Diagnostic transitions in mild cognitive impairment subtypes

2009 ◽  
Vol 21 (6) ◽  
pp. 1088-1095 ◽  
Author(s):  
Orestes Vicente Forlenza ◽  
Breno Satler Diniz ◽  
Paula Villela Nunes ◽  
Claudia Maia Memória ◽  
Monica Sanches Yassuda ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Diagnosis ◽  
Cognitive Aging ◽  
Single Domain ◽  
Cognitive State ◽  
Cognitive States ◽  
Common Diagnosis ◽  
Multiple Domain

ABSTRACTBackground: At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia.Methods: 139 subjects (78% women, mean age, 68.5 ± 6.1 years; mean educational level, 11.7 ± 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 ± 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis.Results: The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer's disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%).Conclusion: The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

Cognitive Functions in the Geriatric Population

2021 ◽  
pp. 123-146
Author(s):  
Shivani Sharma ◽  
Ashima Nehra
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Diagnosis ◽  
Predictive Validity ◽  
Cognitive Deficits ◽  
Cognitive Functions ◽  
Diagnostic Challenge ◽  
Geriatric Population ◽  
Clinical Criteria ◽  
Cognitive States

This chapter describes how one of the challenging issues of clinical diagnosis is distinguishing between the cognitive deficits manifested in normal aging, depression, mild cognitive impairment (MCI) and dementia. The diagnostic challenge is that there is a great deal of overlap in the symptom constellations of these conditions. It is thus important to establish conceptual and clinical criteria with sufficient predictive validity to accurately identify differences and similarities in cognitive states to justify initiation of appropriate treatments.

scholarly journals The effects of age, gender, education, and APOE on the transitions from a cognitively normal state to mild cognitive impairment and dementia

2021 ◽  
Vol 8 (4) ◽  
pp. 110-116
Author(s):  
Badr Alnasser ◽  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Normal State ◽  
Cognitive State ◽  
Data Set ◽  
Cognitively Normal ◽  
Transient States ◽  
Cognitive States ◽  
Absorbing States

To determine the effects of a number of risk factors on the transition from a cognitively normal state to mild cognitive impairment (MCI), as transient states, and then to dementia and death, as absorbing states. The study used the data of 8,456 subjects obtained from the Uniform Data Set (UDS) conducted by the National Alzheimer Coordinating Center (NACC), and categorized them into four cognitive states; normal and MCI (transient states), dementia, and death (absorbing states). Then, statistical analysis was conducted to obtain how age, gender, educational attainment, and presence of apolipoprotein 4 allele (APOE) affect the odds of transitioning from one cognitive state to another, and to death as a competing state. Both age and APOE risk had profound effects on the cognitive transition of subjects from one state to another, and to a lesser extent, gender and education attainment. This study has contributed more evidence that risk factors like age, presence of apolipoprotein 4 allele (APOE), and to a lesser extent, education and gender have significant effects in all or some of the transitions from one cognitive state to another among elderly people.

scholarly journals Cognitive impairment and psychological state in acute coronary syndrome patients: A prospective descriptive study at cardiac rehabilitation entry, completion and follow-up

2020 ◽  
pp. 147451512093310
Author(s):  
Robyn Gallagher ◽  
Anna Woolaston ◽  
Geoffrey Tofler ◽  
Adrian Bauman ◽  
Emma Zhao ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cardiac Rehabilitation ◽  
Processing Speed ◽  
Verbal Learning ◽  
Psychological State ◽  
Coronary Syndrome ◽  
Multiple Domain

Background Cognitive impairment may limit the uptake of secondary prevention in acute coronary syndrome patients, but is poorly understood, including in cardiac rehabilitation participants. Aim The aim of this study was to explore cognitive impairment in relation to psychological state in acute coronary syndrome patients over the course of cardiac rehabilitation and follow-up. Methods Acute coronary syndrome patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at cardiac rehabilitation entry, completion and follow-up and scores adjusted using normative data. The hospital anxiety and depression scale measured psychological state. Results Participants ( n = 40) had an average age of 66.2 (±8.22) years and were 70% men. Mild cognitive impairment occurred at cardiac rehabilitation entry in single 62.5% and multiple 22.5% domains but was significantly less prevalent by cardiac rehabilitation completion (52.5% and 15.0%) and follow-up (32.5% and 7.0%). Domains most often impaired were verbal learning (52.5%) and processing speed (25.6%), again decreasing significantly with time (verbal learning cardiac rehabilitation completion 42.5%, follow-up 22.5%; processing speed cardiac rehabilitation completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain cognitive impairment. At cardiac rehabilitation entry patients with cognitive impairment in processing speed, a single domain or multiple domains had more depression, and patients with cognitive impairment in executive function had more depression and anxiety. Conclusions At cardiac rehabilitation entry, mild cognitive impairment is very common in post-acute coronary syndrome patients and worse in patients who have depression or anxiety symptoms. Cognitive impairment decreases significantly by cardiac rehabilitation follow-up. A small proportion of patients has persistent, multiple domain cognitive impairment flagging potential long-term changes and the need for further investigations and cognitive rehabilitation.

Cognitive Functions in the Geriatric Population

2018 ◽  
pp. 94-117
Author(s):  
Shivani Sharma ◽  
Ashima Nehra
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Diagnosis ◽  
Predictive Validity ◽  
Cognitive Deficits ◽  
Cognitive Functions ◽  
Diagnostic Challenge ◽  
Geriatric Population ◽  
Clinical Criteria ◽  
Cognitive States

This chapter describes how one of the challenging issues of clinical diagnosis is distinguishing between the cognitive deficits manifested in normal aging, depression, mild cognitive impairment (MCI) and dementia. The diagnostic challenge is that there is a great deal of overlap in the symptom constellations of these conditions. It is thus important to establish conceptual and clinical criteria with sufficient predictive validity to accurately identify differences and similarities in cognitive states to justify initiation of appropriate treatments.

Elucidating the risk factors for progression from amyloid-negative amnestic mild cognitive impairment to dementia

2020 ◽  
Vol 17 ◽  
Author(s):  
Hyung-Ji Kim ◽  
Jae-Hong Lee ◽  
E-nae Cheong ◽  
Sung-Eun Chung ◽  
Sungyang Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Amnestic Mild Cognitive Impairment ◽  
Amyloid Pet ◽  
Clinical Progression ◽  
Amnestic Mci

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.

scholarly journals EEG Measures of Value-Directed Strategic Processing in Older Adults With and Without Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 292-293
Author(s):  
Lydia Nguyen ◽  
Shraddha Shende ◽  
Daniel Llano ◽  
Raksha Mudar
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Aging ◽  
Spectral Power ◽  
Group Differences ◽  
Cognitive Resources ◽  
Alpha Power ◽  
Strategic Processing ◽  
Unique Word

Abstract Value-directed strategic processing is important for daily functioning. It allows selective processing of important information and inhibition of irrelevant information. This ability is relatively preserved in normal cognitive aging, but it is unclear if mild cognitive impairment (MCI) affects strategic processing and its underlying neurophysiological mechanisms. The current study examined behavioral and EEG spectral power differences between 16 cognitively normal older adults (CNOA; mean age: 74.5 ± 4.0 years) and 16 individuals with MCI (mean age: 77.1 ± 4.3 years) linked to a value-directed strategic processing task. The task used five unique word lists where words were assigned high- or low-value based on letter case and were presented sequentially while EEG was recorded. Participants were instructed to recall as many words as possible after each list to maximize their score. Results revealed no group differences in recall of low-value words, but individuals with MCI recalled significantly fewer high-value words and total number of words relative to CNOA. Group differences were observed in theta and alpha bands for low-value words, with greater synchronized theta power for CNOA than MCI and greater desynchronized alpha power for MCI than CNOA. Collectively, these findings demonstrate that more effortful neural processing of low-value words in the MCI group, relative to the CNOA group, allowed them to match their behavioral performance to the CNOA group. Individuals with MCI appear to utilize more cognitive resources to inhibit low-value information and might show memory-related benefits if taught strategies to focus on high-value information processing.

scholarly journals Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society

2021 ◽  
pp. 1-10
Author(s):  
Ramshekhar N. Menon ◽  
Feba Varghese ◽  
Avanthi Paplikar ◽  
Shailaja Mekala ◽  
Suvarna Alladi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Medical Research ◽  
Sensitivity And Specificity ◽  
Linguistically Diverse ◽  
Z Score ◽  
Indian Languages ◽  
Test Protocol ◽  
Indian Council ◽  
Multiple Domain

<b><i>Background/Aims:</i></b> In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. <b><i>Methods:</i></b> Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. <b><i>Results:</i></b> Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of −0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of &#x3e;80% for diagnosis of MCI. <b><i>Conclusions:</i></b> The ICMR-NCTB is a “first of its kind” approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.

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