293660 DOI: 10.3233/jad-201384] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In comparison with other regions, dementia prevalence in Latin America is growing rapidly, along with the consequent clinical, social, and economic burden upon patients and their families. The combination of fragile health care systems, large social inequalities, and isolated clinical and research initiatives makes the coordination of efforts imperative. The Latin America and the Caribbean Consortium on Dementia (LAC-CD) is a regional organization overseeing and promoting clinical and research activities on dementia. Here, we first provide an overview of the consortium, highlighting the antecedents and current mission. Then, we present the consortium’s regional research, including the multi-partner consortium to expand dementia research in Latin America (ReDLat), which aims to identify the unique genetic, social, and economic factors that drive Alzheimer’s and frontotemporal dementia presentation in LAC relative to the US. We describe an extension of ReDLat which aims to develop affordable markers of disease subtype and severity using high density EEG. We introduce current initiatives promoting regional diagnosis, visibility, and capacity, including the forthcoming launch of the Latin American Brain Health Institute (BrainLat). We discuss LAC-CD-led advances in brain health diplomacy, including an assessment of responses to the impact of COVID-19 on people with dementia and examining the knowledge of public policies among experts in the region. Finally, we present the current knowledge-to-action framework, which paves the way for a future regional action plan. Coordinated actions are crucial to forging strong regional bonds, supporting the implementation of regional dementia plans, improving health systems, and expanding research collaborations across Latin America.
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Affiliation(s)
- Agustin Ibanez
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA.,Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Barranquilla, Colombia.,Latin American Institute for Brain Health (BrainLat), Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibanez, Santiago de Chile, Chile
| | - Mario A Parra
- Universidad Autónoma del Caribe, Barranquilla, Barranquilla, Colombia.,School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Christopher Butler
- Department of Brain Sciences, Imperial College London, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Instituto de Neurología Cognitiva, Buenos Aires, Argentina.,Departamento de Neurología, Pontificia Universidad de Chile, Santiago, Chile
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10
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Custodio N, Castro-Suárez S, Montesinos R, Failoc-Rojas VE, Cruz del Castillo R, Herrera-Perez E. Neuropsychiatric Symptoms in Patients With Alzheimer's Disease During SARS-COV-2 Pandemic in Peru. Am J Alzheimers Dis Other Demen 2021; 36:15333175211039089. [PMID: 34416114 PMCID: PMC10581147 DOI: 10.1177/15333175211039089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To evaluate neuropsychiatric symptoms in patients with Alzheimer's disease (AD) and their association with cognition and functionality during lockdown of the COVID-19's first wave. We included 91 patients and caregivers of people with AD from a memory clinic. The RUDAS, M@T, and CDR were administered to patients and NPI/ADCS-ADL to caregivers. Baseline and lockdown measurements scales were analyzed to compare the frequencies at baseline versus lockdown and conditional Odds Ratio (ORc) was calculated for the neuropsychiatric symptoms. During the pandemic, significant increase in the number of cases was observed in depression (23%), agitation (36.8%), aberrant motor activity (12%), sleep disorders (26.3%), and appetite change (12.1%). In worsening of pre-existing symptoms, the most frequent were delusions (75%), followed by sleep disorders (71.7%). Lockdown induces a rapid increase of neuropsychiatric symptoms affecting cognitive symptoms and functionality of Peruvian patients with AD.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Sheila Castro-Suárez
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Atlantic Senior Fellow of Global Brain Health Institute, University of California, San Francisco, CA. USA
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Virgilio E. Failoc-Rojas
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima, Perú
| | - Rossana Cruz del Castillo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Geriatría, Programa de Atención Domiciliaria-PADOMI, EsSalud, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
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11
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Custodio N, Duque L, Montesinos R, Alva-Diaz C, Mellado M, Slachevsky A. Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America. Front Aging Neurosci 2020; 12:270. [PMID: 33101004 PMCID: PMC7500065 DOI: 10.3389/fnagi.2020.00270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Standard procedures were applied for reviewing the literature. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Results: Thirteen of 211 articles met the inclusion criteria. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI; however, the diagnostic protocols applied differed. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. No publication to date has included an illiterate population. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level. Conclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. Moreover, the diagnostic validity of the INECO frontal screening (IFS) test should be evaluated in populations with a low level of education. Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.
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Affiliation(s)
- Nilton Custodio
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Neurology Department, Instituto Peruano de Neurociencias, Lima, Peru
| | | | - Rosa Montesinos
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Martin Mellado
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
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12
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Reynoso-Guzman W, Pintado-Caipa M, Cuenca J, Gamboa C, Metcalf T. Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru. Front Neurol 2020; 11:374. [PMID: 32477248 PMCID: PMC7232574 DOI: 10.3389/fneur.2020.00374] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education. Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores. Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cut-off <23 (sensitivity 89%, specificity 93%). Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kristhy Chavez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Willyams Reynoso-Guzman
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - José Cuenca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru.,Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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13
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Gómez-Gallego M, Gómez-García J. Stress and verbal memory in patients with Alzheimer's disease: different role of cortisol and anxiety. Aging Ment Health 2019; 23:1496-1502. [PMID: 30247066 DOI: 10.1080/13607863.2018.1506741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Chronic stress has shown to have marked effects on learning and memory. A broader understanding of these effects has special interest in the context of Alzheimer's disease (AD). This study aims to analyze the moderating effect of cognitive impairment in the relationships between stress and verbal memory performance by considering biological and psychological measures of stress. Method: The sample consisted of 80 AD patients and 104 healthy controls. Salivary cortisol and state anxiety was measured as stress markers. Memory Alteration test (M@T) and Hopkins verbal learning test (HVLT-R) were used to measure verbal memory. Results: In controls, cortisol level was negatively associated with HVLT-R total, learning and delayed recall scores as well as M@T free recall scores, while in patients, such associations were not significant. In this group, cortisol negative effects were limited to HVLT-R learning and M@T semantic memory scores. In both groups, anxiety was associated with better M@T encoding and free recall scores. Besides, inverted U-shaped relationships were observed between anxiety and HVLT-R total recall and learning scores as well as M@T orientation scores. Conclusion: Cortisol levels and anxiety are differentially associated with memory performance in older adults. In general, the negative relationship between cortisol levels and memory observed in healthy elderly weakens in AD. However, moderate state anxiety levels seem to be associated with a better memory performance in AD patients and in healthy elderly.
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Affiliation(s)
| | - Juan Gómez-García
- Department ofQuantitative Methods, Faculty of Economic Sciences, University of Murcia , Murcia , Spain
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14
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Hernandez-Córdova G, Cuenca J, Gamboa C, Metcalf T. Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru. Am J Alzheimers Dis Other Demen 2019; 34:513-522. [PMID: 31422688 PMCID: PMC10653366 DOI: 10.1177/1533317519869709] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education. METHODS A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated. RESULTS Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24). CONCLUSIONS The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Dirección de investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Consejo Nacional de Ciencia, Tecnología e Innovación (CONCYTEC), Lima, Peru
| | - Kristy Chavez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Gustavo Hernandez-Córdova
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José Cuenca
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud. Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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15
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Vázquez-Costa JF, Pedrola Vidal L, Moreau-Le Lan S, Teresí-Copoví I, Frasquet M, Chumillas MJ, Sevilla T. Facial onset sensory and motor neuronopathy: a motor neuron disease with an oligogenic origin? Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:172-175. [PMID: 30889971 DOI: 10.1080/21678421.2019.1582671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To describe a patient with facial onset sensory and motor neuronopathy (FOSMN) carrying heterozygous mutations in both TARDBP and SQSTM1 genes. Methods: The patient underwent neurological, neuropsychological, and neurophysiological examinations. Brain magnetic resonance imaging (MRI) and extensive genetic analysis were also performed. Results: The neurological examination showed dysphonia, left trigeminal hypesthesia, and left masseter and temporalis muscle atrophy. Mild cognitive impairment, affecting predominantly executive functions and social cognition, was appreciable in the neuropsychological examination. The electrophysiological studies revealed: left abnormal blink reflex; neurogenic changes in bulbar and cervical muscles; normal motor evoked potential amplitude, central motor conduction time and cortical silent period. Brain MRI showed right-predominant frontotemporal atrophy. Genetic analysis showed a heterozygous mutation in TARDBP (p.A390S) and in SQSTM1 (p.P392L), both previously described as causing amyotrophic lateral sclerosis. The SQSTM1, but not the TARDBP, mutation was found in both healthy siblings. Conclusions: Our data provide new clinical, neuroimaging, and genetic evidence that FOSMN is a neurodegenerative disease of the motor neuron disease and frontotemporal dementia spectrum, with a possible oligogenic origin. Multicentric efforts focusing on cognitive and genetic studies are necessary to confirm this hypothesis and to determine if ALS genes should be systematically screened in these patients.
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Affiliation(s)
- Juan Francisco Vázquez-Costa
- a Instituto de Investigación Sanitaria la Fe (IIS La Fe) , Neuromuscular Research Unit , Valencia , Spain.,b Department of Neurology , ALS Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain.,c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Valencia , Spain
| | - Laia Pedrola Vidal
- d Instituto de Investigación Sanitaria La Fe , Genomic Unit , Valencia , Spain
| | - Sarah Moreau-Le Lan
- d Instituto de Investigación Sanitaria La Fe , Genomic Unit , Valencia , Spain
| | - Irene Teresí-Copoví
- e Department of Neurophysiology , ALS Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Marina Frasquet
- a Instituto de Investigación Sanitaria la Fe (IIS La Fe) , Neuromuscular Research Unit , Valencia , Spain.,b Department of Neurology , ALS Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain.,c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Valencia , Spain
| | - Maria J Chumillas
- a Instituto de Investigación Sanitaria la Fe (IIS La Fe) , Neuromuscular Research Unit , Valencia , Spain.,c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Valencia , Spain.,e Department of Neurophysiology , ALS Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Teresa Sevilla
- a Instituto de Investigación Sanitaria la Fe (IIS La Fe) , Neuromuscular Research Unit , Valencia , Spain.,b Department of Neurology , ALS Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain.,c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Valencia , Spain.,f Department of Medicine , University of Valencia , Valencia , Spain
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16
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Tavares-Júnior JWL, de Souza ACC, Alves GS, Bonfadini JDC, Siqueira-Neto JI, Braga-Neto P. Cognitive Assessment Tools for Screening Older Adults With Low Levels of Education: A Critical Review. Front Psychiatry 2019; 10:878. [PMID: 31920741 PMCID: PMC6923219 DOI: 10.3389/fpsyt.2019.00878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/07/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cognitive assessment of older adults who are either illiterate or with low levels of education is particularly challenging because several battery tasks require a certain educational background. Early detection of mild cognitive impairment (MCI) in the elderly using validated screening tools is of great importance since this population group could benefit from new drugs that are being investigated for the treatment of dementias. Cutoff scores for psychometric properties of cognitive tests are not well established among adults with low levels of education. The present study aimed to critically review the literature on cognitive assessment tools for screening cognitive syndromes including MCI and Alzheimer's disease (AD) in older adults with low levels of education. Methods: We conducted a systematic search of MEDLINE, LILACS, Cochrane, and SCOPUS electronic databases of cross-sectional and prospective studies with adults over 55 years of age. Results: We found a significant number of assessment tools available (n = 44), but only a few of them showed diagnostic accuracy for the diagnosis of MCI and AD in older adults with low levels of education: the Mini-Mental State Exam; the Montreal Cognitive Assessment; the Persian Test of Elderly for Assessment of Cognition and Executive Function; the Six-Item Screener; and the Memory Alteration Test. Few studies evaluated individuals with low levels of education, with a wide range of cutoff scores and cognitive test batteries. Conclusion: We found that a small number of studies evaluated adults with 4 years of formal education or less. Our findings further support the importance of developing specific tools for the assessment of older adults with low levels of education.
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Affiliation(s)
| | - Ana Célia Caetano de Souza
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.,Neurology Service, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Gilberto Sousa Alves
- Translational Psychiatry Research Group, Universidade Federal do Maranhão, São Luís, Brazil
| | - Janine de Carvalho Bonfadini
- Department of Clinical Medicine, Division of Neurology, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurology Service, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Pedro Braga-Neto
- Department of Clinical Medicine, Division of Neurology, Universidade Federal do Ceará, Fortaleza, Brazil.,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.,Neurology Service, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil
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