scholarly journals Impact of different diagnostic measures on drug class association with dementia progression risk: a longitudinal prospective cohort study

2021 ◽  
Author(s):  
Daman Kaur ◽  
Magda Bucholc ◽  
David P Finn ◽  
Stephen Todd ◽  
KongFatt Wong-Lin ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Drug Class ◽  
Acetylcholinesterase Inhibitors ◽  
Clinical Dementia Rating ◽  
Diagnostic Measure ◽  
Diagnostic Measures ◽  
Drug Classes ◽  
Dementia Risk ◽  
Progression Risk

Background: Clinical Dementia Rating Sum of Boxes (CDRSOB) scale is known to be highly indicative of cognitive-functional status, but it is unclear whether it is consistent with clinician diagnosis in evaluating drug class associations with risk of progression to mild cognitive impairment (MCI) and dementia. Methods: We employed multivariate logistic regression on longitudinal NACC data, to identify drug classes associated with disease progression risk, using clinician diagnosis and CDRSOB as the outcome. Results: Non-steroidal anti-inflammatory drugs, anxiolytics, antidiabetics, and Parkinson's medications were significantly associated with decreased progression to mild cognitive impairment (MCI)/dementia, and antihypertensives and Alzheimer's medications significantly associated with increased progression risk. Associations were however dependant on the diagnostic measure used, e.g., antihypertensives were associated with increased Healthy-to-Dementia risk using clinical diagnosis as the outcome (OR:2.05, FDR p<0.001), but not for CDRSOB. Additionally, some associations appear to be gender specific; for instance, antidiabetics had lower MCI-to-Dementia risk for women (OR:0.58, FDR p=0.006) using CDRSOB. Further, in accordance with existing literature, acetylcholinesterase inhibitors were not beneficial in delaying dementia. Conclusions: Overall, we demonstrate that choice of diagnostic measure can influence the magnitude of risk or protection attributed to drug classes. A consensus must be reached within the research community with respect to the most accurate diagnostic outcome to identify risk and improve reproducibility.

scholarly journals Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

2017 ◽  
Vol 24 (2) ◽  
pp. 176-187 ◽  
Author(s):  
Shanna L. Burke ◽  
Miriam J. Rodriguez ◽  
Warren Barker ◽  
Maria T Greig-Custo ◽  
Monica Rosselli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Entorhinal Cortex ◽  
Rating Scale ◽  
Structural Mri ◽  
Diagnostic Group ◽  
Disease Stage ◽  
Clinical Dementia Rating ◽  
Mild Dementia

AbstractObjectives:The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity.Methods:Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group.Results:Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects.Conclusions:Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018,24, 176–187)

scholarly journals Comparative Effects of Physical Exercise and Other Behavioral Interventions on Functional Status Outcomes in Mild Cognitive Impairment

2021 ◽  
pp. 1-8
Author(s):  
Anne L. Shandera-Ochsner ◽  
Melanie J. Chandler ◽  
Dona E. Locke ◽  
Colleen T. Ball ◽  
Julia E. Crook ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Physical Exercise ◽  
Behavioral Interventions ◽  
Functional Decline ◽  
Well Being ◽  
Control Group ◽  
Lifestyle Modifications ◽  
Clinical Dementia Rating ◽  
Group Sessions

Abstract Objectives: Lifestyle modifications for those with mild cognitive impairment (MCI) may promote functional stability, lesson disease severity, and improve well-being outcomes such as quality of life. The current analysis of our larger comparative effectiveness study evaluated which specific combinations of lifestyle modifications offered as part of the Mayo Clinic Healthy Action to Benefit Independence in Thinking (HABIT) program contributed to the least functional decline in people with MCI (pwMCI) over 18 months. Methods: We undertook to compare evidence-based interventions with one another rather than to a no-treatment control group. The interventions were five behavioral treatments: computerized cognitive training (CCT), yoga, Memory Support System (MSS) training, peer support group (SG), and wellness education (WE), each delivered to both pwMCI and care partners, in a group-based program. To compare interventions, we randomly withheld one of the five HABIT® interventions in each of the group sessions. We conducted 24 group sessions with between 8 and 20 pwMCI–partner dyads in a session. Results: Withholding yoga led to the greatest declines in functional ability as measured by the Functional Activities Questionnaire and Clinical Dementia Rating. In addition, memory compensation (calendar) training and cognitive exercise appeared to have associations (moderate effect sizes) with better functional outcomes. Withholding SG or WE appeared to have little effect on functioning at 18 months. Conclusions: Overall, these results add to the growing literature that physical exercise can play a significant and lasting role in modifying outcomes in a host of medical conditions, including neurodegenerative diseases.

scholarly journals Kanji and Kana agraphia in mild cognitive impairment and dementia: A trans-cultural comparison of elderly Japanese subjects living in Japan and Brazil

2010 ◽  
Vol 4 (4) ◽  
pp. 300-305 ◽  
Author(s):  
Kyoko Akanuma ◽  
Kenichi Meguro ◽  
Mitsue Meguro ◽  
Rosa Yuka Sato Chubaci ◽  
Paulo Caramelli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Abilities ◽  
Prevalence Study ◽  
Clinical Dementia Rating ◽  
Spontaneous Writing ◽  
Elderly Japanese ◽  
Questionable Dementia ◽  
State Examination ◽  
Japanese Subjects

Abstract This study verifies the environmental effects on agraphia in mild cognitive impairment and dementia. We compared elderly Japanese subjects living in Japan and Brazil. Methods: We retrospectively analyzed the database of the Prevalence Study 1998 in Tajiri (n=497, Miyagi, Japan) and the Prevalence Study 1997 of elderly Japanese immigrants living in Brazil (n=166, migrated from Japan and living in the São Paulo Metropolitan Area). In three Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy), CDR 0.5 (questionable dementia), and CDR 1+ (dementia) , the Mini-Mental State Examination (MMSE) item of spontaneous writing and the Cognitive Abilities Screening Instrument (CASI) domain of dictation were analyzed with regard to the number of Kanji and Kana characters. Formal errors in characters and pragmatic errors were also analyzed. Results: The immigrants in Brazil wrote similar numbers of Kanji or Kana characters compared to the residents of Japan. In spontaneous writing, the formal Kanji errors were greater in the CDR 1+ group of immigrants. In writing from dictation, all the immigrant CDR groups made more formal errors in Kana than the Japan residents. No significant differences in pragmatic errors were detected between the two groups. Conclusions: Subjects living in Japan use Kanji frequently, and thus the form of written characters was simplified, which might be assessed as mild formal errors. In immigrants, the deterioration in Kanji and Kana writing was partly due to decreased daily usage of the characters. Lower levels of education of immigrants might also be related to the number of Kanji errors.

scholarly journals Fornix Integrity Is Differently Associated With Cognition in Healthy Aging and Non-amnestic Mild Cognitive Impairment: A Pilot Diffusion Tensor Imaging Study in Thai Older Adults

2020 ◽  
Vol 12 ◽  
Author(s):  
Patcharaporn Srisaikaew ◽  
Nahathai Wongpakaran ◽  
Nicole D. Anderson ◽  
J. Jean Chen ◽  
Suchart Kothan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Diffusion Tensor Imaging ◽  
Mild Cognitive Impairment ◽  
Executive Functioning ◽  
Healthy Aging ◽  
Diffusion Tensor ◽  
Imaging Study ◽  
Executive Dysfunction ◽  
Dementia Risk ◽  
Amci Group

Damage to the fornix leads to significant memory impairment and executive dysfunction and is associated with dementia risk. We sought to identify if fornix integrity and fiber length are disrupted in mild cognitive impairment (MCI) and how they associate with cognition. Data from 14 healthy older adult controls (HCs) and 17 subjects with non-amnestic MCI (n-aMCI) were analyzed. Diffusion tensor imaging (DTI) at 1.5 Tesla MRI was performed to enable manual tracing of the fornix and calculation of DTI parameters. Higher fractional anisotropy of body and column of the fornix was associated with better executive functioning and memory, more strongly in the HC than in the n-aMCI group. Fornix fiber tract length (FTL) was associated with better executive function, more strongly in the n-aMCI than in the HC group, and with better memory, more strongly in the HC than in the n-aMCI group. These results highlight a decline in the contributions of the fornix to cognition in n-aMCI and suggest that maintenance of fornix FTL is essential for sustaining executive functioning in people with n-aMCI.

scholarly journals Study of the Risk and Preventive Factors for Progress of Mild Cognitive Impairment to Dementia

2020 ◽  
Vol 35 ◽  
pp. 153331752092532
Author(s):  
Chengping Hu ◽  
Ling Wang ◽  
Yi Guo ◽  
Zhicheng Cao ◽  
Ying Lu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Epidemiological Survey ◽  
Ordinal Regression ◽  
Clinical Dementia Rating ◽  
The Status ◽  
Mini Mental Status Examination ◽  
Analysis Models

Objective: To evaluate the risk factors for progress of mild cognitive impairment to dementia. Methods: This study was based on the epidemiological survey in 2011 (No. PKJ2010-Y26) and contained 441 MCI individuals. Cognitive function was measured by the Mini-Mental Status Examination, clinical dementia rating, and montreal cognitive assessment. The association between demographic characteristics and MCI outcomes were evaluated using single-and multifactor ordered logistic regression analysis models. Results: Of the 441 MCI, 77 progressed to dementia (MCIp: 17.5%, 95% CI: 14.4%-21.6%), 356 remained stable (MCIs: 80.7%, 95% CI: 77.0%-88.4%), and 8 reverted to normal cognition (MCIr: 1.8%, 95% CI: 0.6%-3.0%) at follow-up in 2017. Univariate ordinal regression analysis showed that diabetes ( P = .052), marriage ( P = .028), worker ( P = .069), and manager ( P = .075) may be the risk factor for the status of MCI. Multiple ordinal regression results showed that diabetes ( P = .049) and marriage ( P = .04) significantly affected the cognitive function changes in the MCI patients. Conclusion: Nondiabetics and being married may prevent the progression from MCI to dementia.

scholarly journals Dementia and mild cognitive impairment in patients with Parkinson's disease

2009 ◽  
Vol 67 (2b) ◽  
pp. 423-427 ◽  
Author(s):  
Gloria Maria Almeida Souza Tedrus ◽  
Lineu Corrêa Fonseca ◽  
Grace Helena Letro ◽  
Alexandre Souza Bossoni ◽  
Adriana Bastos Samara
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Parkinson Disease ◽  
Educational Level ◽  
Control Group ◽  
Neuropsychological Battery ◽  
Neurological Assessment ◽  
Clinical Dementia Rating ◽  
Motor Disability

The objective of this research was to assess the occurrence of cognitive impairment in 32 individuals (average age: 67.2 years old) with Parkinson' disease (PD). Procedures: clinical-neurological assessment; modified Hoehn and Yahr staging scale (HYS); standard neuropsychological battery of CERAD (Consortium to Establish a Registry for Alzheimer' Disease); Pfeffer questionnaire; and Clinical Dementia Rating. A comparison was made with a control group (CG), consisting of 26 individuals with similar age and educational level but without cognitive impairment. The PD patients showed an inferior performance in the CERAD battery when compared to the CG. Three PD sub-groups were characterised according to cognition: no cognitive impairment - 15 cases; mild cognitive impairment - 10; dementia - 7 cases. There was a significant association between motor disability (HYS) and the occurrence of dementia. Dementia and mild cognitive impairment frequently occur in PD patients and should be investigated in a routine way.

scholarly journals Response to “Parkinson's disease mild cognitive impairment classifications and neurobehavioral symptoms”

2018 ◽  
Vol 30 (9) ◽  
pp. 1415-1415
Author(s):  
Kyla-Louise Horne ◽  
Daniel J. Myall ◽  
Michael R. MacAskill ◽  
Tim J. Anderson ◽  
John C. Dalrymple-Alford
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Conversion Rate ◽  
Significant Risk ◽  
Cognitive Domain ◽  
Community Needs ◽  
Dementia Risk ◽  
Neurobehavioral Symptoms

A recent paper, “Parkinson's disease mild cognitive impairment classifications and neurobehavioral symptoms” (McDermott et al., 2017), provides an interesting comparison of the influence of different criteria for Parkinson's disease with mild cognitive impairment (PD-MCI) on progression to dementia (PDD). Unfortunately, McDermott et al. (2017) incorrectly stated that “only 21% of PD-MCI participants (identified with a 1.5 SD cut-off) converted to PDD within four years” (p.6) in our study (Wood et al., 2016). However, the important point made by Wood et al. (2016) was that the proportion of conversions to PDD was 51% when the PD-MCI diagnosis required a minimum of two 1.5 SD impairments within any single cognitive domain, whereas additional PD-MCI patients classified with one impairment at 1.5 SD in each of the two domains (but never two impairments in the same domain) had a non-significant risk of dementia relative to non-MCI patients (11% vs. 6% converted, respectively). Our PDD conversion rate was 38% when combining both 1.5 SD criteria (21/56 PD-MCI patients vs. 4/65 non-MCI patients converted); McDermott et al. (2017) found a 42% conversion rate over three years for similarly described PD-MCI patients (10/24 PD-MCI patients vs. 0/27 non-MCI patients converted). Our study was also part of a multinational study (n = 467) showing that PD-MCI has predictive validity beyond known demographic and PD-specific factors of influence (Hoogland et al., 2017). All three studies found that multiple cognitive domain impairments are common in PD-MCI. Nonetheless, the research community needs to clarify the association between PD-MCI subtypes and, especially, the optimal cognitive markers for dementia risk in PD patients.

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