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

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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THE ROAD AHEAD TO CURE AND PREVENT ALZHEIMER’S DISEASE: IMPLEMENTING PREVENTION INTO PRIMARY CARE

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2015.73 ◽

2015 ◽

pp. 1-11

Author(s):

B. Fougère ◽

B. Vellas ◽

J. Delrieu ◽

A.J. Sinclair ◽

A. Wimo ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Cognitive Impairment ◽

Primary Care Physicians ◽

Large Scale ◽

Objective Assessment ◽

Epidemiological Studies ◽

Cognitive Status ◽

Cognitive Screening ◽

Cognitive Complaint

Most old adults receive their health care from their primary care practitioner; as a consequence, as the population ages, the manifestations and complications of cognitive impairment and dementia impose a growing burden on providers of primary care. Current guidelines do not recommend routine cognitive screening for older persons by primary care physicians, although the vast majority recommend a cognitive status assessment and neurological examination for subjects with a cognitive complaint. Also, no clinical practice guidelines recommend interventions in older adults with cognitive impairment in primary care settings. However, primary care physicians need to conduct a review of risks and protective factors associated with cognitive decline and organize interventions to improve or maintain cognitive function. Recent epidemiological studies have indicated numerous associations between lifestyle-related risk factors and incidental cognitive impairment. The development of biomarkers could also help in diagnosis, prognosis, selection for clinical trials, and objective assessment of therapeutic responses. Interventions aimed at cognitive impairment prevention should be pragmatic and easy to implement on a large scale in different health care systems, without generating high additional costs or burden on participants, medical and social care teams.

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Comparison of the Mini-Mental State Examination and Computerized Brief Cognitive Screening Test as Cognitive Screening Tools in Patients with Mild Cognitive Impairment

Current Alzheimer Research ◽

10.2174/1567205018666211215151418 ◽

2021 ◽

Vol 18 ◽

Author(s):

Che-Sheng Chu ◽

I-Chen Lee ◽

Chuan-Cheng Hung ◽

I-Ching Lee ◽

Chi-Fa Hung ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Normal Control ◽

Internal Consistency ◽

Mental State ◽

Screening Test ◽

Mini Mental State Examination ◽

Cognitive Screening ◽

Validity And Reliability ◽

State Examination

Background: The aim of this study was to establish the validity and reliability of the Computerized Brief Cognitive Screening Test (CBCog) for early detection of cognitive impairment. Method: One hundred and sixty participants, including community-dwelling and out-patient volunteers (both men and women) aged ≥ 65 years, were enrolled in the study. All participants were screened using the CBCog and Mini-Mental State Examination (MMSE). The internal consistency of the CBCog was analyzed using Cronbach’s α test. Areas under the curves (AUCs) of receiver operating characteristic analyses were used to test the predictive accuracy of the CBCog in detecting mild cognitive impairment (MCI) in order to set an appropriate cutoff point. Results: The CBCog scores were positively correlated with the MMSE scores of patients with MCI-related dementia (r = 0.678, P < .001). The internal consistency of the CBCog (Cronbach’s α) was 0.706. It was found that the CBCog with a cutoff point of 19/20 had a sensitivity of 97.5% and a specificity of 53.7% for the diagnosis of MCI with education level ≥ 6 years. The AUC of the CBCog for discriminating the normal control elderly from patients with MCI (AUC = 0.827, P < 0.001) was larger than that of the MMSE for discriminating the normal control elderly from patients with MCI (AUC= 0.819, P < .001). Conclusion: The CBCog demonstrated to have sufficient validity and reliability to evaluate mild cognitive impairment, especially in highly educated elderly people.

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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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A path to early diagnosis of mild cognitive impairment and dementia: validity and reliability of the myMemCheck® self-administered screening tool

Family Practice ◽

10.1093/fampra/cmaa014 ◽

2020 ◽

Vol 37 (4) ◽

pp. 561-567

Author(s):

William E Mansbach ◽

Ryan A Mace ◽

Melissa A Tanner ◽

Steven P Simmons

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Assessment Tool ◽

Nursing Home Residents ◽

Cognitive Status ◽

Diagnostic Process ◽

Validity And Reliability ◽

Characteristic Analysis ◽

Cross Sectional

Abstract Background Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed at home to identify older adults that would benefit from a more comprehensive cognitive evaluation. Objective Two prospective cross-sectional studies were conducted to examine the psychometric properties and clinical utility of myMemCheck®. Methods In Study 1, participants were independent living residents referred to an outpatient memory clinic (N = 59); older adults in the community and post-acute nursing home residents (N = 357) comprised Study 2. Results Psychometric analyses were performed on cognitive and psychological testing data, including myMemCheck®. myMemCheck® evidenced adequate reliability and strong construct validity. Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults at risk for MCI or dementia. myMemCheck® explained 25% of cognitive status beyond basic patient information. Conclusions myMemCheck® may help fast-track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in health care and prevent negative outcomes associated with undetected cognitive impairment.

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Contributions of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) for the diagnosis of MCI in Brazil

International Psychogeriatrics ◽

10.1017/s1041610214000726 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1483-1491 ◽

Cited By ~ 6

Author(s):

Cláudia M. Memória ◽

Mônica S. Yassuda ◽

Eduardo Y. Nakano ◽

Orestes V. Forlenza

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Goodness Of Fit ◽

Formal Education ◽

Factor Model ◽

Characteristic Curve ◽

Reliability And Validity ◽

Cognitive Status ◽

Cognitive Screening ◽

Extensive Evaluation

ABSTRACTBackground:The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) is a computer-based cognitive screening instrument that involves automated administration and scoring and immediate analyses of test sessions. The objective of this study was to translate and culturally adapt the Brazilian Portuguese version of the CANS-MCI (CANS-MCI-BR) and to evaluate its reliability and validity for the diagnostic screening of MCI and dementia due to Alzheimer's disease.Methods:The test was administered to 97 older adults (mean age 73.41 ± 5.27 years) with at least four years of formal education (mean education 12.23 ± 4.48 years). Participants were classified into three diagnostic groups according to global cognitive status (normal controls, n = 41; MCI, n = 35; AD, n = 21) based on clinical data and formal neuropsychological assessments.Results:The results indicated high internal consistency (Cronbach's α = 0.77) in the total sample. Three-month test-retest reliability correlations were significant and robust (0.875; p < 0.001). A moderate level of concurrent validity was attained relative to the screening test for MCI (MoCA test, r = 0.76, p < 0.001). Confirmatory factor analysis supported the three-factor model of the original test, i.e., memory, language/spatial fluency, and executive function/mental control. Goodness of fit indicators were strong (Bentler Comparative Fit Index = 0.96, Root Mean Square Error of Approximation = 0.09). Receiver operating characteristic curve analyses suggested high sensitivity and specificity (81% and 73% respectively) to screen for possible MCI cases.Conclusions:The CANS-MCI-BR maintains adequate psychometric characteristics that render it suitable to identify elderly adults with probable cognitive impairment to whom a more extensive evaluation by formal neuropsychological tests may be required.

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Rapid Screening for Cognitive Impairment in Parkinson’s Disease: A Pilot Study

Parkinson s Disease ◽

10.1155/2015/348063 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

YanHong Dong ◽

Way Inn Koay ◽

Leonard Leong Litt Yeo ◽

Christopher Li-Hsian Chen ◽

Jing Xu ◽

...

Keyword(s):

Cognitive Impairment ◽

Discriminant Validity ◽

Operating Characteristic ◽

Mini Mental State Examination ◽

Characteristic Curve ◽

Rapid Screening ◽

Cognitive Screening ◽

Clinical Dementia Rating ◽

Cognitive Screen ◽

State Examination

Aim. This study sought to establish the discriminant validity of a rapid cognitive screen, that is, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol, and compare its discriminant validity to the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) in detecting cognitive impairment (CI) in PD patients.Methods. One hundred and one PD patients were recruited from a movement disorders clinic in Singapore and they received the NINDS-CSN 5-minute protocol, MoCA, and MMSE. No cognitive impairment (NCI) was defined as Clinical Dementia Rating (CDR) = 0 and CI was defined as CDR ≥ 0.5.Results. Area under the receiver operating characteristic curve of NINDS-CSN 5-minute protocol was statistically equivalent to MoCA and larger than MMSE (0.86 versus 0.90,P=0.07; 0.86 versus 0.76,P=0.03). The sensitivity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) (0.77 versus 0.85,P=0.13) and superior to MMSE (<24) (0.77 versus 0.52,P<0.01) in detecting CI, while the specificity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) and MMSE (<24) (0.78 versus 0.88,P=0.34).Conclusion. The NINDS-CSN 5-minute protocol is time expeditious while remaining statistically equivalent to MoCA and superior to MMSE and therefore is suitable for rapid cognitive screening of CI in PD patients.

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Individual Perception of Telehealth: Validation of a German Translation of the Telemedicine Perception Questionnaire and a Derived Short Version

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020902 ◽

2022 ◽

Vol 19 (2) ◽

pp. 902

Author(s):

Patrick Altmann ◽

Dominik Ivkic ◽

Markus Ponleitner ◽

Fritz Leutmezer ◽

Ulrike Willinger ◽

...

Keyword(s):

Intraclass Correlation ◽

Physician Satisfaction ◽

Integrative Approach ◽

Short Version ◽

Validity And Reliability ◽

Item Questionnaire ◽

Growing Domain ◽

Individual Perception ◽

Adolescents And Adults ◽

Remote Patient

Telehealth is a growing domain with particular relevance for remote patient monitoring. With respect to the biopsychosocial model of health, it is important to evaluate perception and satisfaction with new methods in telehealth as part of an integrative approach. The Telemedicine Perception Questionnaire (TMPQ) is a 17-item questionnaire measuring patients’ perception of and satisfaction with telecare. We translated this survey into German and determined its validity and reliability in 32 adolescents and adults. Furthermore, we derived a short version of the TMPQ, named Patient and Physician Satisfaction with Monitoring (PPSM), which is a 5-item questionnaire that can be administered to both patients and physicians. Validity and reliability were tested in 32 patients and 32 physicians. Crohnbach’s α for the translated TMPQ was 0.76, and the German version yielded high validity (intraclass correlation coefficient (ICC) 0.995). We tested the PPSM in both patients and physicians and found acceptable values for Crohnbach’s α (0.72 and 0.78) with excellent validity (ICC 0.965). We therefore concluded from this small study that both German versions of the TMPQ and PPSM can be used to investigate the acceptance of telehealth applications.

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

Innovation in Aging ◽

10.1093/geroni/igab046.2467 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 656-657

Author(s):

Karl Grewal ◽

Michaella Trites ◽

Megan O'Connell ◽

Andrew Kirk ◽

Stuart MacDonald ◽

...

Keyword(s):

Cognitive Impairment ◽

Test Performance ◽

Short Form ◽

Verbal Learning ◽

Cognitive Status ◽

Forced Choice ◽

Future Research ◽

Clinical Dementia Rating ◽

Significant Group ◽

Impairment Severity

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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NEUROPSYCHOLOGICAL PROFILE OF “COGNITIVE FRAILTY” SUBJECTS IN MAPT STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2016.94 ◽

2016 ◽

pp. 1-9

Author(s):

J. Delrieu ◽

S. Andrieu ◽

M. Pahor ◽

C. Cantet ◽

M. Cesari ◽

...

Keyword(s):

Cognitive Impairment ◽

Alzheimer Disease ◽

Cognitive Status ◽

Physical Frailty ◽

Clinical Dementia Rating ◽

Frailty Phenotype ◽

Cognitive Frailty ◽

Clinical Criteria ◽

Neuropsychological Profile ◽

Set Up

Objectives: An international group proposed the existence of “cognitive frailty”, a condition defined by simultaneous presence of physical frailty and cognitive impairment in the absence of dementia. The objective was to compare the neuropsychological profiles in subgroups of elders differentiated across their physical frailty (Fried phenotype) and cognitive status (Clinical Dementia Rating score) to characterize the “cognitive frailty” entity. Method: We studied baseline characteristics of 1,617 subjects enrolled in Multidomain Alzheimer Disease Preventive Trial (MAPT). Included subjects were aged 70 years or older and presented at least 1 of the 3 following clinical criteria: (1) Memory complaint spontaneously reported to a general practitioner, (2) limitation in one instrumental activity of daily living, (3) slow gait speed. Subjects with dementia were not included in the trial. Results: “Cognitive frailty individuals” significantly differed from “individuals with cognitive impairment and without physical frailty”, scoring worse at executive, and attention tests. They presented subcortico-frontal cognitive pattern different of Alzheimer Disease. Cognitive performance of subjects with 3 criteria or more of the frailty phenotype are cognitively more impaired than subjects with only one. Discusion: The characterization of “cognitive frailty” must be done in frail subjects to set up specific preventive clinical trials for this population.

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Vitamin D Increases Aβ140 Plasma Levels and Protects Lymphocytes from Oxidative Death in Mild Cognitive Impairment Patients

Current Alzheimer Research ◽

10.2174/1567205015666171227154636 ◽

2018 ◽

Vol 15 (6) ◽

pp. 561-569 ◽

Cited By ~ 9

Author(s):

Carol D. SanMartín ◽

Mauricio Henriquez ◽

Carlos Chacon ◽

Daniela P. Ponce ◽

Felipe Salech ◽

...

Keyword(s):

Vitamin D ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Plasma Levels ◽

Vitamin D Supplementation ◽

Cognitive Status ◽

Clinical Dementia Rating ◽

Vitamin D Levels ◽

Increased Susceptibility

Background: Mild cognitive impairment (MCI) has an increased rate of progression to dementia. Alterations of some metabolic factors, such as deficiency of vitamin D, are a risk factor for cognitive deterioration. Vitamin D is involved in the clearance of β-amyloid (Aβ) from the brain. We have reported that lymphocytes from Alzheimer's disease (AD) patients have an increased susceptibility to oxidative death by H2O2 exposure, but currently it is unknown if this characteristic is modifiable in vivo. Objective: To determine if correction of low vitamin D levels protects lymphocytes from oxidative death and increases Aβ1-40 plasma levels in MCI and very early AD (VEAD) patients. Method: Sixteen MCI, 11 VEAD and 25 healthy control (HC) voluntaries were evaluated with the Clinical Dementia Rating (CDR), Montreal Cognitive assessment (MoCA), and Memory Index score (MIS). Lymphocyte death was measured by flow cytometry after 20h exposure to H2O2. In patients with low levels of vitamin D -11 MCI, 9 VEAD and 20 HC- lymphocyte H2O2-death, plasma Aβ1-40 levels and cognitive status were evaluated pre- and post-vitamin D supplementation for 6 months. Results: Lymphocytes from MCI and VEAD patients showed increased susceptibility to oxidative death at study entry. In MCI, but not VEAD patients, lymphocyte susceptibility to death and Aβ1-40 levels plasma levels improved after 6 months of vitamin D supplementation. In addition, cognitive status on follow-up (18 months) improved in MCI patients after vitamin D supplementation. Conclusion: Vitamin D supplementation may be beneficial in MCI. The lack of effect in VEAD may be due to a more advanced stage or different characteristics of the neurodegenerative process.

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