Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study

Background: Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. Objective: We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. Methods: We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants’ cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). Results: The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia above of a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. Conclusion: Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.

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eGFR and deep white matter hyperintensity as predictors of cognitive decline long after carotid endarterectomy

Scientific Reports ◽

10.1038/s41598-019-54459-6 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Akira Nakamizo ◽

Toshiyuki Amano ◽

Takahiro Kuwashiro ◽

Masahiro Yasaka ◽

Yasushi Okada

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

White Matter ◽

Cognitive Decline ◽

Carotid Endarterectomy ◽

Area Under The Curve ◽

Cognitive Status ◽

White Matter Hyperintensity ◽

Characteristic Analysis ◽

Severe Cognitive Impairment

AbstractChronic kidney disease and white matter hyperintensity (WMH) are associated with cognitive decline. The aim of this study was to assess the correlations between estimated glomerular filtration rate (eGFR) or WMH and cognitive function in patients who have undergone carotid endarterectomy (CEA). Cognitive functions were investigated using the Neurobehavioral Cognitive Status Examination (Cognistat) in 83 patients who had undergone CEA. The eGFR at 5 years prior to examination was significantly associated with severe cognitive impairment (odds ratio, 0.89 per 1-mL/min/1.73 m2 increase, 95% confidence interval 0.82–0.97, p = 0.0004). Receiver operating characteristic analysis revealed that a cutoff eGFR of 46.8 mL/min/1.73 m2 at 5 years prior to examination offered the most reliable predictor of severe cognitive impairment (sensitivity 88.9%, specificity 76.5%, area under the curve 0.848). The eGFR at 5 years prior to examination showed a significant linear association with total Cognistat score (r2 = 0.11035, p = 0.0032) compared to eGFR at 3 years prior to examination (r2 = 0.06455, p = 0.0230) or at examination (r2 = 0.0210, p = 0.0210). Spearman’s correlation coefficient revealed that orientation, comprehension, repetition, construction, memory, and similarity correlated with eGFR at 5 years prior to examination. Conversely, Fazekas grade for deep WMH at examination was associated with total Cognistat score (p = 0.0016), unlike that at 3 years (p = 0.0100) or 5 years prior to examination (p = 0.0172). While eGFR correlates with future cognitive function, deep WMH associates with present cognitive function in patients who have undergone CEA.

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Neuropsychiatric symptoms and severity of dementia

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn70200006 ◽

2013 ◽

Vol 7 (2) ◽

pp. 171-175

Author(s):

Gustavo Henrique de Oliveira Caldas ◽

Sueli Luciano Pires ◽

Milton Luiz Gorzoni

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Motor Behavior ◽

Neuropsychiatric Symptoms ◽

Prevalence Ratio ◽

Cross Sectional Study ◽

Clinical Dementia Rating ◽

Cross Sectional ◽

Specific Stage ◽

Severity Of Dementia

ABSTRACT Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families Objective: To evaluate the prevalence of NPS as a specific stage of dementia status. Methods: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. Results: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). Conclusion: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

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The Sequence of Physical and Cognitive Impairment and the Association with Mortality Among Unimpaired Older Mexican Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glz238 ◽

2019 ◽

Vol 75 (7) ◽

pp. 1386-1392

Author(s):

Brian Downer ◽

Sadaf Milani ◽

Rebeca Wong

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mortality Risk ◽

Multinomial Logistic Regression ◽

Cognitive Status ◽

Cognitively Impaired ◽

Proportional Hazard ◽

Physical Impairments ◽

Aging Study ◽

Mexican Adults

Abstract Background Many older adults become physically and cognitively impaired. However, it is unclear whether unimpaired older adults are more likely to become physically or cognitively impaired first and if this sequence impacts mortality risk. Methods Data came from the Mexican Health and Aging Study. The sample included 1,283 participants aged ≥60 years who were physically and cognitively unimpaired in 2001. Multinomial logistic regression was used to estimate probabilities of being unimpaired, cognitively impaired only, physically impaired only, or cognitively-physically impaired in 2003. Proportional hazard models were used to estimate mortality risk through 2015 according to physical and cognitive status in 2003. Results The probabilities for being unimpaired, physically impaired only, cognitively impaired only, and cognitively-physically impaired in 2003 were 0.45, 0.22, 0.19, and 0.13, respectively. Older age, female sex, and arthritis were associated with significantly greater probability of becoming physically impaired only than cognitively impaired only in 2003. Cognitive impairment only (hazard ratio [HR] = 1.42, 95% confidence interval [CI] = 1.09–1.85) in 2003 but not physical impairment only (HR = 1.22, 95% CI = 0.94–1.58) was associated with greater mortality than being unimpaired in 2003. Cognitively-physically impaired participants had higher mortality risk than participants who were physically (HR = 1.58, 95% CI = 1.18–2.12) or cognitively (HR = 1.36, 95% CI = 1.01–1.84) impaired only. Discussion The likelihood of becoming only physically or cognitively impaired over 2 years varies by demographic and health characteristics. The mortality risk for unimpaired older adults who become cognitively impaired only is similar to those who become physically impaired only. Research should determine if the sequence of cognitive and physical impairments is associated with other outcomes.

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Short Sitting Height and Low Relative Sitting Height Are Associated with Severe Cognitive Impairment among Older Women in an Urban Community in China

Neuroepidemiology ◽

10.1159/000439569 ◽

2015 ◽

Vol 45 (4) ◽

pp. 257-263 ◽

Cited By ~ 2

Author(s):

Xiaoniu Liang ◽

Xiantao Li ◽

Ding Ding ◽

Qianhua Zhao ◽

Jianfeng Luo ◽

...

Keyword(s):

Cognitive Impairment ◽

Older Women ◽

Body Height ◽

Late Life ◽

The Elderly ◽

Leg Length ◽

Severe Cognitive Impairment ◽

Sitting Height ◽

Aging Study ◽

Anthropometric Indexes

Background: Anthropometric indexes are powerful indicators of the environment and the plasticity of the human body. This study aimed at exploring the anthropometric indexes that are associated with late-life cognition impairment among the elderly Chinese in the Shanghai Aging Study. Methods: The height, weight, and sitting height of 3,741 participants were measured. Participants were diagnosed with ‘dementia', ‘mild cognitive impairment', or ‘cognitive normal' by neurologists using DSM-IV and Petersen criteria. Logistic regression was used to evaluate the association between height, sitting height, leg length or relative sitting height and cognitive function. Results: Participants with dementia had the shortest body height (mean 157.2 cm, SD 9.1), the shortest sitting height (mean 81.8 cm, SD 5.6), and the lowest relative sitting height (mean 52.0 cm, SD 1.9). After adjustment for age, gender, education, lifestyles, medical history, apolipoprotein genotype and weight, shorter sitting height (OR 1.08, 95% CI 1.01-1.16 per cm), longer leg length (OR 0.93, 95% CI 0.88-0.99 per cm), and lower relative sitting height (OR 1.17, 95% CI 1.04-1.31 per 1%) were found to be significantly associated with dementia in older women. Conclusions: The potential risks for late-life severe cognitive impairment may be related to health problems in childhood and slow growth during puberty in women.

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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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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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Depression, Type 2 Diabetes, and Poststroke Cognitive Impairment

Neurorehabilitation and Neural Repair ◽

10.1177/1545968316656054 ◽

2016 ◽

Vol 31 (1) ◽

pp. 48-55 ◽

Cited By ~ 13

Author(s):

Walter Swardfager ◽

Bradley J. MacIntosh

Keyword(s):

Type 2 Diabetes ◽

Cognitive Impairment ◽

Executive Function ◽

Depressive Symptoms ◽

Processing Speed ◽

Recurrent Stroke ◽

Cognitive Status ◽

Stroke Survivors ◽

Severe Cognitive Impairment

Background. Ten percent of stroke survivors develop dementia, which increases to more than a third after recurrent stroke. Other survivors develop less severe vascular cognitive impairment. In the general population, depression, and diabetes interact in predicting dementia risk, and they are both prevalent in stroke. Objective. To assess the cumulative association of comorbid depressive symptoms and type 2 diabetes with cognitive outcomes among stroke survivors. Methods. Multicenter observational cohort study of people within 6 months of stroke. Depression and cognitive status were screened using the Center for Epidemiological Studies Depression (CES-D) scale and the Montreal Cognitive Assessment (MoCA), respectively. Processing speed, executive function and memory were assessed using the Trail Making Test parts A and B, and the 5 Word Delayed Free Recall task. Results. Among 342 participants (age 67.0 ± 13.5 years, 43.3% female, 46 ± 35 days poststroke), the prevalence of type 2 diabetes was 32.2% and depressive symptoms (CES-D ≥16) were found in 40.6%. Diabetes and depressive symptoms increased the risk of severe cognitive impairment (MoCA <20) with adjusted odds ratio (OR) 2.12 (95% confidence interval [CI] 1.20-3.74, P = .010) for 1 comorbidity and OR 3.18 (95% CI 1.26-8.02, P = .014) for both comorbidities. Associated cognitive deficits included executive function ( F1, 168 = 3.43, P = .035) but not processing speed ( F1, 168 = 1.86, P = .16) or memory ( F1, 168 = 0.82, P = .44). Conclusions. Diabetes and depressive symptoms were associated cumulatively with poorer cognitive screening outcomes poststroke, particularly deficits in executive function. Having 1 comorbidity doubled the odds of screening for severe cognitive impairment, having both tripled the odds.

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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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The association between cognitive impairment and neuropsychiatric symptoms in patients with Parkinson's disease dementia

International Psychogeriatrics ◽

10.1017/s1041610212001317 ◽

2012 ◽

Vol 24 (12) ◽

pp. 1980-1987 ◽

Cited By ~ 20

Author(s):

Wei-Ju Lee ◽

Chia-Fen Tsai ◽

Serge Gauthier ◽

Shuu-Jiun Wang ◽

Jong-Ling Fuh

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Motor Behavior ◽

Sleep Problems ◽

Task Force ◽

Mmse Score ◽

Neuropsychiatric Symptoms ◽

Principal Component ◽

Principal Component Factor Analysis

ABSTRACTBackground: Neuropsychiatric symptoms (NPS) are common in patients with dementia associated with Parkinson's disease (PDD). The relationship between cognition and NPS in PDD has not been well studied.Methods: Patients diagnosed with PDD were assessed for cognitive function and NPS. The instruments used were the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), and semantic verbal fluency according to the recommendation of the Movement Disorder Society Task Force.Results: We evaluated 127 PDD patients (76 males/51 females; mean age 77 ± 6.3 years). Their mean MMSE score was 17 ± 6.5 and the mean NPI score was 19 ± 20.4. The most prevalent NPI items were anxiety (57.5%), sleep problems (53.5%), and apathy (52.0%). Principal component factor analysis revealed that 12 items formed three factors, namely “mood and psychosis” (delusion, hallucination, agitation, depression, anxiety, apathy, and irritability), “vegetative” (sleep and appetite problems), and “frontal” (euphoria, disinhibition, and aberrant motor behavior). Symptoms of hallucination were significantly associated with MMSE score, even after controlling for the confounding variables.Conclusion: NPS are common and diverse among patients with PDD. Three specific subgroups of NPS were identified. Hallucination was significantly correlated with cognitive impairment, and could be a predictor of cognition in PDD patients.

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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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