scholarly journals Clinical and Objective Cognitive Measures for the Diagnosis of Cognitive Frailty Subtypes: A Comparative Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Qingwei Ruan ◽  
Weibin Zhang ◽  
Jian Ruan ◽  
Jie Chen ◽  
Zhuowei Yu
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychological Test ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Cognitive Screening ◽  
Cognitive Frailty ◽  
Clinical Criteria ◽  
Clinical Assessments ◽  
Normal Cognition

BackgroundCognitive frailty (CF) includes reversible and potentially reversible subtypes; the former is known as concurrent physical frailty (PF) and pre-mild cognitive impairment subjective cognitive decline (pre-MCI SCD), whereas the latter is known as concurrent PF and MCI. The diagnoses of pre-MCI SCD and MCI are based on clinical criteria and various subjective cognitive decline questionnaires. Heterogeneous assessment of cognitive impairment (CI) results in significant variability of CI, CF, and their subtype prevalence in various population-based studies.ObjectiveThis study aimed to compare the classification differences in CI and CF subtypes from PF and normal cognition by applying clinical and objective cognitive criteria. Clinical criteria comprised Fried PF and clinical MCI criteria combined with the SCD questionnaire, whereas objective criteria comprised Fried PF and objective cognitive criteria based on the norm-adjusted six neuropsychological test scores.MethodsOf the 335 volunteers (age ≥ 60 years) in this study, 191 were diagnosed with CI based on clinical cognitive diagnosis criteria, and 144 were identified as robust normal based on objective cognitive assessment from the community-dwelling older adult cohort. Individuals with clinical CI, including 94 with MCI and 97 with pre-MCI SCD, were reclassified into different z-score-derived MCI, pre-MCI SCD, and normal subgroups based on objective cognitive criteria. The classification diagnostic accuracy of normal cognition, PF, pre-MCI, MCI, CF, and CF subtypes based on clinical and objective criteria was compared before and after adjusting for age, sex, and education level.ResultsThe reclassification of objective assessments indicated better performance than that of clinical assessments in terms of discerning CI severity among different subgroups before adjusting for demographic factors. After covariate adjustment, clinical assessments significantly improved the ability to cognitively discriminate normal individuals from those with pre-MCI SCD and MCI but not the z-score-derived pre-MCI SCD and MCI groups from the robust normal group. Furthermore, the adjustment did not improve the ability to discriminate among individuals with reversible CF from those with potentially reversible CF and pre-MCI only SCD from MCI only SCD.ConclusionsObjective criteria showed better performance than clinical criteria in the diagnosis of individuals with CI or CF subtypes. Rapid clinical cognitive screening in combination with normative z-scores criteria is cost effective and sustainable in clinical practice.

Is the Discrimination of Subjective Cognitive Decline from Cognitively Healthy Adulthood and Mild Cognitive Impairment Possible? A Pilot Study Utilizing the R4Alz Battery

2020 ◽  
Vol 77 (2) ◽  
pp. 715-732
Author(s):  
Eleni Poptsi ◽  
Despina Moraitou ◽  
Emmanouil Tsardoulias ◽  
Andreas L. Symeonidisd ◽  
Magda Tsolaki
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Control ◽  
Cognitive Decline ◽  
Neurocognitive Disorders ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Working Memory Updating

Background: The early diagnosis of neurocognitive disorders before the symptoms’ onset is the ultimate goal of the scientific community. REMEDES for Alzheimer (R4Alz) is a battery, designed for assessing cognitive control abilities in people with minor and major neurocognitive disorders. Objective: To investigate whether the R4Alz battery’s tasks differentiate subjective cognitive decline (SCD) from cognitively healthy adults (CHA) and mild cognitive impairment (MCI). Methods: The R4Alz battery was administered to 175 Greek adults, categorized in five groups a) healthy young adults (HYA; n = 42), b) healthy middle-aged adults (HMaA; n = 33), c) healthy older adults (HOA; n = 14), d) community-dwelling older adults with SCD (n = 34), and e) people with MCI (n = 52). Results: Between the seven R4Alz subtasks, four showcased the best results for differentiating HOA from SCD: the working memory updating (WMCUT-S3), the inhibition and switching subtask (ICT/RST-S1&S2), the failure sets (FS) of the ICT/RST-S1&S2, and the cognitive flexibility subtask (ICT/RST-S3). The total score of the four R4Alz subtasks (R4AlzTot4) leads to an excellent discrimination among SCD and healthy adulthood, and to fare discrimination among SCD and MCI. Conclusion: The R4Alz battery is a novel approach regarding the neuropsychological assessment of people with SCD, since it can very well assist toward discriminating SCD from HOA. The R4Alz is able to measure decline of specific cognitive control abilities - namely of working memory updating, and complex executive functions - which seem to be the neuropsychological substrate of cognitive complaints in community dwelling adults of advancing age.

scholarly journals Heterogeneous Influence of Frailty Phenotypes in Age-Related Hearing Loss and Tinnitus in Chinese Older Adults: An Explorative Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Qingwei Ruan ◽  
Jie Chen ◽  
Ruxin Zhang ◽  
Weibin Zhang ◽  
Jian Ruan ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Lower Probability ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Cognitive Frailty ◽  
Age Related

BackgroundFried physical frailty, with mobility frailty and non-motor frailty phenotypes, is a heterogeneous syndrome. The coexistence of the two phenotypes and cognitive impairment is referred to as cognitive frailty (CF). It remains unknown whether frailty phenotype has a different association with hearing loss (HL) and tinnitus.MethodsOf the 5,328 community-dwelling older adults, 429 participants aged ≥58 years were enrolled in the study. The participants were divided into robust, mobility, and non-mobility frailty, mobility and non-mobility CF (subdivided into reversible and potentially reversible CF, RCF, and PRCF), and cognitive decline [subdivided into mild cognitive impairment (MCI) and pre-MCI] groups. The severity and presentations of HL and/or tinnitus were used as dependent variables in the multivariate logistic or nominal regression analyses with forward elimination adjusted for frailty phenotype stratifications and other covariates.ResultsPatients with physical frailty (mobility frailty) or who are robust were found to have lower probability of developing severe HL and tinnitus, and presented HL and/or tinnitus than those with only cognitive decline, or CF. Patients with RCF and non-mobility RCF had higher probability with less HL and tinnitus, and the presentation of HL and/or tinnitus than those with PRCF and mobility RCF. Other confounders, age, cognitive and social function, cardiovascular disease, depression, and body mass index, independently mediated the severity of HL and tinnitus, and presented HL and/or tinnitus.ConclusionFrailty phenotypes have divergent association with HL and tinnitus. Further research is required to understand the differential mechanisms and the personalized intervention of HL and tinnitus.Clinical Trial RegistrationClinicalTrials.gov identifier, NCT2017K020.

scholarly journals Validity of the Japanese Version of the Quick Mild Cognitive Impairment Screen

2019 ◽  
Vol 16 (6) ◽  
pp. 917 ◽  
Author(s):  
Ayako Morita ◽  
Rónán O’Caoimh ◽  
Hiroshi Murayama ◽  
D. Molloy ◽  
Shigeru Inoue ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Predictive Value ◽  
Mini Mental State Examination ◽  
Japanese Version ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
State Examination ◽  
Normal Cognition ◽  
Moderate Positive Correlation

Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65–84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p < 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70–0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positive predictive value, and 83% negative predictive value for cognitive impairment. Normative data are presented, excluding those with any sMMSE-J < 27. Though further research is required, the Qmci-J screen may be a useful screening tool to identify older adults at risk of cognitive impairment.

Abstract P164: Cognitive Impairment Among Adults With Incident Heart Failure

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Madeline R Sterling ◽  
Deanna Jannat-Khah ◽  
Leslie McClure ◽  
Virginia Wadley ◽  
Frederick W Unverzgat ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Racial Differences ◽  
Disease Risk ◽  
Cognitive Status ◽  
Community Dwelling ◽  
Risk Scores ◽  
Clinical Criteria ◽  
Chd Risk

Background: Cognitive impairment is as high as 70% among adults with heart failure (HF) and its prevalence increases with the duration and severity of HF. However, little is known about the prevalence of cognitive impairment early in the course of HF. This is important, as high cognitive impairment at diagnosis would suggest that earlier screening would be warranted. We examined the prevalence and correlates of cognitive impairment among adults with incident HF. Methods: We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, an observational, longitudinal cohort study of 30,239 community-dwelling adults > 45 recruited from 2003 to 2007. Blacks and residents of the stroke belt were oversampled. Global cognitive status was assessed annually by telephone with the Six-item Screener (SIS) and the diagnosis of incident HF was validated by physicians using medical records and standard clinical criteria. Participants who were hospitalized for incident HF from 2004 until 2016 with a SIS completed > 1 month but < 18 months before the index hospitalization were included. After determining the prevalence of cognitive impairment among this cohort, we identified which of their baseline characteristics were independently associated with cognitive impairment using multivariable logistic regression. We then compared the prevalence of cognitive impairment among adults with incident HF to the prevalence of cognitive impairment among age, sex, and race matched participants without HF, stratifying by 10-year Framingham Coronary Heart Disease Risk Scores (FRS) (<10%, 10-20%, and > 20%). Results: Of the 436 participants with incident HF, 14.9% had cognitive impairment. In an age-adjusted model, older age (OR 1.04 [95% CI 1.01 - 1.08], black race (OR 1.88 [95% 1.08-3.28]), < high school education (OR 1.89 [95% 1.02-3.51]), and anticoagulation (OR 3.01 [95% 1.05 - 8.63]) were independently associated with higher odds of cognitive impairment, whereas female sex (OR 0.54 [95% 0.31 - 0.94]) was associated with lower odds of cognitive impairment. The prevalence of cognitive impairment among participants with incident HF was higher than the prevalence of cognitive impairment among controls with low FRS (9.4%) but was less than the prevalence of cognitive impairment among controls with high FRS (21.9%). Conclusion: The prevalence of cognitive impairment among adults with incident HF was greater than the prevalence of cognitive impairment among matched participants with low CHD risk, but less than the prevalence of cognitive impairment among matched participants with the highest CHD risk. This suggests that the majority of cognitive decline in HF may occur later in the course of the disease. Increased awareness of cognitive impairment among newly diagnosed patients, as well as ways to mitigate cognitive decline in the context of HF management, are warranted.

scholarly journals Predictors of Changes in Cognitive Function in Older Korean Adults: The 2006–2018 Korean Longitudinal Study of Aging

2021 ◽  
Vol 18 (12) ◽  
pp. 6345
Author(s):  
Minjeong Kang ◽  
Inhwan Lee ◽  
Haeryun Hong ◽  
Jeonghyeon Kim ◽  
Hyunsik Kang
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Severe Cognitive Impairment ◽  
Korean Adults ◽  
Age Related ◽  
Normal Cognition

Cognitive decline with normal aging varies widely among individuals. This study aimed to investigate predictors of longitudinal changes in cognitive function in community-dwelling Korean adults aged 65 years and older. Data from 727 older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) survey from 2006 (baseline) until 2018 (seventh wave) were used. Cognitive performance was assessed with the Korean Mini-Mental State Examination. The participants were retrospectively classified into normal cognition, mild cognitive impairment, and moderate/severe cognitive impairment. Education, income, religion, living area, alcohol intake, smoking, physical activity, handgrip strength, functional dependency, depression, comorbidity, medications, fall experience, and unintentional weight loss were included as covariates. A linear mixed regression analysis showed that a steeper decline in cognitive function over time was significantly associated with parameters of poor socio-economic status, health conditions, and unhealthy behaviors. Individuals with mild cognitive impairment or moderate/severe cognitive impairment were likely to have steeper cognitive declines compared with individuals with normal cognition. The current findings of the study showed that age-related cognitive decline was multifactorial in older Korean adults.

Prospective Metamemory Monitoring of Episodic Visual Memory in Community-Dwelling Older Adults with Subjective Cognitive Decline and Mild Cognitive Impairment

2021 ◽  
Author(s):  
Susan Y Chi ◽  
Elizabeth F Chua ◽  
Dustin W Kieschnick ◽  
Laura A Rabin
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Visual Memory ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Self Awareness ◽  
Self Monitoring ◽  
Prodromal Dementia

Abstract Objective Metamemory tasks have been utilized to investigate anosognosia in older adults with dementia, though previous research has not systematically compared memory self-awareness in prodromal dementia groups. This represents an important oversight given that remedial and interventional efforts may be most beneficial before individuals’ transition to clinical dementia. We examine differences in memory self-awareness and memory self-monitoring between cognitively healthy elderly controls and prodromal dementia groups. Methods Participants with subjective cognitive decline despite intact objective neuropsychological functioning (SCD; n = 82), amnestic mild cognitive impairment (aMCI; n = 18), nonamnestic mild cognitive impairment (naMCI; n = 38), and normal cognitive functioning (HC; n = 120) were recruited from the Einstein Aging Study for a cross-sectional study. Participants completed an experimental visual memory-based global metamemory prediction task and subjective assessments of memory/cognition and self-awareness. Results While, relative to HC, memory self-awareness and memory self-monitoring were preserved for delayed memory performance in SCD and aMCI, these processes were impaired in naMCI. Furthermore, results suggest that poor metamemory accuracy captured by our experimental task can be generalized to everyday memory problems. Conclusions Within the framework of the Cognitive Awareness Model, our findings provide preliminary evidence that poor memory self-awareness/self-monitoring in naMCI may reflect an executive or primary anosognosia, with implications for tailored rehabilitative interventions.

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