scholarly journals REM sleep atonia loss distinguishes synucleinopathy in older adults with cognitive impairment

Neurology ◽  
2019 ◽  
Vol 94 (1) ◽  
pp. e15-e29 ◽  
Author(s):  
Stuart J. McCarter ◽  
Grace M. Tabatabai ◽  
Ho-Yann Jong ◽  
David J. Sandness ◽  
Paul C. Timm ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Rem Sleep ◽  
Area Under The Curve ◽  
Class Iii ◽  
Receiver Operating Characteristic Curves ◽  
Diagnostic Thresholds ◽  
Rem Atonia ◽  
Clinical Tools ◽  
Anterior Tibialis

ObjectiveTo determine whether quantitative polysomnographic REM sleep without atonia (RSWA) distinguishes between cognitive impairment phenotypes.BackgroundNeurodegenerative cognitive impairment in older adults predominantly correlates with tauopathy or synucleinopathy. Accurate antemortem phenotypic diagnosis has important prognostic and treatment implications; additional clinical tools might distinguish between dementia syndromes.MethodsWe quantitatively analyzed RSWA in 61 older adults who underwent polysomnography including 46 with cognitive impairment (20 probable synucleinopathy), 26 probable non-synucleinopathy (15 probable Alzheimer disease, 11 frontotemporal lobar dementia), and 15 age- and sex-matched controls. Submentalis and anterior tibialis RSWA metrics and automated REM atonia index were calculated. Group statistical comparisons and regression were performed, and receiver operating characteristic curves determined diagnostic RSWA thresholds that best distinguished synucleinopathy phenotype.ResultsSubmentalis—but not anterior tibialis RSWA—was greater in synucleinopathy than nonsynucleinopathy; several RSWA diagnostic thresholds distinguished synucleinopathy with excellent specificity including submentalis tonic, 5.6% (area under the curve [AUC] 0.791); submentalis any, 15.0% (AUC 0.871); submentalis phasic, 10.8% (AUC 0.863); and anterior tibialis phasic, 31.4% (AUC 0.694). In the subset of patients without dream enactment behaviors, submentalis RSWA was also greater in patients with synucleinopathy than in those without synucleinopathy. RSWA was detected more frequently by quantitative than qualitative methods (p = 0.0001).ConclusionElevated submentalis RSWA distinguishes probable synucleinopathy from probable nonsynucleinopathy in cognitively impaired older adults, even in the absence of clinical dream enactment symptoms.Classification of evidenceThis study provides Class III evidence that quantitative RSWA analysis is useful for distinguishing cognitive impairment phenotypes. Further studies with pathologic confirmation of dementia diagnoses are needed to confirm the diagnostic utility of RSWA in dementia.

Video-Polysomnographic Assessment for the Diagnosis of Disorders of Arousal in Children

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e121-e130
Author(s):  
Régis Lopez ◽  
Christine Laganière ◽  
Sofiène Chenini ◽  
Anna Laura Rassu ◽  
Elisa Evangelista ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Slow Wave Sleep ◽  
Area Under The Curve ◽  
Class Iii ◽  
Receiver Operating Characteristic Curves ◽  
Arousal Index ◽  
Fragmentation Index ◽  
Increased Sensitivity ◽  
Disorders Of Arousal

ObjectivesTo highlight the slow-wave sleep (SWS) fragmentation and validate the video-polysomnographic (vPSG) criteria and cutoffs for the diagnosis of disorders of arousal (DOA) in children, as already reported in adults.MethodsOne hundred children (66 boys, 11.0 ± 3.3 years) with frequent episodes of DOA and 50 nonparasomniac children (32 boys, 10.9 ± 3.9 years) underwent vPSG recording to quantify SWS characteristics (number of N3 sleep interruptions, fragmentation index, slow/mixed and fast arousal ratios, and indexes per hour) and associated behaviors. We compared SWS characteristics in the 2 groups and defined the optimal cutoff values for the diagnosis of DOA using receiver operating characteristic curves.ResultsPatients with DOA had higher amounts of N3 and REM sleep, number of N3 interruptions, SWS fragmentation, and slow/mixed arousal indexes than controls. The highest area under the curve (AUC) values were obtained for SWS fragmentation and slow/mixed arousal indexes with satisfactory classification performances (AUC 0.80, 95% confidence interval [CI] 0.73–0.87; AUC 0.82, 95% CI 0.75–0.89). SWS fragmentation index cutoff value of 4.1/h reached a sensitivity of 65.0% and a specificity of 84.0%. Slow/mixed arousal index cutoff of 3.8/h reached a sensitivity of 69.0% and a specificity of 82.0%. At least one parasomniac episode was recorded in 63.0% of patients and none of the controls. Combining behavioral component by vPSG increased sensitivity of both biomarkers to 83% and 89%, respectively.ConclusionsWe confirmed that SWS fragmentation and slow/mixed arousal indexes are 2 relevant biomarkers for the diagnosis of DOA in children, with different cutoffs obtained than those validated in adults.Classification of EvidenceThis study provides Class III evidence that SWS fragmentation and slow/mixed arousal indexes on vPSG accurately identify children with DOA.

Comparing the Mini-Mental State Examination and the modified Mini-Mental State Examination in the detection of mild cognitive impairment in older adults

2018 ◽  
Vol 31 (5) ◽  
pp. 693-701 ◽  
Author(s):  
Ryan Van Patten ◽  
Karysa Britton ◽  
Geoffrey Tremont
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Mental State ◽  
Normative Data ◽  
Mini Mental State Examination ◽  
Area Under The Curve ◽  
Neuropsychological Evaluations ◽  
Composite Scores ◽  
State Examination

ABSTRACTObjectives:To show enhanced psychometric properties and clinical utility of the modified Mini-Mental State Examination (3MS) compared to the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI).Design:Psychometric and clinical comparison of the 3MS and MMSE.Setting:Neuropsychological clinic in the northeastern USA.Participants:Older adults referred for cognitive concerns, 87 of whom were cognitively intact (CI) and 206 of whom were diagnosed with MCI.Measurements:The MMSE, the 3MS, and comprehensive neuropsychological evaluations.Results:Both instruments were significant predictors of diagnostic outcome (CI or MCI), with comparable odds ratios, but the 3MS explained more variance and showed improved classification accuracies relative to the MMSE. The 3MS also demonstrated greater receiver operating characteristic area under the curve values (0.85, SE = 0.02) compared to the MMSE (0.74, SE = 0.03). Scoring lower than 95/100 on the 3MS suggested MCI, while scoring lower than 28/30 on the MMSE suggested MCI. Additionally, compared to the MMSE, the 3MS shared more variance with neuropsychological composite scores in Language and Memory domains but not in Attention, Visuospatial, and Executive domains. Finally, 65.5% MCI patients were classified as impaired (scoring ≤1 SD below the mean) using 3MS normative data, compared to only 11.7% of patients who were classified as impaired using MMSE normative data.Conclusions:Broadly speaking, our data strongly favor the widespread substitution of the MMSE with the 3MS in older adults with concerns for cognitive decline.

scholarly journals Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia

2021 ◽  
Vol 15 (2) ◽  
pp. 200-209
Author(s):  
Patrícia Helena Figueirêdo do Vale-Britto ◽  
Laura Rabin ◽  
Livia Spindola ◽  
Ricardo Nitrini ◽  
Sonia Maria Dozzi Brucki
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Utility ◽  
Area Under The Curve ◽  
The Elderly ◽  
Relevant Information ◽  
Practical Judgment ◽  
Brazilian Sample ◽  
Everyday Problems

ABSTRACT. Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions. Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both. Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br). Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82. Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

Evaluation of Bedside Tests of Attention and Arousal Assessing Delirium in Parkinson’s Disease, Dementia, and Older Adults

2021 ◽  
pp. 1-11
Author(s):  
Rachael A. Lawson ◽  
Sarah J. Richardson ◽  
Daisy Kershaw ◽  
Daniel Davis ◽  
Blossom C.M. Stephan ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Digit Span ◽  
Lewy Bodies ◽  
Area Under The Curve ◽  
Optimal Tests ◽  
Bedside Tests ◽  
Simple Bedside

Background: Delirium is a serious acute neuropsychiatric condition associated with altered attention and arousal. Objective: To evaluate simple bedside tests for attention and arousal to detect delirium in those with and without Parkinson’s disease (PD) and dementia. Methods: Participants from two prospective delirium studies were pooled comprising 30 with PD without cognitive impairment, 24 with Lewy body cognitive impairment (PD dementia or dementia with Lewy bodies), 16 with another dementia and 179 PD and dementia-free older adults. Participants completed standardised delirium assessments including tests of attention: digit span, Memorial Delirium Assessment Scale (MDAS) attention and months of the year backwards; and arousal: Glasgow Coma Scale (GSC), Observational Scale of Level of Arousal (OSLA), Modified Richmond Agitation Scale and MDAS consciousness. Delirium was diagnosed using the DSM-5 criteria. Results: On their first admission, 21.7%participants had prevalent delirium. Arousal measures accurately detected delirium in all participants (p <  0.01 for all), but only selected attention measures detected delirium in PD and dementia. In PD and dementia-free older adults, impaired digit span and OSLA were the optimal tests to detect delirium (area under the curve [AUC] = 0.838, p <  0.001) while in PD and dementia the optimal tests were MDAS attention and GCS LB. Conclusion: Simple bedside tests of attention and arousal at a single visit could accurately detect delirium in PD, dementia and PD and dementia-free older adults; however, the optimal tests differed between groups. Combined attention and arousal scores increased accuracy, which could have clinical utility to aid the identification of delirium neurodegenerative disorders.

Altered heart rate variability during sleep in mild cognitive impairment

SLEEP ◽  
2020 ◽  
Author(s):  
Shawn D X Kong ◽  
Camilla M Hoyos ◽  
Craig L Phillips ◽  
Andrew C McKinnon ◽  
Pinghsiu Lin ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Eye Movement ◽  
Rem Sleep ◽  
Nrem Sleep ◽  
Sleep Stages ◽  
Rapid Eye Movement

Abstract Study Objectives Cardiovascular autonomic dysfunction, as measured by short-term diurnal heart rate variability (HRV), has been reported in older adults with mild cognitive impairment (MCI). However, it is unclear whether this impairment also exists during sleep in this group. We, therefore, compared overnight HRV during sleep in older adults with MCI and those with subjective cognitive impairment (SCI). Methods Older adults (n = 210) underwent overnight polysomnography. Eligible participants were characterized as multi-domain MCI or SCI. The multi-domain MCI group was comprised of amnestic and non-amnestic subtypes. Power spectral analysis of HRV was conducted on the overnight electrocardiogram during non-rapid eye movement (NREM), rapid eye movement (REM), N1, N2, N3 sleep stages, and wake periods. High-frequency HRV (HF-HRV) was employed as the primary measure to estimate parasympathetic function. Results The MCI group showed reduced HF-HRV during NREM sleep (p = 0.018), but not during wake or REM sleep (p &gt; 0.05) compared to the SCI group. Participants with aMCI compared to SCI had the most pronounced reduction in HF-HRV across all NREM sleep stages—N1, N2, and N3, but not during wake or REM sleep. The naMCI sub-group did not show any significant differences in HF-HRV during any sleep stage compared to SCI. Conclusions Our study showed that amnestic MCI participants had greater reductions in HF-HRV during NREM sleep, relative to those with SCI, suggesting potential vulnerability to sleep-related parasympathetic dysfunction. HF-HRV, especially during NREM sleep, may be an early biomarker for dementia detection.

scholarly journals The Diagnostic Utility of the NINDS-CSN Neuropsychological Battery in Memory Clinics

2016 ◽  
Vol 6 (2) ◽  
pp. 276-282 ◽  
Author(s):  
Xin Xu ◽  
Qun Lin Chan ◽  
Saima Hilal ◽  
Mohammad Kamran Ikram ◽  
Narayanaswamy Venketasubramanian ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Area Under The Curve ◽  
Diagnostic Utility ◽  
Neuropsychological Battery ◽  
Receiver Operating Characteristic Curves ◽  
Before And After ◽  
Memory Clinics ◽  
Lower Education ◽  
Education Groups ◽  
Cognitively Intact

Aims: To examine the diagnostic utility of the National Institute of Neurological Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) neuropsychological battery in memory clinics comparing controls with patients with no cognitive impairment (NCI), patients with cognitive impairment-no dementia (CIND) at varying severity levels (mild/moderate), and patients with dementia. Methods: A total of 405 participants with NCI, CIND or dementia were assessed with the NINDS-CSN battery. The discriminatory properties of all three protocols (5, 30 and 60 min) before and after education stratification (none/primary vs. secondary/above) were examined by receiver operating characteristic curves. Results: Overall, the shorter protocols are equivalent to the longer protocol in diagnosing dementia, regardless of education. To discriminate between nondementia groups, before education stratification, the 5-min protocol showed varied discriminatory properties between different diagnostic/severity groups. After stratification, the 5-min protocol was broadly equivalent to the longer protocols in lower-education groups [area under the curve (AUC) range: 0.77-0.87] but was less accurate in the higher-education groups (AUC range: 0.68-0.78). The 30- and 60-min protocol constantly showed moderate-to-excellent differentiating capacities regardless of education (AUC range: 0.80-0.90). Conclusion: The NINDS-CSN neuropsychological battery can be applied in memory clinics and effectively discriminate between cognitively intact individuals and those with cognitive impairments of varying severity. Furthermore, level of education should be taken into consideration when choosing protocols with different lengths for cognitive assessment.

scholarly journals Cross-Validation of the Financial Exploitation Vulnerability Scale

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1038-1038
Author(s):  
Juno Moray ◽  
Peter Lichtenberg
Keyword(s):  
Older Adults ◽  
Reading Ability ◽  
Cross Validation ◽  
Word Reading ◽  
Area Under The Curve ◽  
Initial Study ◽  
Contextual Risk ◽  
Financial Exploitation ◽  
Clinical Tools ◽  
Neurocognitive Measures

Abstract Most of the available clinical tools that detect the experience of financial exploitation (FE) are not practical for use by the many professionals who work with older adults. The available measures are often time-consuming, require specialized training to administer, or focus exclusively on the cognitive aspects of financial decision-making. The need for a brief, standardized measure of contextual risk prompted the development of the Financial Exploitation Vulnerability Scale (FEVS; Lichtenberg et al., 2020). The purpose of this study was to cross-validate the FEVS as a psychometrically sound measure of contextual risk for FE. Participants were recruited from the community (n=95), and through a financial coaching service for older adults who had experienced a financial scam (n=21). A total of 114 older adults were recruited for the study, 33 who had experienced FE and 81 who had not. An independent samples t-test demonstrated that the FEVS total score successfully differentiated older adults based on the experience of financial exploitation. The FEVS total score was correlated with age, but no other demographic factors or collected neurocognitive measures. A ROC curve detecting FE analysis revealed an area under the curve of 0.68. Internal consistency of the FEVS was a=0.80. In a logistic regression model, only the FEVS and word-reading ability were related to FE. The results of this cross-validation study are very similar to the initial study, demonstrating that the FEVS is an accessible, theory-based tool that detects the experience of FE.

scholarly journals Normative and isolated rapid eye movement sleep without atonia in adults without REM sleep behavior disorder

SLEEP ◽  
2019 ◽  
Vol 42 (10) ◽  
Author(s):  
John C Feemster ◽  
Youngsin Jung ◽  
Paul C Timm ◽  
Sarah M Westerland ◽  
Thomas R Gossard ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Older Men ◽  
Sleep Behavior ◽  
Rem Sleep Without Atonia ◽  
Rem Atonia ◽  
Male Sex ◽  
Anterior Tibialis

Abstract Study Objectives Values for normative REM sleep without atonia (RSWA) remain unclear. Older age and male sex are associated with greater RSWA, and isolated elevated RSWA has been reported. We aimed to describe normative RSWA and characterize isolated RSWA frequency in adults without REM sleep behavior disorder (RBD). Methods We visually quantified phasic, “any,” and tonic RSWA in the submentalis (SM) and anterior tibialis (AT) muscles, and the automated Ferri REM Atonia Index during polysomnography in adults without RBD aged 21–88. We calculated RSWA percentiles across age and sex deciles and compared RSWA in older (≥ 65) versus younger (<65) men and women. Isolated RSWA (exceeding diagnostic RBD cutoffs, or >95th percentile) frequency was also determined. Results Overall, 95th percentile RSWA percentages were SM phasic, any, tonic = 8.6%, 9.1%, 0.99%; AT phasic and “any” = 17.0%; combined SM/AT phasic, “any” = 22.3%, 25.5%; and RAI = 0.85. Most phasic RSWA burst durations were ≤1.0 s (85th percentiles: SM = 1.07, AT = 0.86 seconds). Older men had significantly higher AT RSWA than older women and younger patients (all p < 0.04). Twenty-nine (25%, 18 men) had RSWA exceeding the cohort 95th percentile, while 17 (14%, 12 men) fulfilled diagnostic cutoffs for phasic or automated RBD RSWA thresholds. Conclusions RSWA levels are highest in older men, mirroring the demographic characteristics of RBD, suggesting that older men frequently have altered REM sleep atonia control. These data establish normative adult RSWA values and thresholds for determination of isolated RSWA elevation, potentially aiding RBD diagnosis and discussions concerning incidental RSWA in clinical sleep medicine practice.

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