Dementia in Conversation: Observations from Triadic Memory Clinic Interactions

2020 ◽  
pp. 195-221
Author(s):  
Christopher Elsey
Keyword(s):  
Memory Clinic

The Memory Clinic Guide: Pocketbook

2001 ◽  
Author(s):  
Robert Butler ◽  
Zuzana Walker
Keyword(s):  
Memory Clinic

scholarly journals Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion

2019 ◽  
Vol 40 (9) ◽  
pp. 1869-1878 ◽  
Author(s):  
Doeschka A Ferro ◽  
Henri JJM Mutsaerts ◽  
Saima Hilal ◽  
Hugo J Kuijf ◽  
Esben T Petersen ◽  
...  
Keyword(s):  
Arterial Spin Labeling ◽  
Cerebral Perfusion ◽  
Region Of Interest ◽  
Resonance Imaging ◽  
Memory Clinic ◽  
Anterior Circulation ◽  
Cortical Gray Matter ◽  
Arterial Transit Time ◽  
Magnetic Resonance Imaging Mri ◽  
Continuous Arterial Spin Labeling

Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = −.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.

scholarly journals Progression to dementia in memory clinic patients with mild cognitive impairment and normal β-amyloid

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Rosenberg ◽  
Alina Solomon ◽  
Vesna Jelic ◽  
Göran Hagman ◽  
Nenad Bogdanovic ◽  
...  
Keyword(s):  
Medial Temporal Lobe ◽  
Predictive Performance ◽  
Csf Biomarkers ◽  
Memory Clinic ◽  
Alzheimer Type ◽  
Normal Range ◽  
Medial Temporal Lobe Atrophy ◽  
Dementia Risk ◽  
Β Amyloid ◽  
Lobe Atrophy

Abstract Background Determination of β-amyloid (Aβ) positivity and likelihood of underlying Alzheimer’s disease (AD) relies on dichotomous biomarker cut-off values. Individuals with mild cognitive impairment (MCI) and Aβ within the normal range may still have a substantial risk of developing dementia, primarily of Alzheimer type. Their prognosis, as well as predictors of clinical progression, are not fully understood. The aim of this study was to explore the associations of cerebrospinal fluid (CSF) biomarkers (Aβ42, total tau, phosphorylated tau) and other characteristics, including modifiable vascular factors, with the risk of progression to dementia among patients with MCI and normal CSF Aβ42. Methods Three hundred eighteen memory clinic patients with CSF and clinical data, and at least 1-year follow-up, were included. Patients had normal CSF Aβ42 levels based on clinical cut-offs. Cox proportional hazard models with age as time scale and adjusted for sex, education, and cognition (Mini-Mental State Examination) were used to investigate predictors of progression to dementia and Alzheimer-type dementia. Potential predictors included CSF biomarkers, cognitive performance (verbal learning and memory), apolipoprotein E (APOE) ε4 genotype, medial temporal lobe atrophy, family history of dementia, depressive symptoms, and vascular factors, including the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score. Predictive performance of patient characteristics was further explored with Harrell C statistic. Results Lower normal Aβ42 and higher total tau and phosphorylated tau were associated with higher dementia risk, and the association was not driven by Aβ42 values close to cut-off. Additional predictors included poorer cognition, APOE ε4 genotype, higher systolic blood pressure, and lower body mass index, but not the CAIDE dementia risk score. Aβ42 individually and in combination with other CSF biomarkers improved the risk prediction compared to age and cognition alone. Medial temporal lobe atrophy or vascular factors did not increase the predictive performance. Conclusions Possibility of underlying AD pathology and increased dementia risk should not be ruled out among MCI patients with CSF Aβ42 within the normal range. While cut-offs may be useful in clinical practice to identify high-risk individuals, personalized risk prediction tools incorporating continuous biomarkers may be preferable among individuals with intermediate risk. The role of modifiable vascular factors could be explored in this context.

EXPRESS: Long-term Neurobehavioral Correlates of Brain Cortical Microinfarcts in a Memory Clinic Cohort in Singapore

2021 ◽  
pp. 174749302110062
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Christopher Li-Hsian Chen ◽  
Saima Hilal
Keyword(s):  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Functional Decline ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Clinical Assessments ◽  
The Impact

Background Cortical cerebral microinfarcts (CMIs) are a small vessel disease (SVD) biomarker underlying cognitive impairment and dementia. However, it is unknown whether CMIs are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional SVD markers. Aims We investigated the associations of CMI burden with incidence and progression of neuropsychiatric subsyndromes (NPS) in a memory clinic cohort of elderly in Singapore. Methods In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and 2 years later. Cortical CMIs and other SVD markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. NPS were clustered into subsyndromes of Hyperactivity, Psychosis, Affective, and Apathy following prior findings. Functional decline was determined using the Clinical Dementia Rating (CDR) scale. Results The presence of multiple CMIs (≥2) was associated with higher NPS-total (β=4.19, 95% CI=2.81-5.58, p<0.001), particularly Hyperactivity (β=2.01, 95% CI=1.30-2.71, p<0.01) and Apathy (β=1.42, 95% CI=0.65-2.18, p<0.01) at baseline. Between baseline and year-2, multiple CMIs were associated with accelerated progression in NPS-total (β=0.29, 95% CI=0.06-0.53, p=0.015), driven by Hyperactivity (β=0.45, 95% CI=0.17-0.72, p<0.01). Subjects with multiple CMIs also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with NPS-total progression (β=0.31, 95% CI=0.11-0.51, p<0.01), or Hyperactivity (β=0.34, 95% CI=0.13-0.56, p<0.01). Conclusion Cortical CMIs are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional SVD markers. The impact of incident CMIs on neurocognitive and neuropsychiatric trajectories warrants further investigations.

Cross-Sectional Examination of Homocysteine Levels with Sarcopenia and Its Components in Memory Clinic Outpatients

2021 ◽  
pp. 1-10
Author(s):  
Yosuke Yamada ◽  
Hiroyuki Umegaki ◽  
Fumie Kinoshita ◽  
Chi Hsien Huang ◽  
Taiki Sugimoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Linear Regression ◽  
Logistic Regression Analysis ◽  
Linear Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Memory Clinic ◽  
Cross Sectional

Background: Homocysteine is a common risk factor for cognitive impairment and sarcopenia. However, very few studies have shown an association between sarcopenia and serum homocysteine levels after adjustment for cognitive function. Objective: The purpose of this study was to investigate the relationship between homocysteine and sarcopenia in memory clinic patients. Methods: This cross-sectional study investigated outpatients in a memory clinic. We enrolled 1,774 participants (≥65 years old) with measured skeletal muscle mass index (SMI), hand grip strength (HGS), and homocysteine. All participants had undergone cognitive assessments and were diagnosed with dementia, mild cognitive impairment, or normal cognition. Patient characteristics were compared according to sarcopenia presence, SMI level, or HGS. Multivariate logistic regression analysis was performed to determine the association of homocysteine with sarcopenia, low SMI, or low HGS. Next, linear regression analysis was performed using HGS as a continuous variable. Results: Logistic regression analysis showed that low HGS was significantly associated with homocysteine levels (p = 0.002), but sarcopenia and low SMI were not. In linear regression analysis, HGS was negatively associated with homocysteine levels after adjustment for Mini-Mental State Examination score (β= –2.790, p <  0.001) or clinical diagnosis of dementia (β= –3.145, p <  0.001). These results were similar for men and women. Conclusion: Our results showed a negative association between homocysteine and HGS after adjustment for cognitive function. Our findings strengthen the assumed association between homocysteine and HGS. Further research is needed to determine whether lower homocysteine levels lead to prevent muscle weakness.

scholarly journals Comment on Physical Performance in Memory Clinic Patients: The Potential Role of the White Matter Network

2019 ◽  
Vol 67 (12) ◽  
pp. 2666-2666
Author(s):  
Christine Cooper ◽  
Barbara Marebwa ◽  
Leonardo Bonilha
Keyword(s):  
White Matter ◽  
Physical Performance ◽  
Potential Role ◽  
Memory Clinic

P2-364: The changing face of the memory clinic in Sheffield, United Kingdom

2013 ◽  
Vol 9 ◽  
pp. P493-P493
Author(s):  
Daniel Blackburn ◽  
Sarah Wakefield ◽  
Peter Walpole ◽  
Kirsty Harkness ◽  
Markus Reuber ◽  
...  
Keyword(s):  
United Kingdom ◽  
Memory Clinic

scholarly journals Prevalence and Covariates of Elevated Depressive Symptoms in Rural Memory Clinic Patients with Mild Cognitive Impairment or Dementia

2014 ◽  
Vol 4 (2) ◽  
pp. 209-220 ◽  
Author(s):  
Julie G. Kosteniuk ◽  
Debra G. Morgan ◽  
Megan E. O'Connell ◽  
Margaret Crossley ◽  
Andrew Kirk ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mild Cognitive Impairment ◽  
Memory Clinic

scholarly journals Heterogeneity of Amyloid Binding in Cognitively Impaired Patients Consecutively Recruited from a Memory Clinic: Evaluating the Utility of Quantitative 18F-Flutemetamol PET-CT in Discrimination of Mild Cognitive Impairment from Alzheimer’s Disease and Other Dementias

2020 ◽  
pp. 1-14
Author(s):  
Yi-Wen Bao ◽  
Anson C.M. Chau ◽  
Patrick Ka-Chun Chiu ◽  
Yat Fung Shea ◽  
Joseph S.K. Kwan ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Amyloid Β ◽  
Standardized Uptake Value ◽  
Subjective Cognitive Decline ◽  
Cognitively Impaired ◽  
Memory Clinic ◽  
Pet Ct

Background: With the more widespread use of 18F-radioligand-based amyloid-β (Aβ) PET-CT imaging, we evaluated Aβ binding and the utility of neocortical 18F-Flutemetamol standardized uptake value ratio (SUVR) as a biomarker. Objective: 18F-Flutemetamol SUVR was used to differentiate 1) mild cognitive impairment (MCI) from Alzheimer’s disease (AD), and 2) MCI from other non-AD dementias (OD). Methods: 109 patients consecutively recruited from a University memory clinic underwent clinical evaluation, neuropsychological test, MRI and 18F-Flutemetamol PET-CT. The diagnosis was made by consensus of a panel consisting of 1 neuroradiologist and 2 geriatricians. The final cohort included 13 subjective cognitive decline (SCD), 22 AD, 39 MCI, and 35 OD. Quantitative analysis of 16 region-of-interests made by Cortex ID software (GE Healthcare). Results: The global mean 18F-Flutemetamol SUVR in SCD, MCI, AD, and OD were 0.50 (SD-0.08), 0.53 (SD-0.16), 0.76 (SD-0.10), and 0.56 (SD-0.16), respectively, with SUVR in SCD and MCI and OD being significantly lower than AD. Aβ binding in SCD, MCI, and OD was heterogeneous, being 23%, 38.5%, and 42.9% respectively, as compared to 100% amyloid positivity in AD. Using global SUVR, ROC analysis showed AUC of 0.868 and 0.588 in differentiating MCI from AD and MCI from OD respectively. Conclusion: 18F-Flutemetamol SUVR differentiated MCI from AD with high efficacy (high negative predictive value), but much lower efficacy from OD. The major benefit of the test was to differentiate cognitively impaired patients (either SCD, MCI, or OD) without AD-related-amyloid-pathology from AD in the clinical setting, which was under-emphasized in the current guidelines proposed by Amyloid Imaging Task Force.

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