scholarly journals Screening for Sleep Apnoea in Mild Cognitive Impairment: The Utility of the Multivariable Apnoea Prediction Index

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Georgina Wilson ◽  
Zoe Terpening ◽  
Keith Wong ◽  
Ron Grunstein ◽  
Louisa Norrie ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Sleep Apnoea ◽  
Self Report ◽  
Screening Tools ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Obstructive Sleep

Purpose. Mild cognitive impairment (MCI) is considered an “at risk” state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA) is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI), a patient self-report survey, to assess OSA in MCI.Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG). Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI). Receiver-operating characteristics (ROC) curve analyses were performed using various cut-off scores for apnoea severity.Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI:r=0.47,P=0.017). However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC) in the MCI sample compared to the controls across all AHI severity cut-off scores.Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.

scholarly journals Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea

2018 ◽  
Vol 52 (5) ◽  
pp. 1801137 ◽  
Author(s):  
Katia Gagnon ◽  
Andrée-Ann Baril ◽  
Jacques Montplaisir ◽  
Julie Carrier ◽  
Sirin Chami ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Obstructive Sleep Apnoea ◽  
Mental State ◽  
Cognitive Assessment ◽  
Mini Mental State Examination ◽  
Sleep Apnoea ◽  
Screening Tests ◽  
Obstructive Sleep ◽  
State Examination

Obstructive sleep apnoea increases the risk for mild cognitive impairment and dementia. The present study aimed to characterise the ability of two cognitive screening tests, the Mini-Mental State Examination and the Montreal Cognitive Assessment, to detect mild cognitive impairment in adults aged 55–85 years with and without obstructive sleep apnoea.We included 42 subjects with mild and 67 subjects with moderate-to-severe obstructive sleep apnoea. We compared them to 22 control subjects. Mild cognitive impairment was diagnosed by a comprehensive neuropsychological assessment. We used receiver operating characteristic curves to assess the ability of the two screening tests to detect mild cognitive impairment.The two screening tests showed similar discriminative ability in control subjects. However, among the mild and the moderate-to-severe obstructive sleep apnoea groups, the Mini-Mental State Examination was not able to correctly identify subjects with mild cognitive impairment. The Montreal Cognitive Assessment's discriminant ability was acceptable in both sleep apnoea groups and was comparable to what was observed in controls.The Mini-Mental State Examination should not be used to screen for cognitive impairment in patients with obstructive sleep apnoea. The Montreal Cognitive Assessment could be used in clinical settings. However, clinicians should refer patients for neuropsychological assessment when neurodegenerative processes are suspected.

scholarly journals Pharmacological and Non-Pharmacological Interventions to Enhance Sleep in Mild Cognitive Impairment and Mild Alzheimer s Disease: A Systematic Review

2020 ◽  
Author(s):  
Jonathan Blackman ◽  
Marta Swirski ◽  
James Clynes ◽  
Sam Harding ◽  
Yue Leng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Experimental Studies ◽  
Total Sample ◽  
Behavioural Therapy ◽  
Sleep Apnoea ◽  
Small Sample ◽  
Control Group ◽  
Obstructive Sleep

Suboptimal sleep causes cognitive decline and probably accelerates Alzheimer s Disease (AD) progression. Several sleep interventions have been tested in established AD dementia cases. However early intervention is needed in the course of AD at Mild Cognitive Impairment (MCI) or mild dementia stages to help prevent decline and maintain good quality of life. This systematic review aims to summarize evidence on sleep interventions in MCI and mild AD dementia. Seven databases were systematically searched for interventional studies where greater than 75% of participants met diagnostic criteria for MCI/mild AD dementia, with a control group and validated sleep outcome measures. Studies with a majority of participants diagnosed with Moderate to Severe AD were excluded. 20164 references were returned after duplication removal. 284 full papers were reviewed with 12 retained. Included papers reported 11 separate studies, total sample (n=602), mean age 76.3 years. Nine interventions were represented: Cognitive Behavioural Therapy Insomnia (CBT I), A Multi-Component Group Based Therapy, Phase Locked Loop Acoustic Stimulation, Melatonin, Donepezil, Galantamine, Rivastigmine, Tetrahydroaminoacridine and Continuous Positive Airway Pressure (CPAP). Psychotherapeutic approaches utilising adapted CBT-I achieved statistically significant improvements in the Pittsburgh Sleep Quality Index with one study reporting co-existent improved actigraphy variables. Melatonin significantly reduced sleep latency and sleep to wakefulness transitions in a small sample. CPAP demonstrated efficacy in participants with Obstructive Sleep Apnoea. Evidence to support other interventions was limited. There is a paucity of evidence for sleep interventions in MCI and mild AD highlighting a pressing need for high quality experimental studies exploring alternative sleep interventions.

scholarly journals Clinical and demographic parameters predict the progression from mild cognitive impairment to dementia in elderly patients

2020 ◽  
Author(s):  
Giovanni Zuliani ◽  
Michele Polastri ◽  
Tommaso Romagnoli ◽  
Lisa Marabini ◽  
Davide Seripa ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Elderly Patients ◽  
Predictive Value ◽  
Clinical Chemistry ◽  
Area Under The Curve ◽  
Demographic Parameters ◽  
Roc Curve Analysis ◽  
Risk Of Progression

Abstract Objectives To evaluate the possibility of predicting the risk of progression from mild cognitive impairment (MCI) to dementia using a combination of clinical/demographic parameters. Methods A total of 462 MCI elderly patients (follow-up: 33 months). Variable measured included cognitive functions, age, gender, MCI type, education, comorbidities, clinical chemistry, and functional status. Results Amnestic type (aMCI) represented 63% of the sample, non-amnestic (naMCI) 37%; 190 subjects progressed to dementia, 49% among aMCI, and 28% among naMCI. At Cox multivariate regression analysis, only MMSE (one point increase HR 0.84; 95% CI 0.79–0.90), aMCI (HR 2.35; 95% CI 1.39–3.98), and age (1 year increase HR 1.05; 95% CI 1.01–1.10) were independently associated with progression to dementia. A score was created based on these dichotomized variables (score 0–3): age (≥ or < 78 years), MMSE score (≥ or < 25/30) and aMCI type. The conversion rate progressed from 6% in subjects with score 0 (negative predictive value: 0.94), to 31% in individuals with score 1, to 53% in subjects with score 2, to 72% in individuals with score 3 (positive predictive value: 0.72). ROC curve analysis showed an area under the curve of 0.72 (95% CI 0.66–0.75, p 0.0001). Conclusions We have described a simple score, based on previously recognized predictors such as age, MMSE, and MCI type, which may be useful for an initial stratification of the risk of progression to dementia in patients affected by MCI. The score might help the clinicians to evaluate the need for more expansive/invasive examinations and for a closer follow-up in MCI patients.

scholarly journals Mueller-Hillis maneuver and angle of progression: Are they correlated?

2017 ◽  
Vol 63 (6) ◽  
pp. 527-531
Author(s):  
Sofia Mendes ◽  
Rita Silva ◽  
Inês Martins ◽  
Susana Santo ◽  
Nuno Clode
Keyword(s):  
Roc Curve ◽  
Area Under The Curve ◽  
P Value ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Singleton Pregnancy ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Angle Of Progression

Summary Objective: Mueller-Hillis maneuver (MHM) and angle of progression (AOP) measured by transperineal ultrasound have been used to assess fetal head descent during the second stage of labor. We aimed to assess whether AOP correlates with MHM in the second stage of labor. Method: A prospective observational study including women with singleton pregnancy in the second stage of labor was performed. The AOP was measured immediately after the Mueller-Hillis maneuver. A receiver-operating characteristics (ROC) curve analysis was performed to determine the best discriminatory AOP cut-off for the identification of a positive MHM. A p-value less than 0.05 was considered statistically significant. Results: One hundred and sixty-six (166) women were enrolled in the study and 81.3% (n=135) had a positive MHM. The median AOP was 143º (106º to 210º). The area under the curve for the prediction of a positive maneuver was 0.619 (p=0.040). Derived from the ROC curve, an AOP of 138.5º had the best diagnostic performance for the identification of a positive MHM (specificity of 65% and a sensitivity of 67%). Conclusion: An AOP of 138º seems to be associated with a positive MHM in the second stage of labor.

scholarly journals P141 High prevalence of obstructive sleep apnoea in patients with mild cognitive impairment or mild dementia

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A67-A67
Author(s):  
I Szollosi ◽  
T Georgeson ◽  
D Curtin ◽  
K Natarajan ◽  
E Eeles ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Obstructive Sleep Apnoea ◽  
Mini Mental State Examination ◽  
Sleep Apnoea ◽  
Recommended Treatment ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
Respiratory Disturbance ◽  
State Examination

Abstract Aims Obstructive sleep apnoea (OSA) occurs with greater frequency in advancing age. The resulting sleep fragmentation and oxygen desaturations may induce or contribute to neurodegeneration. As such, OSA may be an important modifiable risk factor for the development of dementia. However, the prevalence of OSA within the population with cognitive impairment remains uncharacterised. This study aims to assess the prevalence of OSA in patients attending a specialist memory clinic with either mild cognitive impairment (MCI) or mild stages of dementia (Mini-Mental State Examination (MMSE) &gt; 20). Methods Eligible and consenting participants were asked to wear an ApneaLink™ (ResMed) device overnight that measured nasal airflow and oximetry to generate a Respiratory Disturbance Index (RDI). The Epworth Sleepiness Scale (ESS) was used to evaluate subjective symptoms. Results 64 participants completed the study. Mean(±SD) age=76.1±9.2 years, MMSE=25.6±2.8, RDI=15.5±12.0. The distribution of normal, mild, moderate and severe OSA was 16%, 44%, 26% and 14% respectively. 84% of participants had an abnormal RDI (&gt;5), with 40% being moderate to severe (RDI &gt;15) where CPAP may be the recommended treatment. Mean ESS was 7.08±4.45 and not correlated with OSA severity. Conclusion The prevalence of OSA in MCI or early stages of dementia is high and represents a potential target for therapeutic intervention. Further research studies are required to determine whether treatment of OSA alters dementia progression.

scholarly journals Optimal Cutoff Scores for Dementia and Mild Cognitive Impairment in the Brazilian Version of the Montreal Cognitive Assessment among the Elderly

2019 ◽  
Vol 9 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Tiago C.C. Pinto ◽  
Marília S.P. Santos ◽  
Leonardo Machado ◽  
Tatiana M. Bulgacov ◽  
Antônio L. Rodrigues-Junior ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Elderly People ◽  
Roc Curve ◽  
Cognitive Assessment ◽  
The Elderly ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Brazilian Version ◽  
Cutoff Scores

Objective: To propose cutoff scores for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) stratified by education in order to detect mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) in the elderly. Method: A transversal study in health centers was performed on 159 elderly people with 4–12 years of education and 70 of their peers with over 12 years of schooling. The MoCA-BR cutoff scores for screening cognitive impairment were determined based on an ROC curve analysis. Results: The ROC curve analysis indicated that cutoff scores under 20 were good for screening elderly people with cognitive impairment with more than 12 years of education, and scores under 21 were good for screening those with 4–12 years of education. Conclusions: MoCA-BR scores under 21 points (after adding 1 point to the elderly with ≤12 years of education) indicate a need to continue the diagnostic investigation with regular follow-ups.

scholarly journals Paediatric Sleep Questionnaire for Obstructive Sleep Apnoea Syndrome Screening: Is Sleep Quality Worthy of Note?

2021 ◽  
Vol 11 (4) ◽  
pp. 1440 ◽  
Author(s):  
Vera Panzarella ◽  
Giovanna Giuliana ◽  
Paola Spinuzza ◽  
Gaetano La Mantia ◽  
Laura Maniscalco ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Screening Tools ◽  
Obstructive Sleep Apnoea Syndrome ◽  
P Value ◽  
Predictive Values ◽  
Sleep Questionnaire ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep

Obstructive sleep apnoea syndrome (OSAS) is the most severe condition on the spectrum of sleep-related breathing disorders (SRBDs). The Paediatric Sleep Questionnaire (PSQ) is one of the most used and validated screening tools, but it lacks the comprehensive assessment of some determinants of OSAS, specifically anamnestic assessment and sleep quality. This study aims to assess the accuracy of some specific items added to the original PSQ, particularly related to the patient’s anamnestic history and to the quality of sleep, for the screening of OSAS in a paediatric population living in Sicily (Italy). Fifteen specific items, divided into “anamnestic” and “related to sleep quality” were added to the original PSQ. The whole questionnaire was administered via a digital form to the parents of children at 4 schools (age range: 3–13 years). For each item, sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The highest sensitivity (80.0, 95% CI: 28.4; 99.5), in combination with the highest specificity (61.1, 95% CI: 35.7; 82.7), was found for the Item 32 (“assumption of bizarre or abnormal positions during sleep”). This item was found statistically significant for predicting the occurrence of OSAS in children (p-value ≤0.003). The study demonstrates the accuracy of specific items related to sleep quality disturbance for the preliminary assessment of the disease. Although these results should be validated on a larger sample of subjects, they suggest that including the factors discriminating sleep quality could further increase the efficiency and accuracy of PSQ.

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