Cognitive Status & Dementia Severity in CVLT-II-SF Forced Choice Recognition: Implications for Effort Assessment

Abstract Effort testing is critical to neuropsychological practice, including dementia assessment. Questions exist around whether cognitive status or impairment severity impacts effort test performance in this population. Presently, we examined whether scores on an embedded effort test - the California Verbal Learning Test II Short Form (CVLT-II-SF) Forced Choice Recognition (FCR) - differed across diagnostic cognitive status groups and how severity of impairment modulated test performance. In a sample of memory clinic patients, three cognitive status groups were identified: subjective cognitive impairment (SCI; n = 92), amnestic mild cognitive impairment (a-MCI; n = 18), and dementia due to Alzheimer’s Disease (AD; n = 70). Significant group differences in FCR performance were observed using one-way ANOVA (p < .001), with post-hoc analysis indicating the AD group performed significantly worse scores than the other groups. Using multiple regression, FCR performance was modelled as a function of cognitive status, impairment severity indexed MMSE, and their interaction, with a parallel analysis for the Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores as an alternate severity measure. Results yielded significant main effects for MMSE (p = 0.019) and cognitive status (p = 0.026), as well as a significant interaction (p = 0.021). Thus, increases in impairment severity disproportionately impaired FCR performance for persons with AD, calling into question research-based cut scores for effort determination in dementia contexts. Corresponding CDR-SOB analyses were non-significant. Future research should examine whether CVLT-II-SF-FCR is an appropriately specific inclusion in a best-practice testing battery for evaluating effort in dementia populations.

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Paraoxonase 1, B Vitamins Supplementation, and Mild Cognitive Impairment

Journal of Alzheimer s Disease ◽

10.3233/jad-210137 ◽

2021 ◽

pp. 1-19

Author(s):

Joanna Perła-Kaján ◽

Olga Włoczkowska ◽

Anetta Zioła-Frankowska ◽

Marcin Frankowski ◽

A. David Smith ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Controlled Trial ◽

Verbal Learning ◽

Cognitive Status ◽

B Vitamins ◽

Paraoxonase 1 ◽

Phenyl Acetate ◽

Double Blind ◽

Trail Making

Background: Identification of modifiable risk factors that affect cognitive decline is important for the development of preventive and treatment strategies. Status of paraoxonase 1 (PON1), a high-density lipoprotein-associated enzyme, may play a role in the development of neurological diseases, including Alzheimer’s disease. Objective: We tested a hypothesis that PON1 status predicts cognition in individuals with mild cognitive impairment (MCI). Methods: Individuals with MCI (n = 196, 76.8-years-old, 60% women) participating in a randomized, double-blind placebo-controlled trial (VITACOG) were assigned to receive a daily dose of folic acid (0.8 mg), vitamin B12 (0.5 mg) and B6 (20 mg) (n = 95) or placebo (n = 101) for 2 years. Cognition was analyzed by neuropsychological tests. Brain atrophy was quantified in a subset of participants (n = 168) by MRI. PON1 status, including PON1 Q192R genotype, was determined by quantifying enzymatic activity of PON1 using paraoxon and phenyl acetate as substrates. Results: In the placebo group, baseline phenylacetate hydrolase (PhAcase) activity of PON1 (but not paraoxonase activity or PON1 Q192R genotype) was significantly associated with global cognition (Mini-Mental State Examination, MMSE; Telephone Inventory for Cognitive Status-modified, TICS-m), verbal episodic memory (Hopkins Verbal Learning Test-revised: Total Recall, HVLT-TR; Delayed Recall, HVLT-DR), and attention/processing speed (Trail Making A and Symbol Digits Modalities Test, SDMT) at the end of study. In addition to PhAcase, baseline iron and triglycerides predicted MMSE, baseline fatty acids predicted SDMT, baseline anti-N-Hcy-protein autoantibodies predicted TICS-m, SDMT, Trail Making A, while BDNF V66M genotype predicted HVLT-TR and HVLT-DR scores at the end of study. B-vitamins abrogated associations of PON1 and other variables with cognition. Conclusion: PON1 is a new factor associated with impaired cognition that can be ameliorated by B-vitamins in individuals with MCI.

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Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery

Journal of Alzheimer s Disease ◽

10.3233/jad-210620 ◽

2021 ◽

pp. 1-12

Author(s):

Ilona Dutzi ◽

Michael Schwenk ◽

Marietta Kirchner ◽

Eva Jooss ◽

Jürgen M. Bauer ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Status ◽

Mediating Effect ◽

Future Research ◽

Rehabilitation Outcome ◽

Rehabilitation Outcomes ◽

Rehabilitation Programs ◽

Observational Cohort ◽

The Relationship ◽

State Examination

Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status were considered. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17–26, 16.12±7.19 and MMSE > 26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE < 17, 48.9%versus MMSE 17–26, 65.5%and MMSE > 26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE < 17, 73.3%versus MMSE 17–26, 88.5%and MMSE > 26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p < 0.001) of the relationship between CI and rehabilitation outcome. Conclusion: Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.

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The Impact of Cognitive Dysfunction on Locomotor Rehabilitation Potential in Multiple Sclerosis

Journal of Central Nervous System Disease ◽

10.1177/1179573519884041 ◽

2019 ◽

Vol 11 ◽

pp. 117957351988404

Author(s):

Stijn Denissen ◽

Alexander De Cock ◽

Tom Meurrens ◽

Luc Vleugels ◽

Ann Van Remoortel ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Word Association ◽

Verbal Learning ◽

Cognitive Status ◽

Attentional Deficits ◽

Ambulatory Patients ◽

The Impact ◽

Locomotor Rehabilitation

Background: Cognitive dysfunction is a frequent manifestation of multiple sclerosis (MS) but its effect on locomotor rehabilitation is unknown. Objective: To study the impact of cognitive impairment on locomotor rehabilitation outcome in people with MS. Methods: We performed a retrospective analysis involving ambulatory patients with MS who were admitted for intensive, inpatient, multidisciplinary rehabilitation at the National Multiple Sclerosis Center of Melsbroek between the years 2012 and 2017. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was used to determine the cognitive status of subjects as either impaired (COG–) or preserved (COG+). Locomotor outcome was compared between groups with the difference in 6-minute walk test (6MWT) measured at admission and discharge (Δ6MWT). In addition, individual test scores of the BRB-N for attention (Paced Auditory Serial Addition Test 2” and 3”), visuospatial learning/memory (7/24 Spatial Recall Test), verbal learning/memory (Selective Reminding Test) and verbal fluency (Controlled Oral Word Association Test) were correlated to the Δ6MWT. Results: A total of 318 complete and unique records were identified. Both groups showed a significant within-group Δ6MWT during hospitalization (COG+: 47.51 m; COG–: 40.97 m; P < .01). In contrast, Δ6MWT values were comparable between groups. The odds of achieving a minimal clinical important difference on the 6MWT did not differ significantly between both groups. Only attention/concentration was significantly correlated with Δ6MWT (r = 0.16, P = .013). Conclusion: Cognitive impairment based on BRB-N results appears not to impede locomotor rehabilitation in ambulatory patients with MS. Attentional deficits are correlated to the extent of locomotor rehabilitation, suggesting the presence of a subtle effect of cognition.

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Neuropsychological Test Norms in Cognitively Intact Oldest-Old

Journal of the International Neuropsychological Society ◽

10.1017/s1355617719000122 ◽

2019 ◽

Vol 25 (05) ◽

pp. 530-545 ◽

Cited By ~ 3

Author(s):

Zarui A. Melikyan ◽

Maria M. Corrada ◽

Malcolm B. Dick ◽

Christina Whittle ◽

Annlia Paganini-Hill ◽

...

Keyword(s):

Cognitive Impairment ◽

Short Form ◽

Oldest Old ◽

Neuropsychological Test ◽

Verbal Learning ◽

Test Norms ◽

Increased Risk ◽

Neuropsychological Test Norms ◽

Cognitively Intact ◽

Fluency Test

AbstractObjectives: Individuals aged 90 or older (oldest-old), the fastest growing segment of the population, are at increased risk of developing cognitive impairment compared with younger old. Neuropsychological evaluation of the oldest-old is important yet challenging in part because of the scarcity of test norms for this group. We provide neuropsychological test norms for cognitively intact oldest-old. Methods: Test norms were derived from 403 cognitively intact participants of The 90+ Study, an ongoing study of aging and dementia in the oldest-old. Cognitive status of intact oldest-old was determined at baseline using cross-sectional approach. Individuals with cognitive impairment no dementia or dementia (according to DSM-IV criteria) were excluded. Participants ranged in age from 90 to 102 years (mean=94). The neuropsychological battery included 11 tests (Mini-Mental Status Examination, Modified Mini-Mental State Examination, Boston Naming Test – Short Form, Letter Fluency Test, Animal Fluency Test, California Verbal Learning Test-II Short Form, Trail Making Tests A/B/C, Digit Span Forward and Backwards Test, Clock Drawing Test, CERAD Construction Subtests), and the Geriatric Depression Scale. Results: Data show significantly lower scores with increasing age on most tests. Education level, sex, and symptoms of depression were associated with performance on several tests after accounting for age. Conclusions: Provided test norms will help to distinguish cognitively intact oldest-old from those with cognitive impairment. (JINS, 2019, 25, 530–545)

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Meta-Analysis of the Effects of Neuropsychological Interventions on Cognitive Function in Non–Central Nervous System Cancer Survivors

Integrative Cancer Therapies ◽

10.1177/1534735416638737 ◽

2016 ◽

Vol 15 (4) ◽

pp. 424-434 ◽

Cited By ~ 13

Author(s):

Yingchun Zeng ◽

Andy S. K. Cheng ◽

Chetwyn C. H. Chan

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cancer Survivors ◽

Meta Analysis ◽

Verbal Learning ◽

Mean Difference ◽

Future Research ◽

Cns Cancer

Background. Cognitive impairment is a common complaint among cancer survivors, significantly impacting working memory, attention, executive function, and information processing speed. This meta-analysis aims to evaluate the effect of neuropsychological interventions on the cognitive function of non–central nervous system (non-CNS) cancer survivors. Methods. Three databases (PubMed, PsycInfo, and CAJ Full-text Database) were searched from January 2010 to September 2015. Controlled clinical trials of neuropsychological interventions for the treatment of cognitive impairment in cancer survivors were considered for inclusion. Results. A total of 10 eligible trials were included in this meta-analysis. Three trials assessed the effects of cognitive rehabilitation (CR) interventions, and the weighted mean difference (WMD) for the overall intervention effect was −0.19 (95% confidence interval [CI] = −2.98 to 2.61). Two trials examined the effects of cognitive training (CT) interventions on the cognitive function of cancer survivors; the standardized mean difference (SMD) for the overall effect was 0.52 (95% CI = 0.06 to 0.98). The overall effect of CR interventions on neuropsychological status at postintervention was 5.66 (95% CI = 2.97 to 8.35). The SMD of CR and CT intervention for objective function by verbal learning tests was 0.50 (95% CI = 0.19 to 0.81) at postintervention, and 0.58 (95% CI = 0.19-0.98) at follow-up assessment within 6 months. Conclusion. Findings from this meta-analysis indicate that neuropsychological interventions can improve cognitive function in non-CNS cancer survivors, and support the need for future research. However, the conclusion from this meta-analysis was based on trials with small sample sizes. Future research should be conducted using a larger sample size. Relevant clinical implications were discussed accordingly.

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Evaluating Residual Cognition in Advanced Cognitive Impairment: The Residual Cognition Assessment

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000520322 ◽

2021 ◽

pp. 1-13

Author(s):

Alex Soli ◽

Giacomina Savoldelli ◽

Angelica Rota ◽

Sara Zonca ◽

Gloria Belotti ◽

...

Keyword(s):

Cognitive Impairment ◽

Intraclass Correlation ◽

Cognitive Status ◽

Short Version ◽

Cognitive Screening ◽

Advanced Dementia ◽

Validity And Reliability ◽

Clinical Dementia Rating ◽

Internal Reliability ◽

Floor Effect

Background: In nursing homes, most of the patients with dementia are affected by severe cognitive disorder. Care interventions follow an accurate and recurring multidimensional assessment, including cognitive status. There is still a need to develop new performance-based scales for moderate-to-advanced dementia. Objectives: The development of the Residual Cognition Assessment (RCA) responds to the need to create new scales for global cognitive screening in advanced dementia, with some peculiar features: performance based, brief (<5 m), available without specific training, and suitable for nonverbal patients with minimal distress. Methods: Two raters have administered the RCA and the Severe Impairment Battery-short version (SIB-S) to 84 participants with MMSE = 0. After 2–3 weeks, the same sample has been retested. The RCA has been also administered to 40 participants with MMSE 1–10 for a comparison. Results: The RCA has exhibited excellent values for test-retest reliability (intraclass correlation [ICC] = 0.956) as well as for inter-rater reliability (ICC = 0.997). The concurrent validity analyzes have shown strong correlations between the RCA and the SIB-S with ρ = 0.807 (p < 0.01), and the RCA and the Clinical Dementia Rating (CDR) with ρ = −0.663 (p < 0.01). Moderate correlation has been found between the RCA and the Functional Assessment Staging Scale with ρ = −0.435 (p < 0.01). The instrument has showed high internal reliability, too (total: α = 0.899). The RCA has low floor effect (2%) with respect to the SIB-S (58%) but shows ceiling effect in the MMSE 1–10 sample (50%). The ROC curve analyses demonstrate that the RCA is acceptably able to discriminate between subjects with CDR 4/5 with an AUC of 0.92. Exploratory factor analysis shows 3 factors, defined as three major degrees of cognitive performance in advanced dementia, indeed hierarchically structured in three possible levels of decline. Conclusions: The RCA has showed excellent validity and reliability as well as good sensitivity to identify advanced cognitive impairment in dementia, without floor effect. The RCA seems complementary to the MMSE, so advisable when the latter reaches 0. Administration and scoring are simple, and only few minutes are required to assess the patient. The RCA can discriminate at least 3 different major stages in advanced dementias: severe, profound, and late.

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Mutual interaction of clinical factors and specific microRNAs to predict mild cognitive impairment in patients receiving dialysis

10.21203/rs.3.rs-31177/v1 ◽

2020 ◽

Author(s):

Jin-Bor Chen ◽

Chiung-Chih Chang ◽

Lung-Chih Li ◽

Wen-Chin Lee ◽

Chia-Ni Lin ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Test Performance ◽

Roc Analysis ◽

Neuron Specific Enolase ◽

Mutual Interaction ◽

Uremic Toxin ◽

Clinical Factors ◽

Clinical Dementia Rating ◽

Functional Scores

Abstract Background To examine mutual interaction of various clinical factors for cognitive impairment in patients receiving dialysis. Methods A total 48 dialysis patients with subjective memory complaints in outpatient clinic were recruited from 2015 to 2017. Demographics, circulating uremic toxin concentrations, miRNA concentrations and nerve injury protein concentrations were collected and measured. Clinical dementia rating (CDR) scores was used to stratify the functional scores of the patients. Receiver operating characteristic(ROC) analysis was used to evaluate diagnostic test performance for predicting dichotomous results, cumulative ROC analysis to examine the combined contribution of clinical factors. Results CDR scale 0 included 15 patients (mean age, 59.1 years; 5 men and 10 women); CDR > 0.5 included 33 patients (mean age, 64.0 years; 18 men and 15 women). On cumulative ROC analysis, the major predictors of mild cognitive impairment were hemoglobin, age, sex, homocysteine, neuron-specific enolase and miR-486. The cumulative AUC on combining hemoglobin, age, and miR-486 was the highest (0.897, 95% confidence interval 0.806–0.988). Two dichotomized variables reached 81.82% sensitivity and 86.67% specificity, with the likelihood ratio for positive and negative results being 6.14 and 0.21, respectively. Conclusion Hemoglobin, age, and miR-486 exerts combined effects on mild cognitive impairment in patients receiving dialysis.

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Cognitive correlates of cerebellar resting-state functional connectivity in Parkinson disease

Neurology ◽

10.1212/wnl.0000000000008754 ◽

2019 ◽

Vol 94 (4) ◽

pp. e384-e396 ◽

Cited By ~ 2

Author(s):

Baijayanta Maiti ◽

Jonathan M. Koller ◽

Abraham Z. Snyder ◽

Aaron B. Tanenbaum ◽

Scott A. Norris ◽

...

Keyword(s):

Cognitive Impairment ◽

Functional Connectivity ◽

Parkinson Disease ◽

Resting State ◽

Cognitive Status ◽

Association Cortex ◽

Resting State Functional Connectivity ◽

Clinical Dementia Rating ◽

Cross Sectional ◽

Global Cognition

ObjectiveTo investigate in a cross-sectional study the contributions of altered cerebellar resting-state functional connectivity (FC) to cognitive impairment in Parkinson disease (PD).MethodsWe conducted morphometric and resting-state FC-MRI analyses contrasting 81 participants with PD and 43 age-matched healthy controls using rigorous quality assurance measures. To investigate the relationship of cerebellar FC to cognitive status, we compared participants with PD without cognitive impairment (Clinical Dementia Rating [CDR] scale score 0, n = 47) to participants with PD with impaired cognition (CDR score ≥0.5, n = 34). Comprehensive measures of cognition across the 5 cognitive domains were assessed for behavioral correlations.ResultsThe participants with PD had significantly weaker FC between the vermis and peristriate visual association cortex compared to controls, and the strength of this FC correlated with visuospatial function and global cognition. In contrast, weaker FC between the vermis and dorsolateral prefrontal cortex was found in the cognitively impaired PD group compared to participants with PD without cognitive impairment. This effect correlated with deficits in attention, executive functions, and global cognition. No group differences in cerebellar lobular volumes or regional cortical thickness of the significant cortical clusters were observed.ConclusionThese results demonstrate a correlation between cerebellar vermal FC and cognitive impairment in PD. The absence of significant atrophy in cerebellum or relevant cortical areas suggests that this could be related to local pathophysiology such as neurotransmitter dysfunction.

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Evaluating Mild Cognitive Impairment in Essential Tremor: How Many and Which Neuropsychological Tests?

Journal of the International Neuropsychological Society ◽

10.1017/s1355617718000747 ◽

2018 ◽

Vol 24 (10) ◽

pp. 1084-1098 ◽

Cited By ~ 6

Author(s):

Tess E.K. Cersonsky ◽

Sarah Morgan ◽

Sarah Kellner ◽

Daphne Robakis ◽

Xinhua Liu ◽

...

Keyword(s):

Cognitive Impairment ◽

Executive Function ◽

Mild Cognitive Impairment ◽

Essential Tremor ◽

Neuropsychological Tests ◽

Verbal Learning ◽

Clinical Dementia Rating ◽

Cognitive Changes ◽

Increased Risk ◽

Prospective Longitudinal

AbstractObjectives:Essential tremor (ET) confers an increased risk for developing both amnestic and non-amnestic mild cognitive impairment (MCI). Yet, the optimal measures for detecting mild cognitive changes in individuals with this movement disorder have not been established. We sought to identify the cognitive domains and specific motor-free neuropsychological tests that are most sensitive to mild deficits in cognition as defined by a Clinical Dementia Rating (CDR) of 0.5, which is generally associated with a clinical diagnosis of MCI.Methods:A total of 196 ET subjects enrolled in a prospective, longitudinal, clinical-pathological study underwent an extensive motor-free neuropsychological test battery and were assigned a CDR score. Logistic regression analyses were performed to identify the neuropsychological tests which best identified individuals with CDR of 0.5 (mild deficits in cognition)versus0 (normal cognition).Results:In regression models, we identified five tests in the domains of Memory and Executive Function which best discriminated subjects with CDR of 0.5versus0 (86.9% model classification accuracy). These tests were the California Verbal Learning Test II Total Recall, Logical Memory II, Verbal-Paired Associates I, Category Switching Fluency, and Color-Word Inhibition.Conclusions:Mild cognitive difficulty among ET subjects is best predicted by combined performance on five measures of memory and executive function. These results inform the nature of cognitive dysfunction in ET and the creation of a brief cognitive battery to assess patients with ET for cognitively driven dysfunction in life that could indicate the presence of MCI. (JINS, 2018,24, 1084–1098)

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Mutual Interaction of Clinical Factors and Specific microRNAs to Predict Mild Cognitive Impairment in Patients Receiving Hemodialysis

Cells ◽

10.3390/cells9102303 ◽

2020 ◽

Vol 9 (10) ◽

pp. 2303

Author(s):

Jin-Bor Chen ◽

Chiung-Chih Chang ◽

Lung-Chih Li ◽

Wen-Chin Lee ◽

Chia-Ni Lin ◽

...

Keyword(s):

Cognitive Impairment ◽

Test Performance ◽

Roc Analysis ◽

Neuron Specific Enolase ◽

Area Under The Curve ◽

Mutual Interaction ◽

Uremic Toxin ◽

Clinical Factors ◽

Clinical Dementia Rating ◽

Functional Scores

Cognitive impairment (CI) is not uncommon in dialysis patients. Various factors have been implicated. This study aims to examine mutual interaction of various clinical factors for CI in patients receiving hemodialysis. A total of 48 hemodialysis patients in outpatient clinic were recruited from 2015 to 2017. Demographics, circulating uremic toxin concentrations, miRNA concentrations, and nerve injury protein concentrations were collected. Clinical dementia rating (CDR) scores were used to stratify the functional scores of the patients. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic test performance for predicting dichotomous results, and cumulative ROC analysis was used to examine the combined contribution of clinical factors. CDR scale 0 included 15 patients (mean age, 59.1 years); CDR > 0.5 included 33 patients (mean age, 64.0 years). On cumulative ROC analysis, the major predictors of mild CI were hemoglobin, age, sex, homocysteine, neuron-specific enolase (NSE), and miR-486. The cumulative area under the curve (AUC) on combining hemoglobin, age, and miR-486 was the highest (0.897, 95% confidence interval 0.806–0.988). Two dichotomized variables reached 81.82% sensitivity and 86.67% specificity, with the likelihood ratio for positive and negative results being 6.14 and 0.21, respectively. In conclusion, hemoglobin, age, and miR-486 display high-degree combined effects on mild CI in patients receiving hemodialysis.

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