Constructional Praxis Research Articles

Cognition in older adults with severe to profound sensorineural hearing loss compared to peers with normal hearing for age

Objective: Cognitive performance of older adults with severe to profound sensorineural hearing loss and indication for cochlear implantation was evaluated compared to peers with age appropriate hearing.Design: Prospective matched case control study.Study sample: Study group consisted of n = 30 patients aged between 60 and 80 years, with adult onset, severe to profound sensorineural hearing loss on both sides and indication for cochlear implantation. Matched control group consisted of n = 30 peers with age-adjusted hearing abilities, based on age- appropriate norms.Results: Differences in Constructional Praxis and Recall, Trail Making Test A and Stroop were not significant between both groups. However, the differences in Clock Drawing Test, Word Lists and Trail Making Test B were significant. The impairment in TMT B (cognitive flexibility) was mediated via the severity of depressive problems. Cognitive performance was not related to word recognition, the percentage and duration of hearing loss and hearing aid use.Conclusion: Severely hearing-impaired older adults show widespread impairments in cognitive performance.

EXPLORING THE WITHIN-PERSON COUPLING RELATIONSHIP BETWEEN BLOOD PRESSURE AND COGNITION IN OLDER AFRICAN AMERICANS

We examined the within-person relationship between systolic blood pressure (SBP) and cognition and whether this association is moderated by hypertension status and stress level. Analysis was conducted on 50 (39 women and 11 men) community-dwelling African Americans ranging in age from 50 to 80 years (M = 65.40, SD = 8.53). Participants’ blood pressure and cognition (i.e., executive function, memory, perceptual speed, inductive reasoning, constructional praxis, and language) was assessed on 8 different occasions over a 2-week time period. Stress was measured at baseline using the Elderly Life Stress Inventory. Findings show on days systolic blood pressure increased above an individual’s average level, their memory performance also tended to improve on that day. A significant 3-way interaction was further observed; such that on occasions when an individual’s systolic blood pressure was above his or her personal average, their executive functioning performance (i.e., Letter Fluency test) was significantly better, particularly for participants who on average had a high SBP (or were hypertensive) and reported a history of high stress. These results suggest that higher levels of blood pressure are related to better cognitive performance among middle age to older African Americans. These counterintuitive findings may be attributed to the inclusion of a selective sample of resilient African Americans who have survived despite having adverse health conditions. This association may also arise from stress induced high effort coping, which is needed to perform well on cognitive tasks but also increases blood pressure.

Behavioral changes in patients with large vessel occlusion in subacute period of stroke in Kyrgyzstan

Behavioral and cognitive changes in acute and post-stroke period are frequent and take part in patients’s rehabilitation. to distinguish behavioral, mood and cognitive changes in patients in the acute period of large artery atherosclerotic ischemic (LAAIS) and intracerebral hemorrhage (ICH) in the sample of 100 patients. We applied NIHSS scale; MoCA test, FAB test, clock drawing test, "Schulte Table" technique; Spielberger`s Test Anxiety, the Bartell index. Mean age of LAAIS patients was 50.5 ± 9.8 years, there were 54.8% of men. The pronounced cognitive impairment was found in patients with a long-term hypertension (14.6 ± 6.8 points (p = 0.2) in MOCA test). In the ICH group, severe neurologic impairment according to NIHSS 9.5 ± 2.6 points was followed the moderate CI according to MOCA test: 14.7 ± 3.8 points. High personal and moderate situational anxiety (p = 0.006) was specific more to cardioembolic strokes patients. These patients showed a high dependence on others on the Bartell index (74.4 ± 3.7), p = 0.001. Mild cognitive impairment were observed in patients with a small vessel occlusion and this group did not have a functional dependence on others. Cognitive impairment is typical for LAAIS and expressed in iimpaired constructive praxis, speech disturbances and attention span. Slow course of LAA is bringing to cognitive and behavioral changes with secondary depression. The duration of hypertension, large size of the infarction and high level of anxiety made these patients highly dependent on others.

Association of exposure to road traffic noise with cognitive function in elderly women

OPS 43: Noise, stress and mental health, Room 217, Floor 2, August 27, 2019, 4:30 PM - 5:30 PM Background: Adverse effects of traffic noise on cognition have been found in children, but only few studies investigated the (long-term) health effects of noise exposure in adults. However, large parts of the population are exposed to high levels of road traffic noise at the residence. This study on the long-term association of road traffic noise with cognition includes day- and nighttime noise exposure simultaneously, and investigates self-reported noise annoyance in addition to modeled residential noise levels. Methods: In a cohort of 288 elderly women from the longitudinal Study on the influence of Air pollution on Lung function, Inflammation and Aging (SALIA) in Western Germany we investigated the association of residential exposure to road traffic noise and annoyance due to road traffic noise with cognitive performance. Residential noise levels – weighted 24-hour mean and nighttime noise – were modeled for the exposed facade of dwellings. Traffic noise annoyance (day and night) was estimated by questionnaire. Cognitive function was assessed using the Consortium to Establish a Registry on Alzheimer’s Disease (CERAD-Plus) Neuropsychological Assessment Battery. The probability of impaired cognition (cognitive score < 0) was modeled using logistic regression adjusted for potential confounders. Results: While objective noise exposure was associated with impaired total cognition (OR 1.69, p<0.1) and constructional praxis domain (OR 2.72, p<0.05), subjective noise exposure exhibited inverse associations with better performance in semantic memory (OR 0.52, p<0.05) and in the constructional praxis domain (OR 0.56, p<0.1). The findings were independent of air pollution levels, and, although modeled noise levels and noise annoyance were associated, their health effects seemed mutually independent. Conclusions: The relationships between noise exposure, annoyance, and cognitive performance in the elderly turned out complex and could be examined more deeply by incorporating additional factors such as window opening habits, hearing ability, etc., in future studies.

Determining Filipino Normative Data for a Battery of Neuropsychological Tests: The Filipino Norming Project (FNP)

Background: Filipino normative data for neuropsychological tests are lacking. Objectives: This study aimed to determine the Filipino normative data for the Filipino Norming Project (FNP) Neuropsychological Battery, combining the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) and the Neuropsychological Test Battery from the Uniform Dataset of Alzheimer’s Disease Center (UDS-ADC). Methods: We recruited participants 60 years and older with normal cognition (MMSE score of 25 and above and did not fulfill criteria for dementia according to DSM-IV criteria). Psychologists administered the tests to the study participants. We conducted multivariate analyses to study the effect of age, gender, and education on test performance. Results: A total of 191 participants underwent the FNP Neuropsychological Test Battery. The mean age was 68.8 years (SD 5.4). The majority were female (84.1%). The mean score of ADAS-Cog was 9.98 (SD 4.74). The effect of education was prominent throughout the cognitive domains tested while the effect of age was limited to a few cognitive domains. The mean ADAS-Cog scores were 11.80 ± 4.40 for primary education, 9.93 ± 5.08 for secondary, and 8.15 ± 3.95 for tertiary. On average, women scored 2.75 points lower than men and performed better on the verbal components. Men performed better on the constructional praxis component. The same effect of education and gender was observed for the UDS-ADC. Conclusion: For the first time, normative data are available for the ADAS-Cog and UDS-ADC for a Filipino older population. This study stresses the importance of establishing population-specific normative data, taking into account the specific sociocultural and linguistic context of that population.

THALAMIC SHAPE AND COGNITIVE PERFORMANCE IN AMNESTIC MILD COGNITIVE IMPAIRMENT

This study aimed to investigate thalamic shape alterations and their relationships with various episodic memory impairments in subjects with amnestic mild cognitive impairment (aMCI). We compared volumes and morphological alterations of the thalamus between aMCI subjects and healthy controls. In addition, we investigated the correlation between thalamic deformations and various memory impairments in aMCI subjects using a comprehensive neuropsychological battery. The normalized left thalamic volumes of the aMCI group were significantly smaller than those of the healthy control group (p < 0.0001). aMCI subjects exhibited significant thalamic deformations in the left thalamic dorso-medial and antero-medial areas compared with healthy individuals. CERAD-K Word List Memory scores were significantly correlated with the left dorso-medial areas in aMCI subjects. There were no significant correlations between verbal fluency, Boston naming test, constructional praxis, Word List Recognition, and Visuospatial Recall scores and thalamic shape in aMCI subjects. Verbal delayed recall scores were also significantly correlated with the left dorso-medial areas in the aMCI group. Structural alterations in the thalamic deformations in the left dorso-medial and antero-medial areas might be core underlying neurobiological mechanisms of thalamic dysfunction related to Word List Memory and delayed verbal recall in individuals with aMCI.

P1‐470: INCIDENCE OF DEMENTIA IN MEXICAN OLDER ADULTS AND ITS ASSOCIATION WITH PERFORMANCE IN CONSTRUCTIVE PRAXIS, SEMANTIC VERBAL FLUENCY, AND DELAYED RECALL TASKS IN A THREE‐YEAR FOLLOW‐UP

Dementia is a growing public health problem worldwide. Straightforward and accessible tools are needed in order to identify subjects at risk of developing cognitive impairment. Specific neuropsychological assessments can be used to detect subtle cognitive changes, and have the advantage of being low-cost, simple and time-effective. It has been reported that the test of verbal semantic fluency1, delayed recall2and constructive praxis3are useful test to predict incident dementia. We analyzed a subsample of 1,226 subjects from the Mexican arm of the 10/66 Dementia Research Group aged 65 years or older, without dementia, in a three-year follow-up. Cognitive tests studied included constructional praxis with the task of pentagons and circles copy, three-word delayed recall and animal category semantic verbal fluency task subtests from the Cognitive Screening Instrument for Dementia (CSI-D), with a total application time of approximately five minutes. After adjusting for age, neuropsychiatric symptoms, diabetes, and illiteracy we found significant associations between: incident dementia and CSI-D pentagon and circles copy subtest risk ratio (RR) = 2.28, confidence interval (CI) 95% 1.30-4.00); and with three-word delayed recall subtest RR= 2.20, (CI 95% 1.40-3.46). No association was found between verbal fluency and incident dementia. It is possible to identify below par performance in constructive praxis and delayed recall tasks years before the onset of dementia-related cognitive decline, which implies that these evaluations, are adequate neuropsychological screening tools to detect subjects at risk to develop dementia. These tests are easy to implement, low-cost and applicable in population-based studies and in first-contact clinical contexts. References. [1] Alegret, M. et al. (2018) Journal of Alzheimer's Disease 62, 611–619 [2] Zhao et al. (2012) PLoS One. 7, (12) [3] Serra et al. (2014) Journal of Alzheimer's Disease 38, (2), 391-402.

Facial Expression Recognition Patterns in Mild and Moderate Alzheimer's Disease.

Facial expression recognition is one of the essential abilities for social cognition. We aimed to compare facial expression recognition among people with mild and moderate Alzheimer's disease (AD) and to identify which factors were associated with impairment according to disease severity. We included 52 participants with either mild or moderate AD. FACES includes four subtasks requiring matching expressions with picture stimuli (tasks 1 and 2), labelling emotions (task 3), and recognizing situations with evident emotional content (task 4). There were significant differences between groups in FACES global scores, task 2 and task 4. In the mild AD group, FACES global score was influenced by educational background and cognitive performance, task 1 was associated with comprehension and constructive praxis, task 2 was associated with cognitive flexibility, and task 3 was associated with word finding. In subtask 4, no significant associations were found after adjusting for level of cognitive decline. In the moderate AD group, the awareness of emotional state domain was associated with FACES global score, task 1 was associated with constructive praxis, task 3 was associated with neuropsychiatric symptoms, and task 4 was associated with the ability to recognize emotions through situations. No significant associations were found on task 2, after adjusting for level of cognitive decline. Our findings suggest emotional processing difficulties across AD stages. However, when participants needed to recognize the most preponderant emotion in a situation with evident emotional content, our results suggest that in both groups there was no influence of cognitive impairment.

Road Traffic Noise at the Residence, Annoyance, and Cognitive Function in Elderly Women.

The detrimental effects of traffic noise on cognition in children are well documented. Not much is known about the health effects in adults. We investigated the association of residential exposure to road traffic noise and annoyance due to road traffic noise with cognitive function in a cohort of 288 elderly women from the longitudinal Study on the influence of Air pollution on Lung function, Inflammation and Aging (SALIA) in Germany. Residential noise levels—weighted 24-h mean (LDEN) and nighttime noise (LNIGHT)—were modeled for the most exposed facade of dwellings and dichotomized at ≥50 dB(A). Traffic noise annoyance (day and night) was estimated by questionnaire. Cognitive function was assessed using the Consortium to Establish a Registry on Alzheimer’s Disease (CERAD-Plus) Neuropsychological Assessment Battery. The modeled noise levels were associated with impaired total cognition and the constructional praxis domain, independently of air pollution. Self-reported noise annoyance was associated with better performance in semantic memory and constructional praxis domains. This finding should be interpreted with caution since we could not control for potential confounding by hearing loss. Noise levels and annoyance were associated, but their health effects seemed mutually independent.

Efficacy of Cognitive Intervention Program for Persons with Mild Cognitive Impairment according to Cognitive Trainers

Objective：The aim of this study is to investigate the effects of cognitive training and cognitive trainer on cognitive function in persons with mild cognitive impairment (MCI). Methods：A randomized controlled single blind trial with 2 treatment groups was designed and 40 participants were included in this study. They received cognitive training intervention by cognitive professional and non-professional. The cognitive training focused on memory strategies. This cognitive intervention consisted of 8 sessions training and once a week. The effect of program was examined in performance-based measures of cognitive abilities; memory, language, constructional praxis, attention, and working memory. The comparison of effect of trainer was examined by repeated measure analysis of variance. Results：Thirty-six MCI completed the cognitive intervention and was assessed neurocognitive test on pre- and post-interven- tion. Attention, language inhibition and semantic language were significantly improved compared with baseline in total group. The memory (p=0.003) was significantly improved in Professional Program Group and attention (p=0.007) was significantly improved in Non-Professional Program Group (NPG). Distinctively, Korean version of Short form of Geriatric Depression Scale mean score in NPG was statistically improved from 4.24 to 3.29 (p=0.018) after intervention, but the comparison between groups was not significant. Conclusion：This study shows that the cognitive intervention program may improve on memory, attention and language in cognitive functions of MCI. But there is difference in improvement of the domains of cognitive abilities depending on the trainer.

Improvement in cognitive performance and mood in healthy older adults: a multimodal approach.

The aim of this research was to evaluate if being involved in a programme that integrates physical, mental, and social activities could help to reduce the impacts of cerebral ageing on cognitive functions. Fifty healthy adults over 65years of age and without cognitive impairment were randomly assigned to either an experimental or a control group; subjects were equally divided by age, sex, schooling, physical health, mood, and social integration. For 6months, the experimental group had biweekly meetings, participating in a multimodal approach based on a combination of simultaneous physical, mental, and social activities. At pre-test and post-test, both experimental and control subjects underwent a neuropsychological assessment, including tests to measure attention, verbal and spatial memory, language, constructional praxis, executive functions, processing speed, and intelligence. Furthermore, a visual analogue scale was used to examine well-being and mood states. Compared to the pre-test levels and the control subjects, the performance of subjects in the experimental group significantly improved in several neuropsychological tests, including attention, processing speed, memory, and executive functions, as well as mood state. Even in older subjects without cognitive impairments, a multimodal approach based on simultaneous physical, mental, and social activity can be a useful strategy that has beneficial effects on mood and cognition. The results suggest that an active lifestyle may protect against cognitive decline in ageing.

Transcranial direct current stimulation (tDCS) in elderly with mild cognitive impairment: A pilot study.

ABSTRACT.Transcranial direct current stimulation (tDCS) is a non-invasive, painless and easy-to use-technology. It can be used in depression, schizophrenia and other neurological disorders. There are no studies about longer usage protocols regarding the ideal duration and weekly frequency of tDCS.Objective:to study the use of tDCS twice a week for longer periods to improve memory in elderly with MCI.Methods:a randomized double-blind controlled trial of anodal tDCS on cognition of 58 elderly aged over 60 years was conducted. A current of 2.0 mA was applied for 30 minutes for 10 sessions, twice a week. The anode was placed over the left dorsolateral prefrontal cortex (LDLFC). Subjects were evaluated before and after 10 sessions by the following tests: CAMCOG, Mini-Mental State Examination (MMSE), Trail Making, Semantic Verbal Fluency (Animals), Boston naming, Clock Drawing Test, Word list memory (WLMT), Direct and Indirect Digit Order (WAIS-III and WMS-III) and N-back.Results:After 10 sessions of tDCS, significant group-time interactions were found for the CAMCOG - executive functioning (χ2 = 3.961, p = 0.047), CAMCOG - verbal fluency (χ2 = 3.869, p = 0.049), CAMCOG - Memory recall (χ2 = 9.749, p = 0.004), and WMLT - recall (χ2 = 7.254, p = 0.007). A decline in performance on the CAMCOG - constructional praxis (χ2 = 4.371, p = 0.037) was found in the tDCS group after intervention. No significant differences were observed between the tDCS and Sham groups for any other tasks.Conclusion:tDCS at 2 mA for 30 min twice a week over 5 consecutive weeks proved superior to placebo (Sham) for improving memory recall, verbal fluency and executive functioning in elderly with MCI.

Relevance of brain lesion location for cognition in vascular mild cognitive impairment.

BackgroundVascular mild cognitive impairment (VMCI) is a potentially transitional state between normal aging and vascular dementia. The presence of macroscopic white matter lesions (WML) of moderate or severe extension on brain MRI is the hallmark of the VMCI.ObjectiveTo assess the clinical relevance of the frequency of WML in patients with VMCI independently of total lesion volume (LV).MethodsIn this multicenter study, we included 110 patients with VMCI (age: 74.3 ± 6.6 years; sex: 60 women). Cognitive assessment was performed with the VMCI-Tuscany Neuropsychological Battery, which allowed to identify four VMCI groups: amnestic single (n = 9) and multi-domain (n = 76), non-amnestic single- (n = 10) and multi-domain (n = 15). Distribution and frequency of WML on MRI FLAIR images were evaluated with lesion probability map (LPM). Voxelwise statistics was performed with nonparametric permutation tests, controlling for age, sex, slice thickness, center, magnetic field strength, total LV and head size (p < .01, family-wise error-corrected for multiple comparisons across space).ResultsLPM of the WML had a fairly symmetric and widespread distribution across brain. A higher frequency of WML along association tracts of the WM such as inferior longitudinal fascicle, inferior fronto-occipital fascicle and superior longitudinal fascicle, was correlated with worst cognitive scores at the Trail Making Test Part A and Copy of the Rey–Osterrieth Complex Figure. The non-amnestic groups showed a higher frequency of WML in the anterior cingulum and superior longitudinal fascicle close to the frontal gyrus.ConclusionsOur study showed that in patients with VMCI, independently of total LV, the higher frequency of lesions along association tracts of the WM, which mediate intrahemispheric long-range connectivity, is related with psychomotor speed and constructional praxis. Moreover, a prevalence of lesions in the frontal WM seems to characterize VMCI patients with involvement of non-amnestic domains.

Variability of glycemia and cognitive impairment in patients with diabetes mellitus type 1.

Diabetes mellitus type 1 is associated with impaired cognitive function. Based on the results of systematic reviews and meta-analyzes, the most likely modifiable risk factor is the degree of metabolic control, in particular the variability of glycemia. Aims: to determine the influence of the variability of glycemia on cognitive functions in patients with type 1 diabetes mellitus. Material and methods. Design-observational, one-stage, cross-sectional research. We examined 30 patients with type 1 diabetes mellitus who were divided into 2 groups: 1 group (main) with cognitive impairment, and 2 (control) with normal cognitive functions. All patients were screened for cognitive functions using the Montreal scale (MoCa test). For the diagnosis of fluctuations in glucose level, continuous monitoring of glycemia was carried out using the iPro-2 device (Medtronic, USA): mean glycemic mean (MEAN), standard deviation (SD), mean amplitude of glycemic fluctuation (MAGE), long-term glycemic index (CONGA) Glycemia lability index (LI), hypoglycemia risk index (LBGI), hyperglycemia risk index (HBGI), mean hourly rate of glycemic change (MAG). Results. The study revealed that in patients with type 1 diabetes mellitus, cognitive impairment was dominated by a violation of constructive praxis, memory and attention. Recorded a significant difference in MEAN, SD, CONGA, Gindex, LBGI, HBGI, MAGE, Mvalue and MAG. Correlation analysis revealed the relationship of cognitive impairments with the level of HbA1c, as well as the variability parameters MEAN, SD, CONGA, Gindex, LBGI, HBGI, MAGE, Mvalue, MAG. Conclusions. The relationship between the variability of glycemia and cognitive impairment was registered in patients with type 1 diabetes mellitus

Seizure frequency and risk of cognitive impairment in people living with epilepsy in a sub-urban community in South Eastern Nigeria

This study is aimed at assessing the impact of seizure frequency on the cognitive performance of epileptic adult patients in a rural community in South Eastern Nigeria. A total of 51 patients with epilepsy (33 males and 18 females) with a mean age of 30.7 ± 12.1 years and 51 age and sex matched controls participated in this study. The cognitive performances of the people with epilepsy and controls were assessed using the Community Screening Interview for Dementia (CSID) and the computerized cognitive assessment test battery, the FePsy. The control group performed better in almost all the neurocognitive tests compared with the low seizure frequency (LSF) and high seizure frequency (HSF) groups. Analysis of covariance revealed that patients with LSF performed better (p = 0.04) in visual reaction time – dominant hand (VRT-D) compared with the HSF group. There was lack of significant differences in mean total CSID scores and mean sub-total scores for language, memory, orientation, attention, constructional praxis, auditory reaction time-dominant hand and non-dominant hand, VRT – non-dominant hand and figure recognition. HSF patients indicated significantly greater prevalence (80% vs. 20%; p = 0.020) and risk (OR, 8.0; 95% CI, 1.8–33.8)) of memory impairment, but not in the other neurocognitive domains compared with the LSF group. In conclusion, the present study indicated that adults with epilepsy performed poorly in a wide range of neurocognitive variables compared with the controls. However, no significant adverse effects of high seizure frequency were observed on almost all the neurocognitive variables.

Cognitive impairment in psychiatric patients in the United Arab Emirates

Cognitive impairment is central to the discussion of most psychiatric disorders, because of the implications it has for diagnostic, therapeutic, and rehabilitative progression. In the present study, we compared the levels of cognitive impairment between psychiatric patients and a healthy control group. Thirty psychiatric patients and 30 matching healthy controls participated in this study. Their ages ranged from 17 to 55 years (Mage = 29.17; SD = 8.87). The Brief Neuropsychological Cognitive Examination (BNCE) was used to measure cognitive impairment in both groups. A t-test revealed significant differences between the two groups for all Part I subtests (except comprehension), all Part II subtests, and the BNCE total score, with the patients showing greater cognitive impairment. A Kruskal-Wallis H-test also revealed significant differences in the orientation, comprehension, constructive praxis, shifting sets, attention, Part I total, Part II total, and BNCE total scores within the psychiatric patients: patients with schizophrenia consistently displayed significantly greater cognitive impairment compared to patients with mood, anxiety, and substance use disorders. Results need to be investigated further to clarify the nature of the relationship between mood disorders and orientation. Psychiatric patients may exhibit similar types of cognitive impairments but with different severity.

The Effectiveness of Reality Orientation Therapy in the Treatment of Parkinson Disease Dementia.

Patients with Parkinson disease dementia (PDD) have deficits resulting mainly from frontostriatal dysfunction. The aim of this study was to assess the effectiveness of reality orientation therapy (ROT) combined with drug therapy (acetylcholinesterase inhibitors) in PDD treatment and compare it with that of drug therapy alone. Patients (n = 12) with a diagnosis of PDD were divided into 2 groups: group A-drug therapy and ROT; group B-drug therapy alone. Reality orientation therapy was applied weekly for 6 months, and patients were assessed during the same period. Significant improvements in frontostriatal deficits were observed in the group that received the combined therapy, as shown mainly by the scores in verbal fluency in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery ( P = .02) and in attention in Scales for outcomes of Parkinson's Disease-Cognition ( P = .021) and Clock Drawing Test ( P = .037). Patients who received only medication had worse results in constructional praxis recall in the CERAD battery ( P = .037). Our results indicate that ROT may help in the treatment of frontostriatal cognitive deficits and can potentially be used to complement drug therapy.

Accuracy of praxis test from Cambridge Cognitive Examination (CAMCOG) for Alzheimer's disease: a cross-sectional study.

Praxis impairment may be one of the first symptoms manifested in dementia, primarily in cortical dementia. The Cambridge Cognitive Examination (CAMCOG) evaluates praxis, but little is known about the accuracy of CAMCOG for diagnosing dementia. The aims here were to investigate the accuracy of praxis and its subitems in CAMCOG (constructive, ideomotor and ideational subitems) for diagnosing Alzheimer's disease (AD) among elderly patients. Cross-sectional study on community-dwelling elderly people. 158 elderly patients were evaluated. CAMCOG, Mini-Mental State Examination and Pfeffer Functional Activities Questionnaire were used. ROC curve analysis was used to establish cutoff points. The total scores for praxis and the constructive subitem presented significant differences (P < 0.0001) between healthy elderly people and AD patients. Stage of dementia (clinical dementia rating, CDR = 0, 1 and 2) showed that total and constructive praxis can be used to classify the stages of dementia (mild and moderate cases), i.e. constructive praxis classified 88% of the patients with mild dementia (P < 0.0001) while total praxis classified 56% with moderate dementia. Comparison of normal controls (NC) and mild dementia cases showed specificity of 71% and sensitivity of 88% (AUC = 0.88; P < 0.0001). Some praxis subtests can have higher predictive diagnostic value for detecting Alzheimer's disease in mild stages (total praxis AUC = 0.858; P < 0.0001; constructive AUC = 0.972; P < 0.0001). Constructive praxis as measured using CAMCOG may contribute towards diagnosing dementia, because occurrence of impairment of praxis may help in recognizing an evolving dementia syndrome.

Jigsaw Puzzling Taps Multiple Cognitive Abilities and Is a Potential Protective Factor for Cognitive Aging.

Prevention of neurocognitive disorders is currently one of the greatest unmet medical challenges. The cognitive effects of solving jigsaw puzzles (JPs) have not been studied so far, despite its frequent use as a leisure activity in all age cohorts worldwide. This study aimed at closing this gap between a lack of science and a frequent real-world use by investigating the cognitive abilities recruited by JP as well as the cognitive benefits of lifetime and 30-day JP experience. A total of 100 cognitively healthy adults (≥50 years of age) were randomized to either a 30-day home-based JP intervention (≥1 h/day) plus four sessions of cognitive health counseling (JP group) or four sessions of cognitive health counseling only (counseling group). We measured global visuospatial cognition by averaging the scores of eight z-standardized visuospatial cognitive abilities (perception, constructional praxis, mental rotation, speed, flexibility, working memory, reasoning, and episodic memory). JP skill was assessed with an untrained 40 piece JP and lifetime JP experience with retrospective self-report. JP skill was associated with all assessed cognitive abilities (rs ≥ 0.45, ps < 0.001), and global visuospatial cognition (r = 0.80 [95% CI: 0.72–0.86], p < 0.001). Lifetime JP experience was associated with global visuospatial cognition, even after accounting for other risk and protective factors (β = 0.34 [95% CI: 0.18–0.50], p < 0.001). The JP group connected on average 3589 pieces in 49 h. Compared to the counseling group, they improved in JP skill (Cohen’s d = 0.38 [95% CI: 0.21–0.54], p < 0.001), but not in global visuospatial cognition (Cohen’s d = -0.08, [CI: -0.27 to 0.10], p = 0.39). The amount of jigsaw puzzling was related to changes in global visuospatial cognition within the JP group, only after accounting for baseline performance (β = 0.33 [95% CI: 0.02–0.63], p = 0.03). In sum, our results indicate that jigsaw puzzling strongly engages multiple cognitive abilities and long-term, but not short-term JP experiences could relevantly benefit cognition.Trial Registration: ClinicalTrials.gov Identifier: NCT02667314

Perfil neuropsicológico de pacientes com amputação maior de membros inferiores por etiologia vascular

Objetivo: O estudo objetivou traçar um perfil neuropsicológico breve de pacientes com amputação maior de membros inferiores por etiologia vascular e investigar a existência de correlações dos aspectos cognitivos com fatores sociodemográficos e clínicos. Método: Trata-se de um estudo transversal descritivo, realizado em um centro de reabilitação física de São Paulo - Brasil, em que foram aplicados: um instrumento de avaliação neuropsicológica breve (Neupsilin), um questionário de caracterização da amostra próprio e a Escala de Ansiedade e Depressão Hospitalar (HAD). Resultados: O desempenho cognitivo foi pior em funções que requerem habilidades aritméticas (42,2% dos pacientes com desempenho abaixo do esperado); percepção (46,3% dos pacientes abaixo do esperado); funções executivas, notadamente nas tarefas praxia construtiva (40,6% abaixo do esperado) e fluência verbal (35,9% abaixo do esperado), e linguagem (31,2% abaixo do esperado). Conclusão: O perfil cognitivo dos pacientes deste estudo revelou dificuldades relevantes das funções cognitivas avaliadas, especialmente em funções diretamente relacionadas à funcionalidade do paciente.