Dementia Cognitive Impairment Research Articles

Feeble, fallen, and forgetting: association of cognitive impairment and falls on outcomes of major intra-abdominal surgeries in older adults

BackgroundBoth cognitive impairment/dementia (CID) and falls occur more commonly in older adults than in younger patients. This study aimed to analyze the association of a history of CID or falls with the postoperative outcomes of older adults undergoing major intra-abdominal surgeries on a national level. MethodsWe retrospectively analyzed the American College of Surgeons–National Surgical Quality Improvement Program 2022 Participant Use Data File. Our primary outcome was postoperative mortality. Statistical analysis was performed using the Chi-square test and multivariate regression analysis. ResultsOn multivariable regression analyses, a history of both CID (odds ratio [OR] = 1.9; CI: 1.5–2.5; P < .01) and a fall (OR = 1.8; CI: 1.4–2.3; P < .01) were independently associated with higher adjusted odds of mortality. History of CID or falls was also a predictor of overall complications, major complications, and discharge to a care facility. ConclusionA history of CID or falls in older adults before major intra-abdominal surgeries was associated with a high risk of postoperative mortality and morbidity. Further studies are required to establish the causal relation of these factors and the steps to mitigate the risk of associated adverse outcomes.

Cognitive Dysfunction in Patients Treated with Androgen Deprivation Therapy: A Multimodality Functional Imaging Study to Evaluate Neuroinflammation.

Androgen deprivation therapy (ADT) for prostate cancer is implicated as a possible cause of cognitive impairment (CI). CI in dementia and Alzheimer's disease is associated with neuroinflammation. In this study, we investigated a potential role of neuroinflammation in ADT-related CI. Patients with prostate cancer on ADT for ≥3 months were categorized as having ADT-emergent CI or normal cognition (NC) based on self-report at interview. Neuroinflammation was evaluated using positron emission tomography (PET) with the translocator protein (TSPO) radioligand [11C]-PBR28. [11C]-PBR28 uptake in various brain regions was quantified as standardized uptake value (SUVR, normalized to cerebellum) and related to blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) choice-reaction time task (CRT) activation maps. Eleven patients underwent PET: four with reported CI (rCI), six with reported NC (rNC), and one status unrecorded. PET did not reveal any between-group differences in SUVR regionally or globally. There was no difference between groups on brain activation to the CRT. Regardless of the reported cognitive status, there was strong correlation between PET-TSPO signal and CRT activation in the hippocampus, amygdala, and medial cortex. We found no difference in neuroinflammation measured by PET-TSPO between patients with rCI and rNC. However, we speculate that the strong correlation between TSPO uptake and BOLD-fMRI activation in brain regions involved in memory and known to have high androgen-receptor expression mediating plasticity (hippocampus and amygdala) might reflect inflammatory effects of ADT with compensatory upregulated/increased synaptic functions. Further studies of this imaging readout are warranted to investigate ADT-related CI.

Mild cognitive impairment in dementia with Lewy bodies: an update and outlook.

Dementia with Lewy bodies (DLB), the second most common degenerative neurocognitive disorder after Alzheimer disease (AD), is frequently preceded by a period of mild cognitive impairment (MCI), in which cognitive decline is associated with impairment of executive functions/attention, visuospatial deficits, or other cognitive domains and a variety of noncognitive and neuropsychiatric symptoms, many of which are similar but less severe than in prodromal AD. While 36-38% remain in the MCI state, at least the same will convert to dementia. Biomarkers are slowing of the EEG rhythms, atrophy of hippocampus and nucleus basalis of Meynert, temporoparietal hypoperfusion, signs of degeneration of the nigrostriatal dopaminergic, cholinergic and other neurotransmitter systems, and inflammation. Functional neuroimaging studies revealed disturbed connectivity of frontal and limbic networks associated with attention and cognitive controls, dopaminergic and cholinergic circuits manifested prior to overt brain atrophy. Sparse neuropathological data showed varying Lewy body and AD-related stages associated with atrophy of entorhinal, hippocampal, and mediotemporal cortices. Putative pathomechanisms of MCI are degeneration of limbic, dopaminergic, and cholinergic systems with Lewy pathology affecting specific neuroanatomical pathways associated with progressing AD-related lesions, but many pathobiological mechanisms involved in the development of MCI in LBD remain to be elucidated as a basis for early diagnosis and future adequate treatment modalities to prevent progression of this debilitating disorder.

Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis.

High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis-Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.

The Relationship between Vascular Risk Factors and White Matter Structural and Vascular Imaging Metrics

AbstractBackgroundVascular risk factors are associated with cerebral small vessel disease and dementia pathology and reduced WM integrity is correlated with the severity of cognitive impairment in dementia. We have investigated if vascular risk factors are related to white matter structural and vascular imaging metrics. Imaging metrics include intracellular volume fraction (ICVF), white matter hyperintensities (WMH), and cerebrovascular measures such as cerebral blood flow (CBF), cerebrovascular reactivity (CVR), and arterial transit time (ATT).MethodSixty‐four subjects (Table 1) enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core cohort underwent MRI, including T2 FLAIR, neurite orientation dispersion and density imaging (NODDI), pseudo‐continuous ASL (PCASL). CVR was measured as a percent of increased CBF during a hypercapnic respiratory paradigm. ATT and resting CBF were obtained from a multi‐TI PCASL sequence. ICVF was obtained from NODDI. Head size adjusted WM total lesion volume (TLV) was calculated using SPM12‐LST2 toolbox with T2‐FLAIR image. Linear regression models were performed to examine if CBF, CVR, ATT, ICVF, or TLV are related to the risk factors or cognitive status adjusted covariates: age, sex, and years of education. A covariates adjusted logistic regression estimated weighting factors for each interrelated vascular imaging parameter to create novel cerebrovascular functional composites for each vascular risk group and mild cognitive impairment (MCI) group. The factor score p‐values were also calculated from two‐sample t‐tests with the cerebrovascular composite. The entire analyses were performed within the whole brain WM.ResultIn the whole brain WM, hypertension subjects (p=0.031) showed higher CVR (Figure 1). T2DM subjects (p=0.007) showed higher WM TLV (Figure 2). T2DM and MCI subjects showed lower ICVF than normal subjects did (Figure 3). Based on the weights of each cerebrovascular parameter in the composite (Table 2), the effects of CBF and CVR are stronger in hypertension group while all three cerebrovascular measures had substantial contribution to cognition status.ConclusionEach risk factor and cognitive status differently affected WM structural and vascular dynamic imaging parameters. The findings warrant further investigations of contributions of vascular risk factors to the structural and vascular abnormalities in dementia.

The Relationship between Vascular Risk Factors and White Matter Structural and Vascular Imaging Metrics

AbstractBackgroundVascular risk factors are associated with cerebral small vessel disease and dementia pathology and reduced WM integrity is correlated with the severity of cognitive impairment in dementia. We have investigated if vascular risk factors are related to white matter structural and vascular imaging metrics. Imaging metrics include intracellular volume fraction (ICVF), white matter hyperintensities (WMH), and cerebrovascular measures such as cerebral blood flow (CBF), cerebrovascular reactivity (CVR), and arterial transit time (ATT).MethodSixty‐four subjects (Table 1) enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core cohort underwent MRI, including T2 FLAIR, neurite orientation dispersion and density imaging (NODDI), pseudo‐continuous ASL (PCASL). CVR was measured as a percent of increased CBF during a hypercapnic respiratory paradigm. ATT and resting CBF were obtained from a multi‐TI PCASL sequence. ICVF was obtained from NODDI. Head size adjusted WM total lesion volume (TLV) was calculated using SPM12‐LST2 toolbox with T2‐FLAIR image. Linear regression models were performed to examine if CBF, CVR, ATT, ICVF, or TLV are related to the risk factors or cognitive status adjusted covariates: age, sex, and years of education. A covariates adjusted logistic regression estimated weighting factors for each interrelated vascular imaging parameter to create novel cerebrovascular functional composites for each vascular risk group and mild cognitive impairment (MCI) group. The factor score p‐values were also calculated from two‐sample t‐tests with the cerebrovascular composite. The entire analyses were performed within the whole brain WM.ResultIn the whole brain WM, hypertension subjects (p=0.031) showed higher CVR (Figure 1). T2DM subjects (p=0.007) showed higher WM TLV (Figure 2). T2DM and MCI subjects showed lower ICVF than normal subjects did (Figure 3). Based on the weights of each cerebrovascular parameter in the composite (Table 2), the effects of CBF and CVR are stronger in hypertension group while all three cerebrovascular measures had substantial contribution to cognition status.ConclusionEach risk factor and cognitive status differently affected WM structural and vascular dynamic imaging parameters. The findings warrant further investigations of contributions of vascular risk factors to the structural and vascular abnormalities in dementia.

A Critical Study on the Impact of Dementia on Older People Undergoing Treatment in Care Homes.

Maximum healthcare needs for older people are complex due to diseases, comorbidities, or disabilities, including long-term or mental and physical health issues. Various residential and nursing care homes help care for older people, especially those with special medical needs. Among these special medical needs, dementia is one medical condition requiring exceptional care for the affected to prevent adverse effects of the situation they usually encounter. Dementia is a health condition that involves impairments to memory and thinking due to any injury or disease-causing damage to the brain. Older people suffer from different diseases, which cause cognitive disability and long-term ailments and directly affect patients' quality of life. Given the cognitive impairment dementia causes to older people, it is difficult for the care providers to accurately assess the impact on every individual to formulate a person-centered care plan. During the COVID-19 pandemic, due to administrative restrictions on social distancing to prevent transmission of this disease, caregivers and elderly persons feel tremendous mental stress, further aggravating their problems because of loneliness. Thus, there is a requirement to do the study and analyze the effects on older people to provide quality and person-centered care. Due to the above factors as significant challenges in the current context, there is an ardent need for the results of variegated studies besides a thorough analysis of available literature analyzed to provide proper evidence to the care providers. It will pave the way for understanding the actual impact of the condition in its natural context. In this regard, a literature review and the results of the studies are discussed. This research brings into the limelight all those factors in the context of previous studies and data analysis of the current situation.

Evidence-Based Evaluation and Management of Cognitive Impairment in Dementia With Lewy Bodies

Dementia is a functional decline due to cognitive impairment, and its presence is required to make a diagnosis of dementia with Lewy bodies (DLB). Evaluation and management of cognitive impairment in DLB is complex and requires consideration of cognitive fluctuations as well as motor and behavioral symptoms. This article reviews the literature surrounding evaluation and management of cognitive impairment in DLB, highlighting the specific cognitive profile typically seen in early DLB as well as the available evidence for management of these symptoms. There are several pharmacological and nonpharmacological treatment strategies that are currently under investigation, and these are reviewed as well. [ Psychiatr Ann. 2022;52(10):404–409.]

Effectiveness of Nootropics in Combination with Cholinesterase Inhibitors on Cognitive Function in Mild-to-Moderate Dementia: A Study Using Real-World Data.

The clinical benefits of nootropics in the treatment of cognitive decline has been either limited or controversial. This study aimed to observe the effectiveness of cholinesterase inhibitor (ChEI) and nootropics combination in the treatment of cognitive impairment in dementia. Data were based on electronic medical records in a university health system. Patients with mild-to-moderate dementia and no history of prior cognitive enhancer use were included (n = 583). The subjects were categorized into the ChEI only group and the ChEI and nootropics combination group. The primary outcome measure was the change in cognitive function, as assessed by the mini-mental state examination (MMSE) from baseline to 300–400 days after the first ChEI prescription. Subsequent analyses were conducted in consideration of the dementia type, medical adherence, and type of nootropics. The changes in MMSE scores from baseline to endpoint were not significantly different between the two groups. In Alzheimer’s dementia, the combination group showed significantly less deterioration in MMSE language subscale scores compared to the ChEI only group (F = 6.86, p = 0.009), and the difference was consistent in the highly adherent subjects (F = 10.16, p = 0.002). The choline alfoscerate and the ginkgo biloba extract subgroups in Alzheimer’s dementia showed more significant improvements in the MMSE language subscale scores compared to the other nootropics subgroup (F = 7.04, p = 0.001). The present study showed that the effectiveness of ChEI and nootropics combination on cognition may appear differently according to the dementia type. This emphasizes the need for well-controlled studies to generalize the effectiveness of nootropics across various clinical settings.

Cholinergic models of memory impairment in animals and man: scopolamine vs. biperiden.

Scopolamine has been used as a pharmacologic model for cognitive impairments in dementia and Alzheimer's disease. The validity of this model seems to be limited because findings in animals do not readily translate to novel treatments in humans. Biperiden is also a cholinergic deficit model for cognitive impairments but specifically blocks muscarinic M1 receptors. The effects of scopolamine and biperiden (and pirenzepine) are compared in animal studies and related to findings in humans. It is concluded that the effects on cognitive functions are different for scopolamine and biperiden, and they should be considered as different cognitive deficit models. Scopolamine may model more advanced stages of Alzheimer's disease whereas biperiden may model the early deficits in declarative memory in aging and mild cognitive impairment.

Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model

BackgroundDonepezil, galantamine, rivastigmine and memantine are potentially effective interventions for cognitive impairment in dementia, but the use of these drugs has not been personalised to individual patients yet. We examined whether artificial intelligence-based recommendations can identify the best treatment using routinely collected patient-level information.MethodsSix thousand eight hundred four patients aged 59–102 years with a diagnosis of dementia from two National Health Service (NHS) Foundation Trusts in the UK were used for model training/internal validation and external validation, respectively. A personalised prescription model based on the Recurrent Neural Network machine learning architecture was developed to predict the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores post-drug initiation. The drug that resulted in the smallest decline in cognitive scores between prescription and the next visit was selected as the treatment of choice. Change of cognitive scores up to 2 years after treatment initiation was compared for model evaluation.ResultsOverall, 1343 patients with MMSE scores were identified for internal validation and 285 [21.22%] took the drug recommended. After 2 years, the reduction of mean [standard deviation] MMSE score in this group was significantly smaller than the remaining 1058 [78.78%] patients (0.60 [0.26] vs 2.80 [0.28]; P = 0.02). In the external validation cohort (N = 1772), 222 [12.53%] patients took the drug recommended and reported a smaller MMSE reduction compared to the 1550 [87.47%] patients who did not (1.01 [0.49] vs 4.23 [0.60]; P = 0.01). A similar performance gap was seen when testing the model on patients prescribed with AChEIs only.ConclusionsIt was possible to identify the most effective drug for the real-world treatment of cognitive impairment in dementia at an individual patient level. Routine care patients whose prescribed medications were the best fit according to the model had better cognitive performance after 2 years.

Chronic Renin-Angiotensin System Activation Induced Neuroinflammation: Common Mechanisms Underlying Hypertension and Dementia?

Hypertension is a major risk factor for the pathogenesis of vascular dementia and Alzheimer's disease. Chronic activation of the renin-angiotensin system (RAS) contributes substantially to neuroinflammation. We propose that neuroinflammation arising from chronic RAS activation can initiate and potentiate the onset of hypertension and related dementia. Neuroinflammation induced by chronic activation of the RAS plays a key role in the pathogenesis of dementia. Increased levels of pro-inflammatory cytokines tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and transforming growth factor (TGF)-β have been reported in brain tissue of vascular dementia patients and animal models of vascular dementia induced by either angiotensin II infusion or transverse aortic coarctation. It is proposed that neuronal cell death and synaptic dysfunction induced by neuroinflammation lead to cognitive impairment in dementia. The neuroprotective RAS pathway, regulated by angiotensin-converting enzyme 2 (ACE2) which converts angiotensin II into angiotensin-(1-7), can attenuate hypertension and dementia. Furthermore, the use of anti-hypertensive medications in preventing dementia or cognitive decline in hypertensive patients and animal models of dementia have mostly been beneficial. Current evidence suggests a strong link between RAS induced neuroinflammation and the onset of hypertension and dementia, which warrants further investigation. Strategies to counteract an overactive RAS and enhance the neuroprotective arm of the RAS may help prevent or improve cognitive impairment associated with hypertension.

Evaluating Residual Cognition in Advanced Cognitive Impairment: The Residual Cognition Assessment

Background: In nursing homes, most of the patients with dementia are affected by severe cognitive disorder. Care interventions follow an accurate and recurring multidimensional assessment, including cognitive status. There is still a need to develop new performance-based scales for moderate-to-advanced dementia. Objectives: The development of the Residual Cognition Assessment (RCA) responds to the need to create new scales for global cognitive screening in advanced dementia, with some peculiar features: performance based, brief (<5 m), available without specific training, and suitable for nonverbal patients with minimal distress. Methods: Two raters have administered the RCA and the Severe Impairment Battery-short version (SIB-S) to 84 participants with MMSE = 0. After 2–3 weeks, the same sample has been retested. The RCA has been also administered to 40 participants with MMSE 1–10 for a comparison. Results: The RCA has exhibited excellent values for test-retest reliability (intraclass correlation [ICC] = 0.956) as well as for inter-rater reliability (ICC = 0.997). The concurrent validity analyzes have shown strong correlations between the RCA and the SIB-S with ρ = 0.807 (p < 0.01), and the RCA and the Clinical Dementia Rating (CDR) with ρ = −0.663 (p < 0.01). Moderate correlation has been found between the RCA and the Functional Assessment Staging Scale with ρ = −0.435 (p < 0.01). The instrument has showed high internal reliability, too (total: α = 0.899). The RCA has low floor effect (2%) with respect to the SIB-S (58%) but shows ceiling effect in the MMSE 1–10 sample (50%). The ROC curve analyses demonstrate that the RCA is acceptably able to discriminate between subjects with CDR 4/5 with an AUC of 0.92. Exploratory factor analysis shows 3 factors, defined as three major degrees of cognitive performance in advanced dementia, indeed hierarchically structured in three possible levels of decline. Conclusions: The RCA has showed excellent validity and reliability as well as good sensitivity to identify advanced cognitive impairment in dementia, without floor effect. The RCA seems complementary to the MMSE, so advisable when the latter reaches 0. Administration and scoring are simple, and only few minutes are required to assess the patient. The RCA can discriminate at least 3 different major stages in advanced dementias: severe, profound, and late.

Mental Illness and Amyloid: A Scoping Review of Scientific Evidence over the Last 10 Years (2011 to 2021).

Amyloid precursor protein and its derivates represent a central factor in the process of neurodegeneration in Alzheimer’s disease (AD). Since mental illnesses share with AD cognitive impairment, amyloid indicators have been used to explore the unknown pathophysiologic mechanisms underlining psychiatric illness. This work aims to compare the role of amyloid markers, together with tau proteins, among various mental disorders evaluating the possible role of altered amyloid metabolism in the onset and in the course of psychiatric diseases, considering the relationship with cognitive impairment in dementia. This review includes articles written in English, published between 1 January 2011 and 31 January 2021, which evaluated amyloid and tau proteins in psychiatric patients. After screening, 31 studies were included in the review. Results suggest that amyloid metabolism is altered in major psychiatric disorders and that it could be a marker of cognitive impairment. Nevertheless, the role of amyloid in mental diseases seems to be related to neurodevelopmental alteration as well as neurodegeneration processes, like in AD. The role of amyloid in the pathogenesis of mental disorders is still unknown. Amyloid should not be only considered as a marker of cognitive impairment in mental illness, but also for altered neurodevelopment.

Expanding the horizon of research into thepathogenesis of the white matter diseases: Proceedings of the 2021 Annual Workshop of the Albert Research Institute for White Matter and Cognition.

White matter pathologies are critically involved in the etiology of vascular cognitive impairment–dementia (VCID), Alzheimer’s disease (AD), and Alzheimer’s disease and related diseases (ADRD), and therefore need to be considered a treatable target ( Roseborough A, Hachinski V, Whitehead S. White matter degeneration - a treatable target? Roseborough et al. JAMA Neurol [Internet]. 2020 Apr 27;77(7):793–4, [1] . To help address this often-missed area of research, several workshops have been sponsored by the Leo and Anne Albert Charitable Trust since 2015, resulting in the incorporation of “The Albert Research Institute for White Matter and Cognition” in 2020. The first annual “Institute” meeting was held virtually on March 3–4, 2021. The Institute provides a forum and workspace for communication and support of the advancement of white matter science and research to better understand the evolution and prevention of dementia. It serves as a platform for young investigator development, to introduce new data and debate biology mechanisms and new ideas, and to encourage and support new research collaborations and directions to clarify how white matter changes, with other genetic and health risk factors, contribute to cognitive impairment. Similar to previous Albert Trust–sponsored workshops (Barone et al. in J Transl Med 14:1–14, [2]; Sorond et al. in GeroScience 42:81–96, [3]), established expert investigators were identified and invited to present. Opportunities to attend and present were also extended by invitation to talented research fellows and younger scientists. Also, updates on institute-funded research collaborations were provided and discussed. The summary that follows is a synopsis of topics and discussion covered in the workshop.

Executive function deficits in mild cognitive impairment: evidence from saccade tasks

Objectives: Early detection of mild cognitive impairment (MCI) is necessary to prevent irreversible brain damage caused by incipient Alzheimer’s disease. It has been showing that amnestic MCI (a-MCI) subjects exhibit subtle deficits in executive function that can be tested using saccade eye movements. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. Methods In this study, we used eye-tracking technology to explore saccade impairments to distinguish between a-MCI and the variants of reference controls. 21 patients with AD, 40 patients with a-MCI, and 59 normal participants were recruited in current study. We measured saccade reaction time, saccade errors, saccade omission, and uncorrected saccades using anti-saccade and pro-saccade tasks with ‘gap’ and ‘overlap’ procedures. These parameters were used as markers of executive function and visual attention deficits.Results: The findings revealed that more errors, more omissions, and fewer corrections characterized the saccade behavior of the a-MCI group compared to the reference group. These eye-tracking characteristics can be considered as inhibitory control and working memory deficits in a-MCI subjects. Our results thus demonstrate the applicability of the anti-saccade task as a cognitive marker in a-MCI. Conclusion The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of executive function in aging with cognitive impairments.

Chronic rhinosinusitis and progression of cognitive impairment in dementia

AimThe relationship between chronic inflammatory disease and cognitive decline is still unclear, but there is increasing evidence to support the role of systemic inflammation. The aim of this study was to investigate if chronic rhinosinusitis (CRS) in dementia or mild cognitive impairment (MCI) is associated with the progression of cognitive decline. Material and methodsWe retrospectively reviewed the data of patients who complained of memory impairment, and underwent brain magnetic resonance imaging (MRI) from January 2006 to April 2019. According to the Mini-Mental State Examination (MMSE) score, subjects (n=661) were divided into three groups: dementia (≤17), MCI (18–23), and normal (≥24). CRS was defined as a total score of greater than or equal to 4 according to the Lund–Mackay scoring system using brain MRI. Multiple logistic regression analyses estimated adjusted odds ratio (aOR) for the association between CRS and dementia or MCI. Among the subjects with follow-up MMSE (n=286), a repeated-measures ANOVA was used to assess the difference of changes in MMSE scores between the groups with and without CRS. ResultsAccording to the initial MMSE score, there were 221 subjects with dementia, 195 with MCI, and 245 with normal results. CRS was not significantly associated with dementia (aOR=1.519, CI=0.909–2.538, P=0.111), while being suggestively associated with MCI (aOR=1.740, CI=1.041–2.906, P=0.034). The MMSE scores at follow-up decreased further in subjects with CRS than in those without CRS (P=0.009). Especially, in the initial dementia group, there was a significant between-group difference in the MMSE score from baseline to follow-up (13.6±4.3 to 11.1±6.3 in CRS group vs. 13.5±3.3 to 14.4±5.4 in no CRS group, P=0.002). ConclusionThe result of the present study implies a potential association between CRS and progression of cognitive decline. Physicians should be aware of this possibility in patients with clinically diagnosed CRS.

317 - Behavioural markers of mild cognitive impairment: diagnostic value of eye-tracking study

Background:Early diagnosis of mild cognitive impairment is important in Alzheimer's disease management before brain damage is profoundly established and irreversible. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. We examined the saccade movement deficits in amnestic MCI and compared them with the normal controls and Alzheimer to define early cognitive markers in MCI.Method:This study was a cross-sectional observational study. Twenty-one patients with AD, 40 patients with aMCI, and 59 normal participants were examined by eye tracking using anti-saccade task and pro-saccade task with ‘gap’ and ‘overlap’ procedures.Results:Patients with Alzheimer's made more errors, and corrected fewer errors than a-MCI and age-matched controls. Moreover, a-MCI had higher error rates in the prosaccade gap and overlap (38±1.5, p≤ 0.001; 21± 1.8, p≤ 0.001) and antisaccade gap and overlap (64± 1.4, p≤ 0.001; 45± 1.6, p≤ 0.001) than normal controls. Compared with the control group, a-MCI also showed more uncorrected responses in the prosaccade gap (6± 0.5, p≤ 0.001) and antisaccade gap and overlap (13± 0.4, p≤ 0.001; 10± 0.7, p≤ 0.001). Saccade Omission also revealed significant differences between normal controls and amnestic mild cognitive impairment in prosaccade (p≤ 0.001) and antisaccade (p≤ 0.001) tasks, in both gap and overlap paradigms.Conclusion:Error proportion, target omission and uncorrected saccades impairments in a- a-MCI, support the concept of executive function deterioration, as an early marker of neurocognitive disorder. Our findings also confirm inhibitory and working memory impairments t in a-MCI.

Optimizing Modifiable and Lifestyle-related Factors in the Prevention of Dementia Disorders with Special Reference to Alzheimer, Parkinson and Autism Diseases

Dementia is a syndrome and an umbrella term that encompasses Alzheimer, Parkinson and autism diseases. These diseases are by far the most common cause of dementia; therefore this investigation will chiefly include these disorders, with a limited discussion of few other disorders related to dementia. Alzheimer’s disease (AD) is characterized by the accumulation of cerebral β-amyloid plaques, tau proteins and memory loss; Parkinson by the deterioration of brain cells which regulate the movement of body parts and produce dopamine; and autism by abnormalities of social disorder and difficulty in communicating and forming relationships. Alzheimer’s disease and cognitive impairment in dementia are age-related and manageable only with early diagnosis and prevention. Data based on several decades of research has shown that the major factors responsible for the induction of inflammation in dementia and many chronic diseases are infections, obesity, alcohol, radiation, environmental pollutants, improper nutrition, lack of physical activity, depression, anxiety, genetic factors, and sleep deprivation. There are some studied preventive measures for dementia including continued physical activity and consuming predominantly a plant-based Mediterranean diet comprising olive oil and foods containing flavonoids and other phytochemicals having strong antioxidant and anti-inflammatory properties and along with management of chronic conditions.

Cognitive assessment and rehabilitation tools for stroke and dementia: An online survey of Russian speaking clinicians

Our objective was to survey opinions on cognitive assessment and rehabilitation of Russian-speaking clinicians working with stroke and dementia patients. An online survey was circulated to professional communities soliciting feedback from clinicians about methods used for cognitive assessment and rehabilitation; expected cognitive impairments in dementia and stroke; variables affecting the cognitive abilities of patients; and topics presented during psycho-educational initiatives. Forty-eight physicians, 50 psychologists, and 12 speech-language pathologists completed the survey. 96% of participants reported estimating the cognitive abilities of patients while performing diagnostics and treatment in clinical settings. The most popular tools for cognitive assessment were Russian versions of the MoCA, MMSE, Luria Neuropsychological Battery, and Frontal Assessment Battery (FAB). 60% of participants reported the provision of cognitive rehabilitation, and 61% provided psychoeducation. All groups reported that the cognitive reserve and the idiopathic features of a brain lesion were the main factors influencing patients’ cognitive profile. In the case of stroke patients, clinicians observed aphasia, as well as impairments in attention, memory, and reasoning. For patients with dementia, memory deficits were coincident with executive/frontal, praxis, and visuo-perceptual impairments. Psychotherapy-related psychoeducation was delivered by most of the clinicians. The captured patterns of clinical practice followed, in part, Russian national guidelines for cognitive rehabilitation and, in part, international protocols, wherein we found some professional group differences in implementation of practice. The profile in approaches to stroke and dementia assessment and rehabilitation reveal a new benchmark for future studies and for the development of policies for neuropsychological assessment and treatment in Russian language.