Addenbrooke's Cognitive Examination-Revised Research Articles

Frequency and risk factors for cognitive dysfunction in peritoneal dialysis patients.

There is limited data on cognition in patients undergoing peritoneal dialysis (PD). We assessed prevalence and associated risk factors of neurocognitive impairment (NCI) in PD patients. A cross-sectional cohort study of 149 PD patients at a single centre between 2016 and 2020 who underwent neurocognitive screening at defined intervals by Addenbrooke's Cognitive Examination - Revised (ACE-R) with incorporated Mini-Mental State Examination (MMSE). Paired-sample t-test was used to compare cognitive performance to the general population and compare cohorts for dichotomous risk factors. Residual renal function (RRF) and clearance kinetics were evaluated using local regression models. Sub-analysis was performed in patients with cerebrovascular disease (CVD). Patients on PD performed poorly in ACE-R screening compared to population norms, with discrepancy in all cognitive domains. In patients without CVD, attention and language domains were comparable to norms. The MMSE detected cognitive impairment in 2% of studied patients, significantly fewer than when the ACE-R was applied (32%). Age, gender, diabetic status and depression were associated with lower neurocognitive screening performance (p < .05). Dialysis vintage beyond 12 months conferred poorer cognitive performance. RRF correlated with cognitive performance. Patients on PD have higher prevalence of NCI than the general population, primarily with impairments in memory, fluency and visuospatial reasoning. CVD confers poorer performance in attention and language domains. The MMSE is ineffective in detecting subtle NCI in this population compared with ACE-R. Risk factors for NCI include age, gender, diabetic status, depression and vintage beyond 12 months. Protective factors include RRF.

Lymphocyte Count and Neutrophil-to-Lymphocyte Ratio Are Associated with Mild Cognitive Impairment in Parkinson's Disease: A Single-Center Longitudinal Study.

Lymphocyte count and neutrophil-to-lymphocyte ratio (NLR) may represent useful biomarkers of Parkinson’s disease (PD), but their role in PD-related mild cognitive impairment (MCI) has not been fully elucidated. The present study aimed to confirm whether these immunological measures can discriminate PD patients from healthy controls (HC) and establish their feasibility as prognostic biomarkers of MCI in PD. Immunological data at baseline were analyzed in 58 drug-naïve PD patients and 58 HC matched 1:1 for age, sex, and cardiovascular comorbidities. We selected a subgroup of 51 patients from this initial cohort who underwent longitudinal neuropsychological assessments through the Addenbrooke’s Cognitive Examination Revised (ACE-R) test. We considered the last examination available to analyze the relationship between ACE-R test scores and immunological measures. We found that lymphocyte count was lower and NLR higher in PD than HC (p = 0.006, p = 0.044), with AUC = 0.649 and 0.608, respectively. Secondly, in PD-MCI there were significantly higher levels of circulating lymphocytes (p = 0.002) and lower NLR (p = 0.020) than PD with normal cognitive status (PD-NC). Correlations between lymphocyte count and ACE-R total score and memory subitem (r = −0.382, p = 0.006; r = −0.362, p = 0.01), as well as between NLR and ACE-R total score and memory subitem (r = 0.325, p = 0.02; r = 0.374, p = 0.007), were also found. ROC curve analysis showed that lymphocyte count and NLR displayed acceptable discrimination power of PD-MCI with AUC = 0.759 and 0.691, respectively. In conclusion, we suggest that an altered peripheral immune phenotype could foster cognitive decline development in PD, thus opening the possibility of immune-targeting strategies to tackle this disabling non-motor feature.

Association between Vitamin D and Cognitive Deficiency in Alcohol Dependence.

There are still not enough findings to elucidate how exactly alcohol use impairs cognitive abilities. Some studies have shown that there is a link between alcohol intake and vitamin D levels, but these findings are inconsistent so further research is needed. The aim of this study was to investigate the association between serum vitamin D levels and cognitive impairment in alcohol-dependent individuals. A case-control study was carried out including a total of N = 132 respondents with a medical history of alcoholism, and healthy volunteers. The Montreal Cognitive Assessment (MoCa) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) screening tools were used for cognitive status assessment and serum vitamin D levels analysis (blood samples of respondents). Significant difference (p = 0.022), was found in vitamin D levels in the alcohol-dependent group with cognitive deficiency 13.7 ± 9.4 (ng/mL), alcohol-dependent group without cognitive deficiency 19.5 ± 11.2 (ng/mL) and healthy controls 19.9 ± 11.1 (ng/mL), respectively. Furthermore, vitamin D levels were significantly different across all groups based on MoCa (p = 0.016) and ACE-R (p = 0.004) scores. All three groups exhibited vitamin D deficiency. A significant correlation was found between vitamin D deficiency and cognitive impairment, but it yielded no significant difference in alcohol-dependent individuals.

Effect of donepezil for dementia prevention in Parkinson's disease with severe hyposmia (The DASH-PD study): A randomized long-term placebo-controlled trial.

SummaryBackgroundDementia greatly contributes to poor prognosis in patients with Parkinson's disease (PD). We previously reported that severe olfactory dysfunction may be a good predictor of Parkinson's disease dementia (PDD). In this trial, we investigated whether early administration of donepezil to patients with severe hyposmia can reduce the development of PDD.MethodsThis was a multi-centre, randomized, double-blind, parallel group, placebo-controlled trial in patients with non-demented PD with severe hyposmia (The Donepezil Application for Severe Hyposmic Parkinson's Disease [DASH-PD] study). A total of 201 patients were randomly allocated to receive donepezil or placebo in addition to standard therapy for PD. Patients were followed up every 6 months until the onset of PDD or for a maximum of 4 years. The primary endpoint was the onset of dementia. The secondary endpoint was cognitive impairment measured by Addenbrooke's Cognitive Examination-Revised (ACE-R) and the Clinical Dementia Rating (CDR).(UMIN000009958: February 2013 to May 2019).FindingsA total of 201 hyposmic patients with PD were randomly assigned to a treatment: 103 to donepezil and 98 to placebo. Overall, 141 (70%) patients completed the 4-year intervention. During follow-up, 7 of 103 (6.8%) patients in the donepezil group and 12 of 98 (12.2%) patients in the placebo group developed PDD; however, the hazard ratio of PDD incidence was not statistically significant (hazard ratio (HR), 0.609; 95% confidence interval, 0.240 to 1.547; p = 0.2969). At week 208, the patients in the donepezil group had better scores on the ACE-R (p < 0.005) and the CDR (p < 0.005) than those taking placebo.InterpretationAdministration of donepezil to PD patients with severe olfactory dysfunction for 4 years did not change the incidence of dementia but had a beneficial effect on neuropsychological function, with good tolerability.FundingThe Ministry of Health Labour and Welfare and the Japan Agency for Medical Research and Development provided funding for this study.

Changes in neuropsychiatric symptoms and caregivers’ distress in behavioral variant frontotemporal dementia and Alzheimer’s disease in 12 months

IntroductionIn behavioral variant frontotemporal dementia (bvFTD) neuropsychiatric symptoms are a significant concern as they impact care management and caregiver wellbeing.ObjectivesTo describe change in individual neuropsychiatric symptoms and associated caregivers’ distress assessed by the Neuropsychiatry Inventory (NPI) in patients diagnosed with bvFTD and Alzheimer’s disease (AD) from baseline to a 12-month follow-up.MethodsThe sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The NPI and the Addenbrooke´s Cognitive Examination Revised (ACE-R) were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) were used.ResultsAt baseline, significantly higher scores were observed for the bvFTD group for: agitation, disinhibition and eating disturbances. The latter two were also higher in the NPI Distress subdomains. At followup, there were significantly higher scores for the bvFTD group in agitation, disinhibition, eating disturbances, hallucination and irritability. For the NPI Distress subdomains, agitation, eating disturbances and hallucination scores were significantly higher for the bvFTD group.ConclusionsIn 12 months, neuropsychiatric symptoms increased in both bvFTD and AD groups. However, NPI subdomain and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. Neuropsychiatric symptoms may be associated with care burden in bvFTD and should be a focal point in care management decisions.DisclosureNo significant relationships.

Changes in Cognitive Functioning After Surgical Resection of Language-related, Eloquent-area, High-grade Gliomas Under Awake Craniotomy.

Dominant-hemisphere tumors, especially gliomas, as infiltrative tumors, frequently affect cognitive functioning. Establishing a balance between extensive resection, which is proven to result in longer survival, and less extensive resection, in order to maintain more cognitive abilities, is challenging. To evaluate changes in cognitive functioning before and after surgical resection of language-related, eloquent-area, high-grade gliomas under awake craniotomy. We provided individuals with newly diagnosed high-grade gliomas of the language-related eloquent areas with the same standard of care, including surgical resection of the glioma using intraoperative sensory-motor and cognitive mapping under awake craniotomy, and the same protocol for chemoradiotherapy. Cognitive functioning was assessed using Addenbrooke's Cognitive Examination-Revised (ACE-R) at four time points (preoperatively, early after surgery, and 3 and 6 months postoperatively). The preoperative evaluation revealed a range of cognitive impairments in 70.7% of the individuals, affecting all of the cognitive subdomains (mostly attention and visuospatial abilities). Overall cognitive functioning (ie, ACE-R score) dropped by 13.5% (P = 0.169) early postoperatively. At the 3-month evaluation, an average of 15.3% (P = 0.182) recovery in cognitive functioning was observed (mostly in verbal fluency: 39.1%). This recovery improved further, reaching 29% (P < 0.001) at the 6-month evaluation. The greatest improvement occurred in verbal fluency: 68.8%, P = 0.001. Extensive resection of eloquent-area gliomas with the aid of modern neuroimaging and neuromonitoring techniques under awake craniotomy is possible without significant long-term cognitive sequela.

Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT.

Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers’ burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers’ burden.

Sunbeam Program Reduces Rate of Falls in Long-Term Care Residents With Mild to Moderate Cognitive Impairment or Dementia: Subgroup Analysis of a Cluster Randomized Controlled Trial.

The Sunbeam trial significantly reduced falls in long-term aged care (LTC) residents. The current study's primary objective was to undertake subgroup analysis of the Sunbeam trial, to determine whether the intervention was effective for reducing falls in LTC residents with mild-moderate cognitive impairment/dementia. Secondary objectives were to determine intervention effects on cognitive and physical function. Subgroup analysis of a cluster randomized controlled trial (RCT). Permanent residents of LTC in Australia who participated in the Sunbeam trial with Addenbrooke's Cognitive Examination-Revised (ACE-R) scores <83 (Mini-Mental State Examination >14= main trial inclusion criteria). Of 221 participants, 148 had an ACE-R <83 and were included in this study. Sixteen LTC residences (clusters) were randomized to receive either the Sunbeam program or usual care. The Sunbeam program involved two 1-hour sessions/week of tailored and progressive resistance and balance training for 25weeks followed by a maintenance program (two 30-min sessions/week of nonprogressive exercise for 6months). Assessments were conducted at baseline, 6months, and 12months. Falls were recorded using routinely collected data from the LTC incident management systems. Rate of falls (50%) and risk of falls (31%), multiple falls (40%), and injurious falls (44%)were reduced in the intervention group. The intervention group had significantly better balance (static and dynamic) and sit-to-stand ability when compared with the control group at 6months and significantly better dynamic balance at 12months. There were no serious adverse events. The Sunbeam Program significantly reduced falls and improved physical performance in cognitively impaired LTC residents. This is a novel and important finding, as many previous studies have excluded people with cognitive impairment/dementia and inconsistent findings have been reported when this population has been studied. Our findings suggest that progressive resistance and balance exercise is a safe and effective fall prevention intervention in LTC residents with mild-moderate cognitive impairment/dementia.

Impact of Small Vessel Disease Progression on Long-term Cognitive and Functional Changes After Stroke.

Background and ObjectivesThe severity of white matter hyperintensities (WMH) at presentation with stroke is associated with poststroke dementia and dependency. However, WMH can decrease or increase after stroke; prediction of cognitive decline is imprecise; and there are few data assessing longitudinal interrelationships among changing WMH, cognition, and function after stroke, despite the clinical importance.MethodsWe recruited patients within 3 months of a minor ischemic stroke, defined as NIH Stroke Scale (NIHSS) score <8 and not expected to result in a modified Rankin Scale (mRS) score >2. Participants repeated MRI at 1 year and cognitive and mRS assessments at 1 and 3 years. We ran longitudinal mixed-effects models assessing change in Addenbrooke’s Cognitive Examination–Revised (ACE-R) and mRS scores. For mRS score, we assessed longitudinal WMH volumes (cube root; percentage intracranial volume [ICV]), adjusting for age, NIHSS score, ACE-R, stroke subtype, and time to assessment. For ACE-R score, we additionally adjusted for ICV, mRS, premorbid IQ, and vascular risk factors. We then used a multivariate model to jointly assess changing cognition/mRS score, adjusted for prognostic variables, using all available data.ResultsWe recruited 264 patients; mean age was 66.9 (SD 11.8) years; 41.7% were female; and median mRS score was 1 (interquartile range 1–2). One year after stroke, normalized WMH volumes were associated more strongly with 1-year ACE-R score (β = −0.259, 95% CI −0.407 to −0.111 more WMH per 1-point ACE-R decrease, p = 0.001) compared to subacute WMH volumes and ACE-R score (β = 0.105, 95% CI −0.265 to 0.054, p = 0.195). Three-year mRS score was associated with 3-year ACE-R score (β = −0.272, 95% CI −0.429 to −0.115, p = 0.001). Combined change in baseline-1-year jointly assessed ACE-R/mRS scores was associated with fluctuating WMH volumes (F = 9.3, p = 0.03).DiscussionAfter stroke, fluctuating WMH mean that 1-year, but not baseline, WMH volumes are associated strongly with contemporaneous cognitive scores. Covarying longitudinal decline in cognition and independence after stroke, central to dementia diagnosis, is associated with increasing WMH volumes.

SPECT analysis and language profile in Greek speaking patients with subtypes of frontotemporal dementia.

We aimed to examine if single photon emission computed tomography (SPECT) can discriminate between variants of frontotemporal dementia (FTD). As a secondary investigation we identify and establish the linguistic differences between those variants. Nine patients with semantic variant primary progressive aphasia (svPPA), 8 with non-fluent variant primary progressive aphasia (nfvPPA) and 17 with behavioral variant of frontotemporal dementia (bvFTD) were compared on Addenbrooke's cognitive examination-revised (ACE-R), auditory comprehension, oral expression and verbal fluency. All patients were also compared with healthy controls. Patients were evaluated using technetium-99m-hexamethylproyleneamine oxime (99mTc-HMPAO) brain SPECT as a measure of regional cerebral flow. Significant group differences between all patients and controls were found for ACE-R, auditory comprehension and oral expression. Semantic variant primary progressive aphasia patients performed higher in letter compared to category fluency with significant deficits in auditory comprehension and oral expression. Non-fluent variant primary progressive aphasia patients showed significant deficits in auditory comprehension but not oral expression while performed lightly worse in letter fluency compared to category. Behavioral variant of frontotemporal dementia patients showed deficits in auditory comprehension and oral expression and performed similar in category and letter fluency. Single photon emission computed tomography analysis revealed left frontotemporal hypoperfusion extending to the right frontotemporal region in svPPA patients. Non-fluent variant primary progressive aphasia patients presented left frontotemporal hypoperfusion with participation of the left parietal and right frontotemporal regions. Behavioral variant of frontotemporal dementia patients showed bilateral frontotemporal hypoperfusion compared to parietal and visual cortices. Our findings suggest that SPECT may assist in the discrimination of the FTD variants. We also confirmed that bvFTD patients share similar language deficits with svPPA patients.

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia.

Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers’ burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. Methods: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). Results: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers’ burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). Conclusions: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers’ burden.

EFEITOS DA MÚSICA DE CONCERTO SOBRE A COGNIÇÃO, PARÂMETROS FISIOLÓGICOS E PSICOLÓGICOS EM IDOSOS COM DEMÊNCIA: ESTUDO QUASE EXPERIMENTAL

ABSTRACT.Non-pharmacological interventions, such as the use of music, have been shown to be important potential means of controlling adverse symptoms and signs resulting from chronic diseases already present in elderly patients with dementia.Objectives:The objective of this study was to analyze the effects of concert music on cognitive and physiological parameters, and behavioral and psychological symptoms in institutionalized elderly people with dementia.Methods:A descriptive-exploratory, quantitative, quasi-experimental study was conducted with 14 elderly people. They were allocated in intervention group (IG) (n=7) with eight sessions of music listening, once a week, for 2 months, and control group (CG) (n=7) with the same procedure but without listening to the music. All participants were assessed by Neuropsychiatric Inventory Questionnaire (NPI-Q) and Addenbrooke’s Cognitive Examination – Revised (ACE-R) before and after the intervention. Blood pressure (BP) data were obtained; heart rate (HR) and coherence were obtained through Cardioemotion during sessions. The data were analyzed using Fisher’s exact test and Student’s t-test.Results:There was a predominance of female participants, who were widowed and diagnosed with Alzheimer’s disease (AD) in both groups. A statistically significant reduction was found in the mean of apathy reduction (p=0.038) and the total mean of NPI-Q severity (p=0.033) (paired Student’s t-test) in IG. No significant differences were found in mean level of the pre- and post-analysis variables in CG.Conclusions:Concert music had a positive effect on the behavior of institutionalized elderly. Stimuli and possibilities of improving the current behavioral conditions are observed.

Cognitive functions in individuals with spinal cord injury: Do symptoms of autonomic dysreflexia or orthostatic hypotension have an effect?

Aims: This study aimed to compare the cognitive functions of individuals with spinal cord injury (SCI) and age- and education level-matched healthy controls, and to compare the cognitive functions between individuals with T6 or rostral and T6 caudal injuries. Materials and Methods: This prospective and cross sectional study included 50 individuals with SCI and 47 age- and education level-matched healthy controls. The SCI individuals were divided into two groups as those with T6 or rostral (n = 20) and T6 caudal (n = 30) injuries. All participants underwent the Addenbrook Cognitive Examination-Revised (ACE-R) test to assess memory, attention and orientation, language, and verbal fluency. Results: The memory, verbal fluency, and language subgroups of the ACE-R were significantly higher in the control group than in the SCI group. Compared with the control group, memory, verbal fluency, and language subscores were significantly reduced in individuals with T6 or rostral injury, and memory and verbal fluency were in individuals with T6 caudal injury. However, there was no significant difference in any of the ACE-R subscores between individuals with T6 or rostral and T6 caudal injuries. Conclusion: Significant differences in certain parts of cognitive functioning were found in individuals with SCI compared with age- and education level-matched controls. However, no significant differences were noted in any parts of cognitive functioning between individuals with T6 or rostral and T6 caudal injuries. Although cognitive impairment is an important sequelae following SCI, autonomic dysfunctions appear to have no effect on cognitive impairments in this population.

Impact of Evidence-Based Functional Intervention Approach on an Individual with Wernicke’s Aphasia Based on International Classification of Functioning, Disability and Health Framework: A Case Study

Background Severe comprehension impairments in Wernicke’s aphasia (WA) are often seen to be associated with auditory related impairment and phonological processing, including semantic and executive difficulties. This study investigated whether an intensive functional approach regime underpins the improvement in speech, language and cognitive domains in an individual with WA resulting in a positive impact on functional communication skills and quality of life-based on international classification of functioning (ICF), disability and health framework. Aim To study the impact of evidence-based functional treatment approach on the speech, language, cognitive and quality of life (QoL) domains in a patient diagnosed with WA based on ICF Framework. Objective The purpose of this longitudinal case study was to compare before- and after-scores of speech and language abilities, cognitive abilities and QoL in a patient diagnosed with WA after providing an intensive evidence-based functional communication treatment approach. Material and Methods A case aged 60-years-old male with a one-month history of stroke; was diagnosed as WA. The patient received intensive functional treatment approach focusing on language and cognition for one hour continuously per session, for eight sessions, within 2-months which involved different therapy approaches to improve his communication abilities. The measurement of language, cognitive abilities and QoL was assessed using the English adaptation of the Western Aphasia Battery (WAB), Addenbrooke’s Cognitive Examination-Revised (ACE-R) and World Health Organization Quality of Life Instrument, Short Form ((WHOQoLBREF) respectively. The results obtained were analyzed based upon the scores obtained across the domains of WAB, ACE-R, and QoL in two stages i.e. pre- and post-intensive aphasia functional language intervention program. Results The outcome of the current study revealed improved scores in WAB, ACE-R, and WHOQoL which highlighted the fact that aphasia therapy techniques targeting the language and functional goals must be followed and implemented during the therapeutic sessions based on the client’s type of aphasia. Conclusion The findings of the case study suggests that the impact of functional communication approach targeting the maximum participation of the person with aphasia seems to be one of the most effective and efficient way to rehabilitate aphasics to improve their QoL.

The Addenbrooke’s Cognitive Examination–Revised in the differential diagnosis between Alzheimer's disease and behavioral variant frontotemporal dementia: A new model

AbstractBackgroundThe increase in life expectancy implies the emergence of chronic‐degenerative and disabling conditions, such as cognitive impairment and dementia. Among the frequent disorders in clinical practice, the differential diagnosis between Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) may be challenging, which justifies the improvement in cognitive tools to be used in clinical practice.MethodThe Addenbrooke’s Cognitive Examination‐Revised (ACE‐R) was administered to 102 patients diagnosed with mild dementia due to probable AD and 37 with mild probable bvFTD from two Brazilian research centers (Table 1). All individuals were submitted to the Mattis Dementia Rating Scale (DRS) and the ACE‐R. The performance of the patients was compared and analyzed. ROC curve analyses were conducted to assess the ACE‐R accuracy in the diagnosis of AD and bvFTD. Multivariate logistic regression analysis was used to develop a new model to refine the diagnostic accuracy of the ACE‐R.ResultMean total scores in the ACE‐R were 70.2 (standard deviation ‐ SD = 10.8) in patients with AD and 72.2 (SD = 11.1) in bvFTD. The VLOM ratio showed an area under the curve (AUC) of 0.816, with 87% sensitivity (Sens.) and 71% specificity (Spec.), 73% positive predictive value (PPV) and 86% negative predictive value (NPV) for the differential diagnosis between AD and bvFTD. The logistic regression method with cross‐validation showed that the relationship between Attention and Orientation, Fluency, Language and Age, as independent variables, shared the importance to the diagnostic differentiation between bvFTD and AD (p &lt;0.05; Table 2). The proposed logarithm was superior in discriminating bvFTD and AD than the VLOM ratio, with AUC of 0.865 (Figure 1) with 78% Sens., 85% Spec., 65% PPV and 91% NPV (Table 3).ConclusionThe ACE‐R achieved very good diagnostic power to discriminate AD and bvFTD in the present sample. Furthermore, the final ROC curves showed the superiority of the model proposed in relation to the analysis of the subscales individually. Further analysis in larger samples, with biomarkers or pathological confirmation, are necessary to confirm these findings.

Impact of socio‐demographic features and lifestyle in cognitive performance of Peruvian adults

AbstractBackgroundThe related‐age changes are associated with a continuous process of cognitive decline. In normal aging, only 1‐2% of the population develop dementia compared with 10 to 15 % with previous mild cognitive impairment. In this line, diverse characteristics exist that act as protective factors front the disease onset and are related to better cognitive performance in the population. Our knowledge about these features can be the first step to combat dementia and reduces the impact on the elderly quality of life. The present study aimed to investigate sociodemographic characteristics and lifestyle factors affecting the cognitive function in Peruvian adults.Method1499 subjects (aged from 42 to 98) participated in the Interview Survey in Health Services of Primary Attention in Arequipa (Perú). The cognitive performance was evaluated with the Addenbrooke's Cognitive Examination ‐ Revised (ACE‐R). The χ2 test and multiple logistic regression models were used to define the association between cognitive impairment and socio‐demography and lifestyle variables.ResultThe multivariate analysis indicated that age, sex, single, more years of education, living in the urban area, practicing physical activities, and reading were associated with a lower risk of cognitive impairment.ConclusionRisk factors associated with dementia are even more visible in Latin America Countries (LAC). The wide variability in the sociodemographic characteristics and access to health care services limit early detection of the disease. The lifestyle changes could help prevent or decrease the risk of cognitive impairment and reduce the disease's impact on vulnerable environments.

Everyday cognition in MCI patients and risk of conversion to Alzheimer’s disease: Evidence from a longitudinal study

AbstractBackgroundThe Everyday Cognition scale (ECog) is an informant‐rated questionnaire of cognitive and functional abilities. In recent years, it has been shown to be sensitive for the differentiation of older adults with mild cognitive impairment (MCI) (Farias et al, 2008; Russo et al, 2014), and to the diagnosis of neurodegenerative disease such as Alzheimer’s disease (Farias et al, 2020). However, little is known about its possible utility to predict MCI‐dementia progression in Alzheimer’s clinical syndrome (ACS).Method130 participants (63.8% females), with an average age of 75.27 (SD=5.91), and diagnosed with MCI, were assessed with a comprehensive battery of neuropsychological tests and functional scales, including ECog. In the 2 years follow‐up assessment, 20 participants were diagnosed with ACS. Binary logistic regression and ROC curve statistical analyses were performed.ResultSignificant correlations (p&lt;.05) were found between ECog and neuropsychological tests such as Addenbrooke's Cognitive Examination‐Revised (ACE‐R), Mini‐Mental State Examination (MMSE), a Spanish version of the California Verbal Learning Test (CVLT), the Rey–Osterrieth complex figure test (ROCF) recall, the semantic verbal fluency and the Zoo map. Binary logistic regression results showed that ECog significantly explained the conversion to AD (p&lt;.05). Baseline scores for ECog were significantly higher in participants who developed ACS after two years (p&lt;.05). ROC curve showed a sensitivity of 80% and a specificity of 51% on the optimal cut‐off point (48.5) (AUC=0.69).ConclusionFunctional ability is highly related to cognitive domains. The ECog scale is an useful instrument for the early detection of MCI patients with high risk to develop ACS.

Resting State Networks Related to the Maintenance of Good Cognitive Performance During Healthy Aging.

Purpose: Maintenance of cognitive performance is important for healthy aging. This study aims to elucidate the relationship between brain networks and cognitive function in subjects maintaining relatively good cognitive performance.Methods: A total of 120 subjects, with equal number of participants from each age group between 20 and 70 years, were included in this study. Only participants with Addenbrooke’s Cognitive Examination – Revised (ACE-R) total score greater than 83 were included. Anatomical T1-weighted MR images and resting-state functional MR images (rsfMRIs) were taken from all participants using a 3-tesla MRI scanner. After preprocessing, several factors associated with age including the ACE-R total score, scores of five domains, sub-scores of ACE-R, and brain volumes were tested. Morphometric changes associated with age were analyzed using voxel based morphometry (VBM) and changes in resting state networks (RSNs) were examined using dual regression analysis.Results: Significant negative correlations with age were seen in the total gray matter volume (GMV, r = −0.58), and in the memory, attention, and visuospatial domains. Among the different sub-scores, the score of the delayed recall (DR) showed the highest negative correlation with age (r = −0.55, p < 0.001). In VBM analysis, widespread regions demonstrated negative correlation with age, but none with any of the cognitive scores. Quadratic approximations of cognitive scores as functions of age showed relatively delayed decline compared to total GMV loss. In dual regression analysis, some cognitive networks, including the dorsal default mode network, the lateral dorsal attention network, the right / left executive control network, the posterior salience network, and the language network, did not demonstrate negative correlation with age. Some regions in the sensorimotor networks showed positive correlation with the DR, memory, and fluency scores.Conclusion: Some domains of the cognitive test did not correlate with age, and even the highly correlated sub-scores such as the DR score, showed delayed decline compared to the loss of total GMV. Some RSNs, especially involving cognitive control regions, were relatively maintained with age. Furthermore, the scores of memory, fluency, and the DR were correlated with the within-network functional connectivity values of the sensorimotor network, which supported the importance of exercise for maintenance of cognition.

Language Decline Characterizes Amnestic Mild Cognitive Impairment Independent of Cognitive Decline.

Purpose This research investigated the nature of cognitive decline in prodromal Alzheimer's disease (AD), particularly in mild cognitive impairment, amnestic type (aMCI). We assessed language in aMCI as compared with healthy aging (HA) and healthy young (HY) with new psycholinguistic assessment of complex sentences, and we tested the degree to which deficits on this language measure relate to performance in other general cognitive domains such as memory. Method Sixty-one individuals with aMCI were compared with 24 HA and 10 HY adults on a psycholinguistic measure of complex sentence production (relative clauses). In addition, HA, HY, and a subset of the aMCI participants (n = 22) were also tested on a multidomain cognitive screen, the Addenbrooke's Cognitive Examination-Revised (ACE-R), and on a verbal working memory Brown-Peterson (BP) test. General and generalized linear mixed models were used to test psycholinguistic results and to test whether ACE-R and BP performance predicted performance on the psycholinguistic test similarly in the aMCI and HA groups. Results On the psycholinguistic measure, sentence imitation was significantly deficited in aMCI in comparison with that in HA and HY. Experimental factorial designs revealed that individuals with aMCI had particular difficulty repeating sentences that especially challenged syntax-semantics integration. As expected, the aMCI group also performed significantly below the HY and HA groups on the ACE-R. Neither the ACE-R Memory subtest nor the BP total scores predicted performance on the psycholinguistic task for either the aMCI or the HA group. However, the ACE-R total score significantly predicted psycholinguistic task performance, with increased ACE-R performance predicting increased psycholinguistic task performance only for the HA group, not for the aMCI group. Conclusions Results suggest a selective deterioration in language in aMCI, specifically a weakening of syntax-semantics integration in complex sentence processing, and a general independence of this language deficit and memory decline. Results cohere with previous assessments of the nature of difficulty in complex sentence formation in aMCI. We argue that clinical screening for prodromal AD can be strengthened by supplementary testing of language, as well as memory, and extended evaluation of strength of their relation.

The beneficial effect of physical activity on cognitive function in community-dwelling older persons with locomotive syndrome

BackgroundCognitive decline is closely related to motor decline. Locomotive syndrome (LS) is defined as a state associated with a high risk of requiring support because of locomotive organ disorders, and can be evaluated using a questionnaire. This study aimed to clarify the effectiveness of daily goal-targeted exercise on cognitive function in two different populations classified by scores on the Locomo 25 questionnaire.MethodsSeventy community-dwelling older people who participated in a 13-week health class were divided into two populations based on Locomo 25 scores: <7 (non-LS) and ≥7 (LS). Participants were presented with a daily target steps and worked towards that goal. Cognitive function was evaluated using the Japanese version of Addenbrooke’s Cognitive Examination-Revised (ACE-R). Average daily physical activity (exercise [Ex]) for 13 weeks was measured using a portable activity meter. Depression status was assessed using the Geriatric Depression Scale (GDS-15).ResultsNo significant differences were observed in age, years of education, body mass index, smooth muscle mass index, GDS-15 scores, or ACE-R scores between the non-LS and LS populations. Multiple logistic regression analysis showed that Ex (odds ratio = 5.01, p = 0.002) for 13 weeks was significantly associated with increased cognitive function in the LS population. The Ex threshold for the increase in cognitive function based on receiver operating curve analysis was 2.29 metabolic equivalents of task (METs) × h (METs · h/day) (p = 0.047) in the LS population. After 13 weeks, ACE-R scores were significantly higher in the Ex ≥ 2.29 than in the Ex < 2.29 METs · h/day group (p = 0.024, ηp2 = 0.241) in the LS population based on two-way analysis of covariance. Furthermore, a significant increase in the ACE-R memory domain was seen in the Ex ≥ 2.29 group (p = 0.035, ηp2 = 0.213).ConclusionsThese results suggest that Ex ≥ 2.29 METs · h/day is important for improving cognitive function in LS populations.