Addenbrooke's Cognitive Examination III Research Articles

Addenbrooke's cognitive examination III: diagnostic utility for detecting mild cognitive impairment and dementia in Parkinson's disease.

Cognitive deficit in Parkinson disease (PD) is an important cause of functional disability in these patients and early detection, with sensitive instruments, can contribute to longitudinal monitoring. To investigate the diagnostic accuracy, sensitivity, and specificity of the Addenbrooke's Cognitive Examination-III in patients with PD, using the comprehensive neuropsychological battery as reference method. Cross-sectional, observational, case-control study. rehabilitation service. A total of 150 patients and 60 healthy controls matched for age, sex, and education. For level I assessment, Addenbrooke Cognitive Examination (ACE-III) was used. Level II assessment used a comprehensive neuropsychological battery of standardized tests for this population. All patients remained in on-state during the study. The diagnostic accuracy of the battery was investigated through the receiver operating characteristic (ROC) analysis. The clinical group was divided into 3 subgroups: normal cognition in Parkinson's disease (NC-PD-16%), mild cognitive impairment due to Parkinson's disease (MCI-PD-69.33%), and dementia due to Parkinson's disease (D-PD-14.66%). ACE-III optimal cutoff scores for detecting MCI-PD and D-PD were 85/100 (sensitivity 58.65%, specificity 60%) and 81/100 points (sensitivity 77.27%, specificity 78.33%), respectively. Age was inversely associated with the performance of the scores (totals and domains of the ACE-III), while the level of education had a significantly positive correlation in the performance of these scores. ACE-III is a useful battery for assessing the cognitive domains and to differentiate individuals with MCI-PD and D-PD from healthy controls. Future research, in a community setting, is necessary to provide discriminatory capacity of ACE-III in the different severities of dementia.

The effects of mindfulness-based training in virtual reality on psychotic symptoms, mood and cognitive functioning - a pilot study.

Virtual reality (VR) is growing in popularity in treating various psychiatric disorders, including psychotic ones. However, no studies have been published on mindfulness interventions aided by virtual reality in psychotic patients to date. 25 patients with schizophrenia or schizoaffective disorder were assessed at three time points with 4-week intervals using the six-item Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), and the Addenbrooke's Cognitive Examination III (ACE-III). Additionally, the intensity of seven emotions was rated using the Visual Analog Scale (VAS) before and after each training session. The subjects achieved a significant reduction in symptom severity after completing mindfulness training. This was reflected by the PANSS-6 total score, as well as by the subscales for negative and positive symptoms. A significant increase in cognitive functioning (ACE-III scores) was also found. No significant changes in these measures were observed when only the standard intervention was used. Our study indicates good feasibility of the developed mindfulness intervention in VR in schizophrenic patients. The results indicate potential benefits in terms of lessening of the symptoms and improvement in cognition.

Adaptation and Validation of Addenbrooke's Cognitive Examination-III in Bengali for Screening MCI and Dementia.

Bengali, the 6th most spoken language globally with 268 million speakers, demands a culturally appropriate tool for screening any cognitive compromise in this population. Addenbrooke Cognitive Examination-III (ACE-III) is a standardized tool used for screening and/or diagnostic purpose worldwide. The aim of the present study was to adapt and validate ACE-III into Bengali language. The ACE-III UK Version A (2012) was adapted with linguistically and culturally appropriate items and validated on Bengali speakers. The participants consisted of 40 dementia and 22 Mild Cognitive Impairment (MCI) patients and 120 healthy-controls. Reliability and validity were examined. Discriminant function analysis was done. Sensitivity and specificity were evaluated and optimum cut-offs were established for MCI and dementia. Both sensitivity and specificity of ACE-III-Bengali of identifying dementia was 1; sensitivity for MCI ranged from 0.83 to 1, specificity from 0.76 to 1. Discriminant function analysis showed a significant difference in all domains of ACE-III-Bengali between healthy individuals and persons with neurocognitive impairment. Separate optimum ACE-III-Bengali cut-off scores were established according to level of education. For low education (<Class 10) cut-off was 83 for dementia and 86 for MCI, whereas, for high education (≥Class 10) it was 85 and 88 for dementia and MCI, respectively. The area under curve for distinguishing dementia and MCI ranged from 0.949 to 0.955. The ACE-III-Bengali is found to have high diagnostic accuracy in identifying dementia and MCI in the Bengali population.

Picture-naming test for a linguistically diverse population with cognitive impairment and dementia.

Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. In this cross-sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture-naming performance in patients with MCI and dementia. A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR-PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross-cultural adaptation guidelines and item-wise factor analysis and correlations established separately across five languages, the final version of the ICMR-PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR-PNT were examined, and sensitivity and specificity were examined. The ICMR-PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F2, 615 = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR-PNT scores and a positive correlation between Addenbrooke's Cognitive Examination-III (ACE-III) and ICMR-PNT scores in control and patient groups. The ICMR-PNT was developed by following cross-cultural adaptation guidelines and establishing correlations using item-wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context. What is already known on this subject Picture-naming evaluates language impairment linked to naming difficulties due to semantic memory, lexical retrieval or perceptual disturbances. As a result, picture naming tests (PNTs) play an important role in the diagnosis of dementia. In a heterogeneous population such as India, there is a need for a common PNT that can be used across the wide range of languages. What this study adds to existing knowledge PNTs such as the Boston Naming Test (BNT) were developed for the educated, mostly English-speaking, Western populations and are not appropriate for use in an Indian context. To overcome this challenge, a PNTwas harmonized in five Indian languages (Hindi, Bengali, Telugu, Kannada and Malayalam) and we report the patterns of naming difficulty in patients with MCI and dementia. The ICMR-PNT demonstrated good diagnostic accuracy when distinguishing patients with mild to moderate dementia from cognitively normal individuals. What are the potential or actual clinical implications of this work? With the growing number of persons suffering from Alzheimer's disease and other forms of dementia around the world, its critical to have culturally and linguistically relevant naming tests and diagnosis. This validated ICMR-PNT can be used widely as a clinical tool to diagnose dementia and harmonize research efforts across diverse populations.

Improving Diagnosis of Functional Cognitive Impairment in Younger Adults in Primary Care: Validation of Cognitive Screening Tools and the 4-Item Geriatric Depression Scale.

Cognitive decline is classically attributed to organic causes such as dementia; however, depression can play a role in cognitive decline. To evaluate cognitive screening tools and the 4-item Geriatric Depression Scale (GDS-4) for use in primary care to distinguish cognitive decline secondary to depression. Clinical data collected over 2.5 years for assessed patients in a secondary clinical service for younger adults. Cognitive screening tools (General Practitioner Assessment of Cognition, Addenbrooke's Cognitive Examination-III, Rowland Universal Dementia Assessment Scale, Salzburg Dementia Test Prediction) and GDS-4 were analyzed for their accuracy to differentiate patients with cognitive decline due to depression from those with subjective cognitive complaints. 180 young adults seen in a memory clinic setting (< 65 years) were included. These individuals either had a diagnosis of depression (n = 46) or no cognitive impairment on assessment (n = 134) despite having subjective cognitive complaints. All used cognitive tools had poor accuracy in differentiating cognitive decline secondary to depression from subjective cognitive complaints. The GDS-4 alone, however, was able to differentiate with high accuracy (AUC = 0.818) individuals who had cognitive problems secondary to depression. Cognitive screening tools used alone are ineffective in discriminating cognitive decline secondary to depression. Incorporating the GDS-4 into the screening process by primary practitioners could facilitate early identification and treatment of depression in younger people, avoiding unnecessary referrals memory services.

Suspected Dementia in Young Adults: Cognitive Screening Tools for Use in Primary Care.

Memory complaints are frequent among young adults presenting in general practice. Many of them will have reversable, functional cognitive impairment that can easily be mistaken for dementia. Its accurate and timely identification is warranted to prevent further escalation to overt dementia syndrome. To evaluate the recommended primary care screening cognitive tools for dementia for use in younger people. 2.5 years clinical data were collected during the course of ongoing patient care for all assessed face-to-face patients in a secondary care memory service for younger adults. Cognitive screening and assessment tests used in primary [General Practice Assessment of Cognition (GPCOG)] and secondary [Addenbrooke's Cognitive Examination-III (ACE-III), Rowland Universal Dementia Assessment Scale (RUDAS), Salzburg Dementia Test Prediction (SDTP)] care were analyzed for their accuracy to identify dementia and memory complaints. Area under the curve in receiver operating characteristic curves was used to measure predictive value of tests for a clinical diagnosis of dementia. 348 young adults were assessed for cognitive impairment. Following comprehensive Memory Clinic assessments, 241 (69.25%) were diagnosed with memory complaints in the absence of relevant neuropathology and 107 with dementia. GPCOG, especially the informant part, and RUDAS had low accuracy to identify dementia (AUC = 0.465 and AUC = 0.698, respectively). In contrast, ACE-III and SDTP demonstrated the highest accuracy (AUC = 0.799 and AUC = 0.809/0.817, respectively). Dementia screening in younger people will benefit from SDTP incorporated as part of the screening cognitive toolset. The national guidance on dementia screening tools, diagnostic pathways, and management should also refer to younger adults.

Longitudinal changes in behaviour, mood and functional capacity in the primary progressive aphasia variants.

Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterised by a progressive decline in speech and language functions. Deficits in behaviour, mood and functional capacity are reported in PPA but are less well understood. This study examined the PPA variants' profiles on these domains at initial presentation and over time and evaluated their relations to overall cognitive ability. Behaviour, mood and functional capacity were measured annually (over ~6years) in 145 individuals diagnosed with PPA (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA] and 60 semantic variants [sv-PPA]) using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Overall cognition was assessed annually with the Addenbrooke's Cognitive Examination-III. Distinct profiles were observed across PPA syndromes. Notably, sv-PPA carers reported greater behavioural, eating and motivational disturbances than the other PPA variants throughout the disease course. Reported memory problems were also greater in sv-PPA and lv-PPA than in nfv-PPA across all time points. These disturbances occurred in the context of the sv-PPA group demonstrating a slower rate of cognitive decline than the lv-PPA group and a parallel rate to that found in the nfv-PPA group. Associations between overall cognition and the CBI-R domains were trivial at baseline assessment; however, distinct profiles emerged when mapping each syndrome's overall cognitive decline with their behavioural, mood and functional trajectories. Our findings demonstrate that the evolving behaviour, mood and functional capacity profiles of the PPA variants are distinct and extend beyond the primary disorder of language. These findings have important implications for clinical management and caregiver education in PPA.

Validation of a modified Chinese version of Mini-Addenbrooke's Cognitive Examination for detecting mild cognitive impairment.

BackgroundFor detecting mild cognitive impairment (MCI), brief cognitive screening tools are increasingly required for the advantage of time saving and no need for special equipment or trained raters. We aimed to develop a modified Chinese version of Mini‐Addenbrooke's Cognitive Examination (C‐MACE) and further evaluate its validation in detecting MCI.MethodsA total of 716 individuals aged from 50 to 90 years old were recruited, including 431 cognitively normal controls (NC) and 285 individuals with MCI. The effect size of Cramer's V was used to explore which items in the Chinese version of Addenbrooke's Cognitive Examination‐III (ACE‐III‐CV) best associated with MCI and to form the C‐MACE. Receiver operating characteristic (ROC) analyses were carried out to explore the ability of C‐MACE, ACE‐III‐CV, Chinese version of Montreal Cognitive Assessment‐Basic (MoCA‐BC), and Mini‐Mental State Examination (MMSE) in discriminating MCI from NC.ResultsFive items with greatest effect sizes of Cramer's V were selected from ACE‐III‐CV to form the C‐MACE: Memory Immediate Recall, Memory Delayed Recall, Memory Recognition, Verbal Fluency Animal and Language Naming. With a total score of 38, the C‐MACE had a satisfactory classification accuracy in detecting MCI (area under the ROC curve, AUC = 0.892), superior to MMSE (AUC = 0.782) and comparable to ACE‐III‐CV (AUC = 0.901) and MoCA‐BC (AUC = 0.916). In the subgroup of Age > 70 years, Education ≤ 12 years, the C‐MACE got a highest classification accuracy (AUC = 0.958) for detecting MCI.ConclusionIn the Chinese‐speaking population, C‐MACE derived from ACE‐III‐CV may identify MCI with a good classification accuracy, especially in aged people with low education.

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study.

BackgroundGPs often report using clinical judgment to diagnose dementia.AimTo investigate the accuracy of GPs’ clinical judgment for the diagnosis of dementia.Design & settingDiagnostic test accuracy study, recruiting from 21 practices around Bristol, UK.MethodThe clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia.ResultsA total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75–84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12–36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65–87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70–79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups.ConclusionA GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.

Cognitive impairment in type 2 diabetes and its impact on daily living and self-care: A case - Control study in Kanpur, North India

Background and aimThere have been few studies from South Asia which have shown increased prevalence of cognitive impairment (CI) in diabetes. CI may further hamper self-care and independent living. The present study was designed to evaluate the impairment in cognition and self-care among patients with type 2 diabetes. Materials and methodsWe assessed cognitive function in 54 type 2 diabetes participants and compared them with 54 healthy controls, using Addenbrooke's Cognitive Examination-III (ACE-III) test. Assessment of self-care was done by using Katz index of independence in activities of daily living and revised Summary of Diabetes Self-Care Activities (SDSCA) measures. ResultsThe mean age and HbA1c of cases was 64.5 ± 5.3 years and 8.8 ± 2.5%, respectively. Cognitive impairment was more prevalent among type 2 diabetes participants (Odds ratio 31.3, CI: 10–100, P < 0.0001) with mean Addenbrooke's score of 74.9 ± 11.2 compared to 86.9 ± 5.3 in controls (t-statistic = 7.09, 95% CI: 8.6 to 15.3, P < 0.0001). The adjusted Odds ratio for CI was 9.46 after adjustment for hypertension. All the sub-domains of cognition were affected. The burden of CI was more among females and in those with poor glycemic control (HbA1C > 7.5%) when compared to controls. The diabetic participants with CI had poor SDSCA scores compared to those with no CI. ConclusionDiabetes may cause CI and is related to poor self-care. Considering a high prevalence of CI in diabetes, cognitive assessment should be a part of overall evaluation. ACE-III is a sensitive and convenient tool for this purpose.

Adaption and preliminary validation of the Addenbrooke's Cognitive Examination-III as a screening test for mild cognitive impairment and dementia in hearing-impaired individuals.

A large proportion of older adults assessed for cognitive impairment likely have hearing loss, potentially affecting accuracy of cognitive performance estimations. This study aimed to develop a hearing-impaired version of the Addenbrooke's Cognitive Examination-III (HI-ACE-III) and to assess whether the HI-ACE-III can accurately distinguish people with mild cognitive impairment (MCI) and dementia from cognitively intact controls. The HI-ACE-III was developed by converting verbal instructions into a visual, timed PowerPoint presentation. Seventy-four participants over the age of 60 years were classified into three groups: 29 had MCI, 15 had mild to moderate dementia and 30 were cognitively intact controls. Receiver operating characteristic (ROC) curves were graphed to test screening accuracy. Concurrent validity was examined through correlations between HI-ACE-III domain scores and relevant, visually presented standardized neuropsychological measures. ROC analysis for dementia revealed an area under the curve (AUC) of 0.99, achieving excellent sensitivity (100%) and good specificity (93.3%) at an optimum cut-off of <87. The AUC for MCI was 0.86, achieving reasonable sensitivity (75.9%) and good specificity (86.7%) at an optimum cut-off of <92. HI-ACE-III subtests shared anticipated and statistically significant correlations with established measures of cognitive functioning. Internal consistency of the HI-ACE-III was excellent as verified with Cronbach's alpha (α=0.904). Preliminarily, the HI-ACE-III showed good reliability, validity and screening utility for MCI and dementia in older adults in a hearing-impairment context. The adapted HI-ACE-III may offer accurate and reliable indication of cognitive performance, supporting timely diagnosis and research examining links between hearing loss and cognitive decline.

Longitudinal cognitive and functional changes in primary progressive aphasia.

The variants of primary progressive aphasia (PPA) are predominantly diagnosed on the basis of specific profiles of language impairments. Deficits in other cognitive domains and their evolution over time are less well documented. This study examined the cognitive profiles of the PPA variants over time and determined the contribution of cognition on functional capacity. Longitudinal performance on the Addenbrooke's Cognitive Examination-III (ACE-III) total and cognitive subdomains were investigated in 147 PPA individuals (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA], and 62 semantic variants [sv-PPA]). The relative contribution of ACE-III subdomain scores to overall functional capacity over time was identified using mixed and hierarchical regression modelling. The annual rate of global ACE-III decline was twice that in lv-PPA than in nfv-PPA and sv-PPA, despite lv-PPA performing intermediate to the other variants at baseline assessment. Notably, attention and visuospatial subdomains declined faster in lv-PPA than in nfv-PPA and sv-PPA; and memory impairment was more severe in lv-PPA than in nfv-PPA at all time points. Functional decline was comparable across PPA variants; however, the contribution of cognition on functional capacity varied across variants and over time. The cognitive profiles of the PPA variants are distinct at baseline and over time. Crucially, cognitive decline in lv-PPA was more widespread and pervasive than in nfv-PPA and sv-PPA. Our findings also demonstrate the complex interplay between cognition and functional capacity. This study underscores the importance of routinely assessing cognition and functional capacity in PPA to improve diagnostic accuracy and provide targeted support services.

Relationship Between Neural Cell Adhesion Molecule-1 and Cognitive Functioning in Schizophrenia Spectrum Disorder.

Abnormal synaptic plasticity leads to cognitive impairment in schizophrenia. Markers of synaptic plasticity are known to be altered in schizophrenia, but there are limited data available about neural cell adhesion molecule-1 (NCAM-1) levels and its association with cognitive functions in schizophrenia. The objective of the study was to analyze NCAM-1 levels and its association with various cognitive domains in schizophrenia. One hundred and seventy-six schizophrenia cases and 176 controls were recruited for the study. Serum NCAM-1 levels were analysed in both the groups. Cognitive examination was performed using Addenbrooke cognitive examination-III (ACE-III) and disease severity was assessed using Positive and negative symptoms scale (PANSS). Serum NCAM-1 levels were elevated in schizophrenia cases (p = 0.006) compared to controls. NCAM-1 was positively associated with attention (r = 0.196, p = 0.009), language (r = 0.192, p = 0.011), visuospatial abilities (r = 0.207, p = 0.006) and total ACE-III score (r = 0.189, p = 0.012). We conclude that elevated levels of NCAM-1 are associated with better cognitive functioning in schizophrenia.

Rehabilitation outcomes of persons with severe traumatic brain injury: A cross-sectional survey

Background: The recent literature regarding functional outcomes and the effectiveness of rehabilitation for persons with severe traumatic brain injury (TBI) suggests that these patients are capable of significant functional recovery over a period of months to years after injury. However, the researches concerning this are very limited. Therefore, this study has been conducted to study the rehabilitation outcomes in persons with severe TBI. Objective: To study the rehabilitation outcomes of persons with severe TBI who have completed 8–16 weeks of residential, postacute rehabilitation. Study Design: A cross-sectional survey study design was chosen. Methods: This study was done in Rehabilitation center of Christian Medical College, Vellore. Forty-two patients with severe TBI who completed rehabilitation from January 2014 to November 2016 were selected for this study. Usual care was provided to the participants in a transdisciplinary service delivery model. The Wessex Head Injury Matrix (WHIM), Coma Recovery Scale Revised (CRS-R), Addenbrooke's Cognitive Examination-III (ACE-III), Modified Barthel Index (MBI), Disability Rating Scale, and Community reintegration Questionnaire (CIQ) were used based on the International Classification of Functioning framework to assess the functional gains achieved during and after the rehabilitation process that include admission, discharge, and follow-up. Results: Significant improvements in CRS-R (confidence interval [CI]: −2.879 to − 0.741; P = 0.000), WHIM (CI: −10.42 to − 2.96; P = 0.000), ACE-III (CI: −8.23 to − 26.15; P = 0.000), and MBI (CI: −15.32 to − 39.18; P = 0.000) were found from admission to discharge. A significant change in disability was observed at discharge (CI: 3.79–6.07; P = 0.000) and at follow-up (CI: 0.87–1.75; P = 0.000). Marital status was influencing the CRS-R (CI: −0.82–6.79; P = 0.011) and the WHIM scores (CI: −0.619–14.12; P = 0.047). The mean follow-up CIQ score was 9.77 (standard deviation = 7.01). Only socioeconomic status was influencing CIQ (CI: 2.90–12.98; P = 0.003). Conclusion: Participants showed significant functional gains after the residential, post-acute rehabilitation program. These functional gains were not reflected in their community reintegration.

Cognitive dysfunction in first-episode schizophrenia and its correlation with negative symptoms and insight.

Background:Cognitive dysfunction in schizophrenia is a well-known feature and can adversely affect the patient participation in treatment and rehabilitation. Studies have shown its relationship to the severity of negative symptoms and level of insight also. Not many Indian studies are available on this in first-episode schizophrenia, and hence, this study was undertaken.Materials and Methods:Eight-five cases of first-episode schizophrenia fulfilling inclusion criteria were included in the study after ethical clearance, informed consent, and stabilization of acute symptoms. All were assessed using psychosocial pro forma, Addenbrooke's Cognitive Examination-III Scale, positive and negative syndrome scale, and schedule for the assessment of insight. Data analysis was done using Statistical Package for Social Sciences Version 20:0.Results:Cognitive dysfunction was seen in 40% of patients. Maximum dysfunction was in the memory domain followed by fluency domain and language domain was relatively well preserved. A significant negative correlation was observed between cognitive function and negative symptoms, but a significant positive correlation was seen with insight.Conclusion:Cognitive dysfunction is present in a significant proportion of schizophrenia in the first episode itself. Early assessment will facilitate appropriate interventions directed at insight and cognitive rehabilitation.

Association of hyperglycaemia and hyperlipidaemia with cognitive dysfunction in schizophrenia spectrum disorder

The objective of the study was to investigate the association of blood glucose and lipid profile parameters with cognitive impairment in schizophrenia. A total of 200 schizophrenia patients and 169 controls were enrolled in the study. Blood glucose and lipid profile were estimated in all the subjects. Cognition was assessed using Addenbrooke cognitive examination-III (ACE-III). Fasting glucose (p ≤ .001) and triacylglycerol (p = .018) were increased and HDL-Cholesterol (p ≤ .001), was reduced in schizophrenia. Glucose (r = −0.158, p = .026), total cholesterol (r = −0.249, p = .0001) and triacylglycerol (r = −0.168, p = .018) was negatively correlated with total ACE III score. Triacylglycerol (p = .041) was elevated in cases with mild cognitive impairment. Plasma glucose, total cholesterol and triacylglycerol were associated with various cognitive domains suggesting that hyperglycaemia and hyperlipidaemia might increase the risk of cognitive impairment in schizophrenia.

Psychometric properties of the Addenbrooke's Cognitive Examination III (ACE-III) for the detection of dementia

The Addenbrooke's Cognitive Examination III (ACE-III) is widely used for evaluation of dementia. To assess the psychometric properties of ACE-III, analyzing its factor structure, its reliability (from an Item Response Theory [TRI] model) and its diagnostic usefulness. We studied 1101 older people without cognitive impairment and 63 currently having a diagnosis and receiving treatment for dementia. The presence of two factors for the Attention subscale (Orientation and Attention, separately) was suggested. The factorial analysis showed adequate adjustment in all the subscales, except for the new Attention subscale. In the TRI analysis, the Attention subscale presented a greater number of items with lack of fit compared to the other subscales. Using a proposed threshold of 66 points or less to identify cognitive impairment related to dementia, a sensitivity of 0.97 and specificity of 0.81 was obtained. ACE-III is a valid, reliable, and useful measure for the clinical detection of dementia. The combined use of Orientation and Memory subscales is proposed as an alternative and time-saving ACE-III indicator.

Matrix metalloproteinase-9 increases the risk of cognitive impairment in schizophrenia

Purpose of the article Synaptic plasticity is known to play role in pathogenesis of schizophrenia. Cognitive impairment is one of the complications of schizophrenia, leading to poor quality of life. Matrix metalloprotease-9 (MMP-9) and neurotrophin-3 (NT-3) are markers of synaptic plasticity, widely investigated in neuropsychiatric disorders. The objective of the study was to investigate the levels of MMP-9 and NT-3 and their association with cognitive impairment in schizophrenia. Material and methods 124 schizophrenia patients and 124 controls were enrolled in the study. MMP-9 and NT-3 were estimated in both the groups using ELISA. Cognition was assessed using Addenbrooke cognitive examination-III (ACE-III) and disease severity was assessed using PANSS. Results MMP-9 (p = .003) and NT −3 (p < .001) were found to be elevated in schizophrenia cases compared to controls. There was significant association of MMP-9 with fluency (r = −0.195, p = .030), language (r = −0.196, p = .029) and total ACE-III scores (r = −0.197, p = .029). Also we observed that MMP-9 increases the risk of cognitive impairment in schizophrenia patients (OR = 2.509, CI= 1.215 − 5.18, p = .013). Conclusion MMP-9 and NT-3 are elevated in schizophrenia. MMP-9 was associated with fluency and language component of cognition and increases the risk of cognitive impairment in schizophrenia.

Increasing light physical activity helps to maintain cognitive function among the community-dwelling oldest old population: a cross-sectional study using actigraph from the Arakawa 85+ study.

To investigate the influence of replacing sedentary time with physical activity on cognitive function using an isotemporal substitution model in a population of community-dwelling oldest old. This cross-sectional study included residents of the Arakawa ward, Tokyo, who were part of a prospective cohort from the Arakawa 85+ study. We measured physical activity in 136 participants using a triaxial actigraph. Cognitive function was measured using the Addenbrooke's Cognitive Examination-III and participants were divided into a "cognitive decline group" (Addenbrooke's Cognitive Examination-III ≤88) and "cognitive maintain group" (Addenbrooke's Cognitive Examination-III ≥89). Physical activity was divided into three categories: sedentary behavior (≤1.5 metabolic equivalents), light physical activity (>1.5 to <3.0 metabolic equivalents), and moderate-to-vigorous physical activity (≥3 metabolic equivalents). Using an isotemporal substitution approach, we applied multiple logistic regression analysis to demonstrate the association between cognitive function and replacing 30 min/day of sedentary behavior with an equal period of light physical activity. Covariates included age, education and the Center for Epidemiologic Studies Depression Scale. Our findings showed that in men, replacing 30 min of sedentary behavior per day with light physical activity was associated with a 1.47-fold increase in the odds of maintaining cognitive function. An association between physical activity and cognitive function was not observed in female participants. Our results indicate that substituting sedentary behavior with light physical activity could be helpful in maintaining cognitive function in community-dwelling oldest old men. These results highlight the importance of behavioral changes to promote cognition. Geriatr Gerontol Int 2020; 20: 773-778.

Long-Chain Omega-3 Fatty Acid Intake Is Associated with Age but not Cognitive Performance in an Older Australian Sample.

Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function. Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke's Cognitive Examination-III. Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01 - 0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 - 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function. LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function.