Addenbrooke's Cognitive Examination-Revised Research Articles

Actively station: Effects on global cognition of mature adults and healthy elderly program using eletronic games.

Studies show that aging is accompanied by decline in cognitive functions but also indicate that interventions, such as training on electronic games, can enhance performance and promote maintenance of cognitive abilities in healthy older adults.ObjectiveTo investigate the effects of an electronic game program, called Actively Station, on the performance of global cognition of adults aged over 50 years.Methods124 mature and elderly adults enrolled in the "Actively Station" cognitive stimulation program of São Caetano do Sul City, in the State of São Paulo, participated in training for learning of electronic games. Participants were divided into two groups: training group (TG) n=102 and control group (CG) n=22. Protocol: a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination Revised (ACE-R), the Memory Complaint Questionnaire (MAC-Q), the scale of frequency of forgetfulness, the Geriatric Depression Scale (GDS-15), the Geriatric Anxiety Inventory (GAI), the Global Satisfaction with Life Scale, and two scales on learning in the training.ResultsThe cognitive performance of the TG improved significantly after the program, particularly in the domains of language and memory, and there was a decrease on the anxiety index and frequency of memory complaints, when compared to the CG.ConclusionThese findings suggest that the acquisition of new knowledge and the use of new stimuli, such as electronic games, can promote improvements in cognition and mood and reduce the frequency of memory complaints.

Addenbrooke's cognitive examination-revised: normative and accuracy data for seniors with heterogeneous educational level in Brazil.

Several cognitive tools have been developed aiming to diagnose dementia. The cognitive battery Addenbrooke's Cognitive Examination - Revised (ACE-R) has been used to detect cognitive impairment; however, there are few studies including samples with low education. The aim of the study was to provide ACE-R norms for seniors within a lower education, including illiterates. An additional aim was to examine the accuracy of the ACE-R to detect dementia and cognitive impairment no dementia (CIND). Data originated from an epidemiological study conducted in the municipality of Tremembé, Brazil. The Brazilian version of ACE-R was applied as part of the cognitive assessment in all participants. Of the 630 participants, 385 were classified as cognitively normal (CN) and were included in the normative data set, 110 individuals were diagnosed with dementia, and 135 were classified as having CIND. ACE-R norms were provided with the sample stratified into age and education bands. ACE-R total scores varied significantly according to age, education, and sex. To distinguish CN from dementia, a cut-off of 64 points was established (sensitivity 91%, specificity 76%) and to differentiate CN from CIND the best cut-off was 69 points (sensitivity 73%, specificity 65%). Cut-off scores varied according to the educational level. This study offers normative and accuracy parameters for seniors with lower education and it should expand the use of the ACE-R for this population segment.

Social and nonsocial cognitive functions in patients with schizophrenia: A comparative neuropsychological and neurophysiological study

BackgroundPatients with schizophrenia suffer from cognitive deficits in seven domains in addition to social cognition. P300 latency and amplitude have been linked in these patients to the basic cognitive deficits.ObjectivesComparing patients suffering from schizophrenia with matched healthy subjects as regards auditory event related potential tests as measured by P300.Subjects and methodsFifty-two subjects were divided into 2 groups: group (A): 27 patients with schizophrenia according to the diagnostic and statistical manual of mental disorders-text revised (DSM-IV TR). Those with current substance use, psychiatric disorders or organic disorders were excluded. Group (B): 25 healthy control subjects with negative history of substance and psychiatric disorders. Patients were assessed using Positive and Negative Symptom Scale (PANSS) for severity of psychotic symptoms, Addenbrook's Cognitive Examination Revised (ACE-R) for basic cognitive, reading the mind in the eye test for social cognition, P300 and electro-encephalography (EEG)ResultsThe two groups were different significantly in ACE total and its subtests measuring attention-orientation, memory, language, visuospatial and reading the mind in the eye test for social cognition scores with patients showing lower scores (P = 0.000, 0.012, 0.000, 0.038, 0.041 and 0.001 respectively). Control group had higher amplitude of P300 and shorter latency than patients (P = 0.003 and 0.005 respectively). P300 amplitude correlated positively with visuospatial memory (P = 0.015). PANSS general pathology scale correlated positively with duration of untreated psychosis (P = 0.029) and with fluency (P = 0.047).ConclusionPatients with schizophrenia differ from controls in P300.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Arterial spin labelling detects posterior cortical hypoperfusion in non-demented patients with Parkinson’s disease

While previous studies suggested that perfusion abnormalities in Parkinson's disease (PD) are driven by dementia, our study aimed to identify perfusion underpinning of cognitive alteration in non-demented PD patients. Cerebral blood flow was measured using arterial spin labelling (ASL) in 28 PD patients (age 65years±9.9 SD) and 16 age-matched healthy controls (HC) (age 65years±7.8 SD), who also underwent neurological and cognitive testing. The 3D pseudocontinuous ASL and T2-weighted scans from 22 PD patients and 16 HC were analysed in a voxel-wise manner using SPM8 software. Associations between the ASL values in volumes of interest (VOIs) and behavioural and cognitive measures were assessed by Spearman correlation analysis. Posterior cortical hypoperfusion was found in PD patients compared to HC in the left supramarginal gyrus/superior temporal gyrus (VOI1) and left posterior cingulate/precuneus (VOI2). Positive correlation was revealed between perfusion in the VOI2 and Addenbrooke's Cognitive Examination Revised (ACE-R) scores after filtering out the effect of age, levodopa equivalent dose (LED), and total intracranial volume (TIV) (R=0.51, p=0.04). Conversely, negative correlation between VOI1 and ACE-R was detected (R=-0.62, p=0.01) after regressing out the effects of motor impairment, age, LED, and TIV. In non-demented subjects with PD, blood flow abnormalities in precuneus/posterior cingulate were linked to the level of motor impairment and global cognitive performance. Oppositely, perfusion abnormalities in supramarginal gyrus might serve as a compensatory mechanism for brain degeneration and decreased cognitive performance.

Cognition and adaptive functioning in older people attending drug and alcohol services.

Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

Intensive versus Guideline Blood Pressure and Lipid Lowering in Patients with Previous Stroke: Main Results from the Pilot 'Prevention of Decline in Cognition after Stroke Trial' (PODCAST) Randomised Controlled Trial.

BackgroundStroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial.MethodsIn a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP) 125–170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg) or guideline (target SBP <140 mmHg) BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0–8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l) or guideline (target LDL-c <3.0 mmol/l) lipid lowering. The primary outcome was the Addenbrooke’s Cognitive Examination-Revised (ACE-R).ResultsWe enrolled 83 patients, mean age 74.0 (6.8) years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1–48). Mean BP was significantly reduced with intensive compared to guideline treatment (difference –10·6/–5·5 mmHg; p<0·01), as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference –0·54/–0·44 mmol/l; p<0·01). The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4), and lipid lowering 4.4 (95% CI -2.1 to 10.9). However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison.ConclusionIn patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted.Trial RegistrationISRCTN ISRCTN85562386

Nonmotor symptoms in primary adult-onset cervical dystonia and blepharospasm.

BackgroundThe nature and frequency of nonmotor symptoms in primary adult‐onset cervical dystonia (CD) and blepharospasm (BSP) patients in Chinese populations remain unknown.MethodsHamilton's Depression Scale (HAMD), Hamilton's Anxiety Scale (HAMA), Addenbrooke's Cognitive Examination Revised (ACE‐R), Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to evaluate NMS in 120 patients with primary focal adult‐onset dystonia (60 with BSP and 60 with CD) and 60 age‐, sex‐, and education level‐ matched healthy controls (HCs). Motor symptoms of BSP and CD patients were evaluated by Jankovic rating scale and Toronto Western Spasmodic Torticollis Rating Scale‐severity scale separately.ResultsTwenty patients had depression, and 29 patients had anxiety. The mean HAMD and HAMA scores were significantly higher in patient groups. Thirty‐six patients had cognitive decline based on the cut‐off score of 75. The total score and scores of each domain of ACE‐R were significantly lower in patient groups than that in HCs. Quality of sleep was impaired in patient groups, and patients with CD had worse quality of sleep than patients with BSP. Thirty‐three BSP patients and 43 CD patients suffered from sleep disorder separately. The frequency of excessive daytime sleepiness did not differ between patients and HCs. No significant correlation was found between NMS and motor severity in the two forms of dystonia.ConclusionsCurrent study suggests that NMS are prevalent in Chinese CD and BSP patients, and the motor severity of dystonia did not contribute to the severity of nonmotor symptoms. Assessment of nonmotor symptoms should be considered in clinical management of focal dystonia

Interictal epileptiform discharges were associated with poorer cognitive performance in adult epileptic patients

ObjectiveCognitive impairment is one of the major consequences of epilepsy and has been shown to reduce quality of life. Interictal epileptiform discharges (IEDs) were associated with poorer cognitive performance in children, and the aim of this study was to determine whether there was a similar association in adults. MethodsA prospective cohort of 167 seizure-free adult patients underwent EEG recording and extensive cognitive evaluations. Global cognition was evaluated using Addenbrooke’s Cognitive Examination-Revised (ACE-R), while sub-dimensions of cognition were evaluated using the Auditory Verbal Learning Test (AVLT), Trial Making Test (TMT)-A and -B, and the 5 constitutive subscales of ACE-R. ResultsPerformance in ACER, but not AVLT or TMT, was significantly lower in patients with general IEDs. Furthermore, the five subscale scores of ACE-R were significantly lower in patients with general IEDs, and verbal fluency and language scores contributed in a major way to the low scores. Stratified analysis showed that sleep-phase IEDs were also associated with lower performance in ACE-R and its subscales. Finally, non-rapid eye movement (NREM)-IEDs were found to be associated with visuospatial and memory impairment, and IEDs while awake, with poorer performance in TMT-B. SignificanceThe results of this study demonstrate that cognitive performance is associated with IEDs in adult epilepsy patients, and could serve as a springboard for further research into reducing IEDs to bring about better cognitive performance.

Beneficial Effects of Yogasanas and Pranayama in limiting the Cognitive decline in Type 2 Diabetes.

Out of many complications that were observed in type 2 diabetes, cognitive impairment is the most neglected. The aim of the present study is to assess the cognitive decline in type 2 diabetes and to observe the role of yogasanas and pranayama in ameliorating the cognitive decline. Sixty eight type 2 diabetic subjects were recruited in the study, 34 of them did specific yogasanas and pranayama (test group) for six months and the remaining age and sex matched 34 subjects were recruited as (control group) who were not on any specific exercise regimen. Glycaemic index was estimated by measuring the glycosylated haemoglobin (HbA1c) concentration with Bio-Rad apparatus and cognition was assessed by using Addenbrook's Cognitive Examination-Revised (ACE-R), which is a neuropsychological battery. Data was analysed with unpaired student t test. P value<0.05 is considered as statistically significant. Validity was assessed by receiver operating characteristics. Analysis of data indicated more cognitive scores in the test group when compared with the control group. In test group six months practice of yogasanas and pranayama has also significantly brought down the high glycaemic values which were observed in the control group. These findings allow the study to conclude that regular practice of yogasanas and pranayama has a beneficial effect on cognitive performance in type 2 diabetic subjects by stabilizing blood glucose.

Screening for Cognitive Impairments in Primary Blepharospasm.

BackgroundsStudies have reported that non-motor symptoms are an important component of primary dystonia. However, evidence supporting cognitive impairment in primary dystonia is limited and contradictory.MethodsWe applied the Chinese version of the Addenbrooke’s Cognitive Examination-Revised and the Mini-Mental State Examination (MMSE) to screen for cognitive impairment in patients with primary blepharospasm. In addition, we investigated the relationship between performance on the Addenbrooke’s Cognitive Examination-Revised and quality of life as measured by the Medical Outcomes Study 36-item Short-Form (SF36).ResultsThe study included 68 primary blepharospasm patients and 68 controls matched by age, sex and education. The prevalence of cognitive deficits was 22.0% and 32.3% in primary blepharospasm patients group, as measured by the MMSE and the Addenbrooke’s Cognitive Examination-Revised, respectively. Primary blepharospasm patents had a broad range of cognitive deficits, with the most frequently affected domains being visuospatial function (30.9%) and language (30.9%), followed by memory (27.9%), orientation/attention (26.4%) and verbal fluency (22.0%). Patients with cognitive deficits had lower total SF36 scores, especially in the subdomains of physical functioning, role-physical and social functioning, compared to those without cognitive deficits. Scores on the Addenbrooke’s Cognitive Examination-Revised were significantly correlated with both the SF36 scores and the scores on the subdomains of physical functioning and social functioning.ConclusionsSome patients with primary blepharospasm have cognitive deficits. Poor performance on the Addenbrooke’s Cognitive Examination-Revised is related to poorer quality of life.

Addenbrooke's Cognitive Examination-Revised: Effects of Education and Age. Normative Data for the Spanish Speaking Population.

Addenbrooke's Cognitive Examination-Revised is a brief test battery for the detection and classification of mild cognitive impairment and dementia. The aims were to investigate the influence of age and education on the Spanish version of the ACE-R and to propose normative data for the Spanish speaking population. Three hundred thirty-four normal healthy volunteers were included in the study. They were classified in three age groups (48-64, 65-75, and 75-89 years of age) and four educational level groups (≤3; 4-8; 9-12, and ≥13 years of education). They were assessed with the version of ACE-R validated in Argentina with some modifications in order to adapt it to the Spanish population. Significant differences were obtained between all age groups in Total ACE-R, Memory, Fluency, and Language indexes. Differences were observed among the 48-64 and 76-89 age groups in the Attention-Orientation and Visuospatial indexes. Regarding education, significant difference between ≤3 years of education and the remaining groups were obtained in Total ACE-R and in all the indexes. Additionally, the group of 4-8 years of education performed significantly worse than the 9-12 and ≥13 groups in Total, Memory, Fluency, and Language indexes. Adjusted scores by education were obtained and percentiles for each age group were calculated. The results show that both age and education have an important effect on ACE-R performance. Consequently, age and education should be taken into account when interpreting results in ACE-R to improve diagnostic accuracy.

THE LONGITUDINAL INTERPLAY OF BEHAVIORAL SYMPTOMS AND FUNCTIONAL DECLINE IN FRONTOTEMPORAL DEMENTIA

Background: Frontotemporal dementia (FTD) presents with marked neuropsychiatric symptoms that impacts negatively on activities of daily living (ADLs). The relationship between neuropsychiatric symptoms and disability in FTD is not well understood. This study aimed to (1) describe baseline function and neuropsychiatric symptoms in behavioural variant FTD (bvFTD) and semantic variant primary progressive aphasia (svPPA); (2) examine longitudinal functional and neuropsychiatric symptom changes; and (3) examine whether function and neuropsychiatric symptoms are associated longitudinally. Methods: 39 people (bvFTD=21; svPPA=18) were seen annually on two to four visits between 2007-2012, with 200 assessments completed in total. The Disability Assessment for Dementia (DAD) assessed function, Cambridge Behavioural Inventory-Revised (CBI-R) evaluated neuropsychiatric symptoms , and Addenbrooke’s Cognitive Examination Revised (ACE-R) measured general cognition. Results: At baseline, people with bvFTD were more impaired functionally than svPPA despite having higher cognitive scores. In terms of baseline neuropsychiatric symptoms, bvFTD showed higher levels of apathy and changes to eating habits, whereas there was no difference in disinhibited or stereotypical behaviours between the groups. Longitudinally, both groups showed functional decline, however bvFTD remained worse than svPPA over time. Apathy and eating changes increased for both groups. Over time, disinhibited and stereotypical behaviours reduced in bvFTD, yet continued to increase for svPPA. Apathy and stereotypical behaviour were associated with functional decline in bvFTD, whereas only apathy made longitudinal contributions to functional disability in svPPA. Conclusions: People with bvFTD are more functionally impaired than svPPA, and despite overlapping baseline neuropsychiatric symptoms, these dissociate over time, with disinhibition and stereotypical behaviour reducing in people with bvFTD and increasing in svPPA. For both bvFTD and svPPA, apathy has a strong role in disability, but stereotypical behaviors only contributed to functional deficits in bvFTD. Aligning with previous clinical observations, our findings suggest that rigid/compulsive behaviors may in fact support activity engagement in svPPA (O'Connor et al. Disability & Rehabilitation 2016). Overall, our results indicate that interventions to address functional disability in FTD should carefully weigh the interaction of neuropsychiatric symptoms and functional status, thus require a tailored approach which may differ from those used in AD dementia.

Evaluation of neuropsychological outcome and "quality of life" after glioma surgery.

Extended tumour resection is imperative to improve the outcome of glioma patients but also carries the risk of increasing morbidity and thus, potentially, of decreasing the patient's quality of life (QOL). In this pilot study, we evaluated how postoperative neurological and neuropsychological alterations impacted on QOL in patients who underwent glioma resection. Twenty-two patients were included in this study and tested at three different time points, i.e. 1day before surgery (t1), on the day of discharge (t2) and 3months following surgery (T3). National Institutes of Health Stroke Scale (NIHSS) score, Addenbrook's Cognitive Examination-Revised (ACE-R) and a comprehensive battery of established tests were used to assess neurological and neuropsychological profiles. QOL and subjectively experienced health condition were ascertained through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC-QLQ C30) and EORTC-QLQ BN20 questionnaires. Postoperatively, 5/22 patients worsened and 5/22 patients improved neurologically. Depending on the neuropsychological test, up to 57.1% of patients experienced deterioration of some sort of neuropsychological function. Most of these functions, however, recovered during the extended observation period (3months). There was no correlation between QOL and a patient's neurological or neuropsychological condition. Our study suggests that extended tumour resection is not necessarily linked to a loss in QOL.

Retrieval Deficiency in Brain Activity of Working Memory in Amnesic Mild Cognitive Impairment Patients: A Brain Event-Related Potentials Study.

In the early stage of Alzheimer disease (AD) or mild cognitive impairment (MCI), working memory (WM) deficiency is prominent and could be attributed to failure in encoding, maintenance or retrieval of information. However, evidence for a retention or retrieval deficit remains equivocal. It is also unclear what cognitive mechanism in WM is impaired in MCI or early AD. We enrolled 46 subjects from our Memory Clinics and community, with 24 amnesic MCI patients and 22 normal subjects. After neurological and cognitive assessments, they performed a classic delayed match to sample (DMS) task with simultaneous event-related potential (ERP) recorded. The ERPs in encoding and retrieval epoch during WM were analyzed separately. The latency and amplitude of every ERP component were compared between two groups, and then analyzed to explore their relationship with neuropsychological performance. Finally, the locations of maximal difference in cortex were calculated by standard low-resolution tomographic analysis. A total of five components were found: P1, N1, P2, N2, and P300. The amplitude of P2 and P300 was larger in normal subjects than in MCI patients only during retrieval, not encoding epoch, while the latency did not show statistical difference. The latency and amplitude of P1 and N1 were similar in two groups. P2 amplitude in the retrieval epoch positively correlated with memory test (auditory verbal learning test) and visual spatial score of Chinese Addenbrooke's Cognitive Examination-Revised (ACE-R), while P300 amplitude correlated with ACE-R. The activation difference in P2 time range was maximal at medial frontal gyrus. However, the difference in cortex activation during P300 time range did not show significance. The amplitude of P2 indicated deficiency in memory retrieval process, potentially due to dysfunction of central executive in WM model. Regarding the location of P2 during WM task, medial frontal plays important role in memory retrieval. The findings in the present study suggested that MCI patients have retrieval deficit, probably due to central executive based on medial frontal gyrus. Thus, it may provide new biomarker for early detection and intervention for aMCI.

Associations between neuropsychiatric symptoms and cognition in Chinese patients with amyotrophic lateral sclerosis

Our objective was to explore features of the neuropsychiatric symptoms in Chinese patients with amyotrophic lateral sclerosis (ALS) and the associations between these neuropsychiatric symptoms and cognition. A total of 91 ALS patients were evaluated using three recommended scales including the Neuropsychiatric Inventory (NPI), Addenbrooke’s Cognitive Examination Revised (ACE-R), and Frontal Assessment Battery (FAB) tests. The mean age of onset was 52.5 ± 10.8 years. The median NPI score of all patients was 2.0. The most common neuropsychiatric symptom was dysphoria/depression (59.3%), followed by anxiety (41.8%) and irritability/lability (26.4%). There were no significant differences in the frequency of neuropsychiatric symptoms in terms of gender, age of onset, onset form and disease duration. There were no significant differences in NPI total score, ACE-R total score and FAB total score in terms of gender, age of onset, onset form and disease duration, except for a higher ACE-R score observed in patients with a shorter disease duration. The NPI score had a strong correlation with the ACE-R score but not with the FAB score. In conclusion, neuropsychiatric symptoms appear to be quite common in Chinese ALS patients, who were likely to present with the emotional states of depression or anxiety. The neuropsychiatric symptoms in ALS are closely related to global cognition dysfunction.

Performance of low-educated elders with depression on Addenbrooke's Cognitive Examination-Revised (ace-r) test.

ABSTRACTAlong with cognitive disorders, depression has been a concern for mental health services due to its highly debilitating effect on the functioning and quality of life of the elderly. However, there is still little understanding of the cognitive alterations resulting from depression or of the difficult differential diagnosis with mild cognitive impairment (MCI). It is known that performance on cognitive tests is strongly influenced by education but few studies have been conducted involving low-educated populations.Objective: To evaluate the performance of elders with low education and no dementia on Addenbrooke's Cognitive Examination-Revised (ACE-R) test and its cognitive domains, and compare patients with Current Major Depressive Episode (CMDE) against those without depressive symptoms. Methods:A retrospective, cross-sectional analytical study was conducted based on medical files of patients treated at the Cerebral Aging Clinic of the Hospital São Lucas of the PUCRS. The study included 116 individuals with low education (< 8 years of education) aged between 60 and 84 (69.6 ± 6.4) years, with MCDE (N = 41) and controls (N = 75). Results:No significant difference was observed between control and MCDE groups in median scores on the ACE-R, Mini-Mental State Examination, and the five cognitive domains. There was also no difference between the groups on separate analyses of results on the clock drawing test, the categorical verbal and phonological fluency test, and the naming test. Conclusion:The results of this study showed that depressive symptoms did not influence scores on the ACE-R tests conducted in elders with low education.

Cognitive functions and magnetic resonance imaging findings in patients with late onset major depression

Background As many as three-quarters of patients with major depressive disorder presenting to old age psychiatrists have late-onset depression. Late-onset depression was conceptualized as a neurologic disease and more often associated with cognitive impairment than early-onset depression. Objectives To compare cognitive functions between early-onset ( Design A cross-sectional, comparative study with a consecutive sample. Subjects Eighty elderly patients with depression were recruited from the Geriatric Outpatient Clinic-Psychiatry and Addiction Hospital in Al Kasr Al-Ainy, Cairo University. They were divided according to the age of onset of depression into 2 groups: Late onset group (A) and Early onset group (B) depression, they were subjected to the following: SCID-I, HDRS (Hamilton Depression Rating Scale), BCRS (Brief Cognitive Rating Scale), GDS (Global deterioration Scale), ACE-R (Addenbrook's Cognitive Examination-Revised), Trail B Test, Digit symbol coding and Digit span subtest of Wechsler Adult Intelligence Scale, MRI-Brain to assess white matter hyperintensities by using modified Fazekas rating. Results Group A had worse performance than group B in trail B test, total memory score, verbal fluency test, total language score, visuospatial abilities, the total (ACE-R) and ischemic changes periventricular and in deep white matter were more in group A than in group B.

Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus

Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of gait disturbance, dementia and urinary incontinence. Outcomes after ventriculoperitoneal shunting for INPH are variable due to a lack of reliable, quantitative outcome data and inconsistent methods of selecting shunt candidates. The aim of this retrospective cohort study was to assess objective and quantitative clinical outcomes of ventriculoperitoneal shunting for INPH. From 2008 to 2013, consecutive patients diagnosed with INPH based on clinical and radiological criteria were included in this single-centre study. All patients received programmable-valve ventriculoperitoneal shunts. Outcome measures were assessed at baseline, 3, 6 and 12months post-operatively. Outcomes included gait time and scores on the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III), the Addenbrooke’s Cognitive Examination Revised (ACE-R) and the Mini-Mental State Examination (MMSE). Thresholds for improvements were set a priori as ⩾20% decrease in gait time, ⩾10point decrease in UPDRS-III score, ⩾5point increase in ACE-R score and ⩾2point increase in MMSE score at last follow-up. The proportion of patients improving varied between measures, being gait time (60%), UPDRS-III (69%), MMSE (63%), and ACE-R (56%). Overall, improvement in at least one outcome measure was observed in 85% of patients and 38% improved in gait time, UPDRS-III score and cognitive scores. Only 15% of patients experienced no improvement on any measure. This study demonstrates that the majority of INPH patients can sustain improvements in multiple symptoms up to 12months after shunting.

Association of serum uric acid level with cognitive function among patients with multiple system atrophy

Background and objectiveOxidative stress is involved in the pathogenesis of multiple system atrophy (MSA) and cognitive impairment. Uric acid has an anti-oxidative effect. Our objective is to clarify the correlations between serum uric acid and cognitive function as well as frontal lobe function in Chinese MSA patients. MethodsAll of MSA patients were evaluated using Addenbrooke's Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery (FAB), and Unified MSA Rating Scale (UMSARS). The fasting serum uric acid concentrations of MSA patients were measured. ResultsA total of 89 probable MSA patients with a mean age of 58.6±10.0years old and disease duration of 2.6±1.5years were included. Thirty-three patients (37.1%) had global cognitive deficits according to ACE-R. Based on FAB, 35 patients (39.3%) had frontal lobe dysfunction. After adjusting for educational years, patients with cognitive deficits had lower uric acid level than patients without cognitive deficits. Patients with frontal lobe dysfunction had lower uric acid level after adjusting for UMSARS scores. In a forward multiple linear regression, uric acid level and educational years were the variables predicting the ACE-R score (F=36.540, R2=0.459, p=0.0001), uric acid accounting for 14% of the total variables. Uric acid was the only variable contributing to the FAB score (F=18.551, R2=0.176, p=0.0001). ConclusionOur study suggested that low level of serum uric acid was associated with cognitive deficits in MSA. Low uric acid level predicting cognitive decline in MSA needs more studies.

The Addenbrooke's Cognitive Examination Revised (ACE-R) and its sub-scores: normative values in an Italian population sample.

The Addenbrooke's Cognitive Examination Revised (ACE-R) is a rapid screening battery, including five sub-scales to explore different cognitive domains: attention/orientation, memory, fluency, language and visuospatial. ACE-R is considered useful in discriminating cognitively normal subjects from patients with mild dementia. The aim of present study was to provide normative values for ACE-R total score and sub-scale scores in a large sample of Italian healthy subjects. Five hundred twenty-six Italian healthy subjects (282 women and 246 men) of different ages (age range 20-93 years) and educational level (from primary school to university) underwent ACE-R and Montreal Cognitive Assessment (MoCA). Multiple linear regression analysis revealed that age and education significantly influenced performance on ACE-R total score and sub-scale scores. A significant effect of gender was found only in sub-scale attention/orientation. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-offs score were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a good significant correlation between ACE-R adjusted scores with MoCA adjusted scores (r = 0.612, p < 0.001). The present study provided normative data for the ACE-R in an Italian population useful for both clinical and research purposes.