Words on the Edge: Confrontation Naming as a Window into Mild Neurocognitive Disorder

To assess the cognitive and motor effects of an intervention utilizing commercial immersive virtual reality (IVR) games in older adults diagnosed with mild neurocognitive disorder (mild NCD) or mild major neurocognitive disorder and compare these effects with those of a motor-cognitive integrated exercise program. This randomized controlled trial will include volunteers aged 60 years and older diagnosed with mild NCD or mild major NCD. Participants will be randomly assigned to two groups, each undergoing two 45-minute sessions weekly for seven weeks. The Virtual Reality Group (VRG) will engage in six IVR games, while the Exercise Group (EG) will perform integrated motor-cognitive exercises. Outcomes will be measured using the mini-BESTest, Dynamic Gait Index, Box and Block Test, 1-minute sit-to-stand test, Grip Strength Test, Neurocognitive Battery, Word Accentuation Test, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Montreal Cognitive Assessment, and Functional Activities Questionnaire. Sample size calculation indicates 32 participants (16 per group) to achieve 80 % power with α = 0.05, accounting for 20 % attrition. The trial is registered at the Brazilian Clinical Trials Registry (RBR-2kk9vnh). It is hypothesized that participants in the VRG will demonstrate greater improvements in cognitive and motor performance compared to the EG. This study aims to determine whether commercial IVR games can serve as effective cognitive and motor interventions for individuals with mild NCD or mild major NCD.

Effects of art therapy for people with mild or major neurocognitive disorders: A systematic review and meta-analysis

Background: Older adults with mild neurocognitive disorders (mild NCD) have a higher risk of major NCD. Cognitive deterioration can cause a deficit in working memory and language. Recent studies have shown some involvement overlapping the brain structure of working memory and language skills. Therefore, working memory intervention effectively enhances language skills in mild NCD. However, more research on this topic in Thailand is required. Objectives: This study aimed to develop and implement a pilot study on a working memory program for improving language skills in older adults with mild NCD. Materials and methods: This study was a developmental research design with two phases. Phase one involved the development and examination of the content validity of the working memory program for improving language skills by five experts. Phase two involved piloting the program with three older adults with mild NCD. The participants were asked to provide suggestions about the clarity of content and images, language usage, font size, the comprehensibility of instructions in each activity, and the quality of audio files used to complement the program activities through semi-structured interviews. Descriptive statistics were employed to analyze the collected data. Results: The program comprised nine activities associated with the phonological loop, visual-spatial sketchpad, episodic buffer, and central executive tasks. The program’s content validity was evaluated by five experts, resulting in a content validity index of 0.94, meeting the established criteria. Among the pilot users, three participants meeting the specified criteria indicated their ability to use and practice the program at home effectively. While most participants agreed that the images were clear and the font size was appropriate, there were concerns regarding the clarity of the training process steps and instructions. Additionally, some participants encountered challenges in accessing audio files through quick response (QR) codes. Conclusion: In summary, the pilot study of the working memory program for improving language skills in older adults with mild NCD passed the content validity test and underwent revisions based on suggestions from the pilot users. Consequently, the program could enhance the language abilities of older adults with mild NCD. The next phase will investigate its effectiveness in improving language skills in older adults with mild NCD.

BackgroundMild cognitive impairment (MCI) is considered a pre-stage of different dementia syndromes. Despite diagnostic criteria refined by DSM-5 and a new term for MCI – “mild neurocognitive disorder” (mild NCD) – this diagnosis is still based on clinical criteria.MethodsTo link mild NCD to the underlying pathophysiology we assessed the degree of white matter hyperintensities (WMH) in the brain and peripheral biomarkers for neuronal integrity (neuron-specific enolase, NSE), plasticity (brain-derived neurotrophic factor, BDNF), and glial function (S100B) in 158 community-dwelling subjects with mild NCD and 82 healthy controls. All participants (63–79 years old) were selected from the Leipzig-population-based study of adults (LIFE).ResultsSerum S100B levels were increased in mild NCD in comparison to controls (p = 0.007). Serum NSE levels were also increased but remained non-significant after Bonferroni-Holm correction (p = 0.04). Furthermore, age by group interaction was significant for S100B. In an age-stratified sub-analysis, NSE and S100B were higher in younger subjects with mild NCD below 71 years of age. Some effects were inconsistent after controlling for potentially confounding factors. The discriminatory power of the two biomarkers NSE and S100B was insufficient to establish a pathologic threshold for mild NCD. In subjects with mild NCD, WMH load correlated with serum NSE levels (r = 0.20, p = 0.01), independently of age.ConclusionOur findings might indicate the presence of neuronal (NSE) and glial (S100B) injury in mild NCD. Future studies need to investigate whether younger subjects with mild NCD with increased biomarker levels are at risk of developing major NCD.

Background: The Montreal Cognitive Assessment (MoCA) is a sensitive screening instrument for mild neurocognitive disorder (mild NCD). However, cut-off scores and accuracy indices should be established using representative samples of the population. In this context, the aim of this study was to update the normative values, and diagnostic efficiency statistics of the MoCA to detect mild NCD in the Chilean population. Methods: This study included 226 participants from the north, center, and south of the country, classified into 3 groups: healthy elderly (HE; n = 113), mild NCD (n = 65), and major neurocognitive disorder (major NCD; n = 48). Results: The optimal cut-off score to discriminate mild NCD from HE participants was 20 points with a sensitivity of 82.8% and a specificity of 84.1%. The observed balance between sensitivity and specificity shows a good test performance either to confirm or discard a diagnosis. The cut-off between mild NCD and major NCD from HE participants was 19 points with 85.6% of sensitivity and 90.3% of specificity. Conclusion: Overall diagnostic accuracy can be considered as outstanding (AUC ≥0.904) when discriminating HE from both mild NCD and major NCD. These results showed that the MoCA is a suitable tool to identify mild NCD and major NCD.

ObjectiveRepeated testing using the Montreal Cognitive Assessment (MoCA) increases risks for practice effects which may bias measurements of cognitive change. The objective of this study is to develop two alternate versions of the MoCA (Hong Kong version; HK-MoCA) and to investigate the validity and reliability of the alternate versions in patients with DSM-5 Mild Neurocognitive Disorder (Mild NCD) and cognitively healthy controls.MethodsConcurrent validity and inter-scale agreement were examined by Pearson correlation of the total scores between the original and alternate versions and the Bland-Altman Method. Criterion validity of the two alternate versions in differentiating patients with Mild NCD was tested using receiver operating characteristic curve (ROC) analysis. One-month test-retest and inter-rater reliability were examined in 20 participants. Internal consistency of the alternate versions was measured by the Cronbach’s α.Results30 controls (age 73.4 [4.5] years, 60% female) and 30 patients (age 75.4 [5.5] years, 73% female) with Mild NCD were recruited. Both alternate versions significantly correlated with the original version (r = 0.79–0.87, p<0.001). Mean differences of 0.17 and -0.40 points were found between the total scores of the alternate with the original versions with a consistent level of agreement observed throughout the range of cognitive abilities. Both alternate versions significantly differentiated patients with Mild NCD from healthy controls (area under ROC 0.922 and 0.724, p<0.001) and showed good one-month test-retest reliability (intra-class correlation [ICC] = 0.92 and 0.82) and inter-rater reliability (ICC = 0.99 and 0.87) and high internal consistency (Cronbach α = 0.79 and 0.75).ConclusionThe two alternate versions of the HK-MoCA are useful for Mild NCD screening.

Plain Language SummaryDementia in its early stages is not fully understood. However, many people with dementia first develop behaviors or psychological problems (known as neuropsychiatric symptoms [NPS]) before any cognitive or memory problems occur. Some examples of NPS include, but are not limited to depression, anxiety, sleep difficulties, agitation, hallucinations, and delusions. NPS are sometimes the only signs someone is developing dementia; NPS can go misdiagnosed because they can look like other disorders. This research study looks at NPS in people at risk for dementia but do not have dementia yet. This study looks at three high risk groups for dementia: (1) people with cognitive problems but can still do activities independently (known as mild neurocognitive disorder [Mild NCD]), (2) people who had clinical depression but recovered (known as major depressive disorder [MDD]), and (3) people who had both Mild NCD and MDD. This study found that the most common NPS was depression. Furthermore, this study found that people with both Mild NCD and MDD had the highest amount of any NPS. Lastly, this study used a technique called factor analysis; factor analysis tries to understand how different symptoms cluster together. The results of the factor analysis showed that NPS clustered differently in the three high risk groups. These differences may improve diagnosis and treatment of people at risk for dementia but do not have dementia. Future research should try to understand how these symptom clusters compare other disease biomarkers for dementia.

BackgroundStrategies to identify and treat mild neurocognitive disorder (mild NCD) are still unclear.ObjectiveThe detection and management of mild NCD are crucial to prevent or delay its progression to major NCD, and to help those affected cope with cognitive impairment. The Cartesio Project aimed to reach a consensus on the management of mild NCD in primary care.MethodsThe Advisory Board of five experts (three neurologists, one geriatrician and one general practitioner (GP)), identified four domains of mild NCD: case finding; differential diagnosis; non-pharmacological, and pharmacological intervention. A literature review was performed by consulting the PubMed, PsycNET and Scopus databases from 2017 until August 2022, and guidelines, reviews and meta-analyses on mild NCD were reviewed. A care pathway involving 18 statements was then proposed and voted on by 61 participants (39% neurologists, 31% geriatricians, 25% GPs and 5% psychiatrists).ResultsAgreement was reached on 14 out of 18 statements. The practice of case finding in primary care and the need for a two-level diagnostic approach was supported, including referral to memory clinics. With regard to non-pharmacological treatments, no consensus was reached on nutritional supplementation. There was support for the use of nootropic drug treatments, but not for drugs to treat Alzheimer's disease.ConclusionsThe Cartesio Project developed a consensus to identify the best care for mild NCD. The consensus highlights educational interventions on timely detection and appropriate management of mild NCD in primary care, which may be of relevance for those patients who eventually develop Alzheimer's disease.

A-75 Predicting neurocognitive impairment using the Green’s Medical Symptom Validity Test dementia profile formula

Executive functions (EF) are central to instrumental activities of daily living (IADL). A novel approach to the assessment of the impact of EF difficulties on IADL may be through the speech acts produced when performing IADL-inspired tasks in a laboratory-apartment. Speech acts may act as a window to the difficulties encountered during task performance. We aim to 1) qualitatively describe the speech acts produced by participants with mild neurocognitive disorder (mild NCD) and healthy controls (HC) as they performed 4 IADL-inspired tasks in a laboratory-apartment, and to then 2) compare their use in both groups. The participants' performance was videotaped, and speech acts produced were transcribed. Qualitative description of all speech acts was performed, followed by a deductive-inductive pattern coding of data. Statistical analyses were performed to further compare their use by mild NCD participants and HC. Twenty-two participants took part in the study (n mild NCD = 11; n HC = 11). Meta-categories of data emerged from pattern coding: strategies, barriers, reactions, and consequences. Mild NCD participants used significantly more strategies and barriers than did HC. They were more defensive of their performance, and more reactive to their difficulties than HC. Mild NCD participants' verification of having completed all tasks was less efficient than controls. An assessment of speech acts produced during the performance of IADL-inspired tasks in a laboratory-apartment may allow to detect changes in the use of language which may reflect EF difficulties linked to cognitive decline.

ABSTRACTIntroduction: Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual–perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy. Method: A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale–4th Edition (WAIS–IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation. Results: Multiple regression indicated that PRI accounted for 23%, 13%, and 15% of the variance in BNT, VNT, and NAB scores, respectively, but dropped out as a significant predictor once VCI was added. Follow-up bootstrap mediation analyses revealed that PRI had a significant indirect effect on naming performance after controlling education, primary language, and severity of cognitive impairment, as well as the mediating effect of general verbal abilities for the BNT (B = 0.13; 95% confidence interval, CI [.07, .20]), VNT (B = 0.01; 95% CI [.002, .03]), and NAB (B = 0.03; 95% CI [.01, .06]). Conclusions: Findings revealed a complex relationship between perceptual reasoning abilities and confrontation naming that is mediated by general verbal abilities. However, when verbal abilities were statistically controlled, perceptual reasoning abilities were found to have a significant indirect effect on performance across all three confrontation naming measures with the largest effect noted with the BNT relative to the VNT and NAB Naming Test.

Effective screening tools can help providers with treatment decisions, including when to refer patients for neuropsychological evaluations, which are the gold standard for cognitive assessment of neurodegenerative disease. The authors examined whether performance on the Addenbrooke's Cognitive Examination-Third Edition (ACE-III), a readily available cognitive screening tool for older adults, predicted performance on subsequent neuropsychological evaluations. In total, 217 patients referred for neurocognitive concerns completed a neuropsychological evaluation, including the ACE-III. Patients were diagnosed as having normal cognition (NC, N=67), mild neurocognitive disorder (mild NCD, N=105), or major NCD (N=45). Regression analyses were used to determine whether ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. Logistic regression was used to assess whether ACE-III total score and overall neuropsychological test performance predicted diagnosis. Separate analyses compared those with higher and lower educational attainments. ACE-III subscales and total scores were compared by diagnostic group. Across all groups, ACE-III subscale scores predicted within-construct neuropsychological performances with moderate to strong effects (p<0.001) but were less predictive for those with lower educational attainment. ACE-III total score was less sensitive than overall neuropsychological test performance in predicting neurocognitive disorders. ACE-III subscale and total scores distinguished diagnostic groups (NC>mild NCD>major NCD, p<0.001). ACE-III subscale scores predicted performance on neuropsychological measures assessing similar constructs. However, overall performance on neuropsychological testing was more sensitive than ACE-III total score in predicting neurocognitive disorder diagnosis. Total ACE-III score differed by level of cognitive impairment. Comprehensive neuropsychological testing is recommended for patients who have lower educational status or complex symptom presentations or are younger.

BackgroundThe 8‐item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many suggested a cutoff of 2 might result in a high false positive rate (up to &gt; 80%). A higher false positive rate in Taiwan was repeatedly shown when AD8 was self‐administered in local government screening programs. This study aimed to examine the performance of AD8, determine its best cutoff value, and discuss factors that may affect the performance of AD8.MethodWe recruited 119 participant‐informant dyads from a psychiatric outpatient clinic of a university medical center. For each dyad, the AD8 was administered first, and then Mini‐Mental Status Examination (MMSE) and the Clinical Dementia Rating (CDR) to minimize contamination effect. Two geriatric psychiatrists made a consensus clinical diagnosis for each subject based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) using all available clinical information, including MMSE, CDR, clinical history, other past neuropsychological tests, and neuroimaging examinations (if available).ResultThere were 37 subjects with normal cognition, 44 with mild neurocognitive disorder (mild NCD), and 28 with major neurocognitive disorder (major NCD). When the cutoff value was 2 for the differentiation between major NCD and no‐dementia subjects (including normal cognition and mild NCD), the AD8 had an AUC of 0.756, a sensitivity of 0.929, and a specificity of 0.582. But the optimal cutoff value was 4 according to the Youden index, with an AUC of 0.888, a sensitivity of 0.786, and a specificity of 0.835.ConclusionAlthough many studies recommended 2 as the best cutoff value for screening dementia, our findings and those of others suggest a cutoff of 2 may result in a high false positive rate. Many factors could affect the performance of AD8, including sample characteristics (e.g. education level), region, conduct of the test, flow of the administration (whether AD8 is administered first or contaminated by other tests), etc. Details will be discussed during the AAIC meeting.

Slow and Steady Does Not Always Win the Race: Investigating the Effect of Processing Speed across Five Naming Tests.

Dysnomia is typically assessed during neuropsychological evaluation through visual confrontation naming. Responsive naming to description, however, has been shown to have a more distributed representation in both fMRI and cortical stimulation studies. While naming deficits are common in dementia, the relative sensitivity of visual confrontation versus auditory responsive naming has not been directly investigated. The current study compared visual confrontation naming and auditory responsive naming in a dementia sample of mixed etiologies to examine patterns of performance across these naming tasks. A total of 50 patients with dementia of various etiologies were administered visual confrontation naming and auditory responsive naming tasks using stimuli that were matched in overall word frequency. Patients performed significantly worse on auditory responsive naming than visual confrontation naming. Additionally, patients with mixed Alzheimer's disease/vascular dementia performed more poorly on auditory responsive naming than did patients with probable Alzheimer's disease, although no group differences were seen on the visual confrontation naming task. Auditory responsive naming correlated with a larger number of neuropsychological tests of executive function than did visual confrontation naming. Auditory responsive naming appears to be more sensitive to effects of increased of lesion burden compared to visual confrontation naming. We believe that this reflects more widespread topographical distribution of auditory naming sites within the temporal lobe, but may also reflect the contributions of working memory and cognitive flexibility to performance.