Early Detection Of Cognitive Impairment Research Articles

Validación de la versión en español del Addenbrooke's Cognitive Examination-Revisado (ACE-R)

Background The Addenbrooke's Cognitive Examination Revised (ACE-R) is an improved version of the earlier brief screening test which has been validated in English with high sensitivity and specificity to detect cognitive dysfunction. The aim of this study was to validate the Spanish version of the ACE-R in an Argentine population. Methods A group of patients with Alzheimer Disease (AD) and patients with behavioural variant Frontotemporal Dementia (bvFTD) paired by age, sex, and years of education with healthy controls were assessed using the ACE-R. Stage of dementia was measured with the Clinical Dementia Rating Scale (CDR). The English version of the ACE-R was first translated into Spanish and then back-translated into English by two blind independent experts. Results Internal reliability was very good (Cronbach's alpha = 0.89). Concurrent validity, determined by the correlation between total ACE-R and CDR was significant ( P < .001) and inter-rater reliability was excellent (Cohen's kappa = 0.98). Controls significantly outperformed AD and bvFTD patients on most subdomains of the ACE-R, with significant differences between the dementia groups. With a cut-off score of 85 points, sensitivity was 97.5% and specificity was 88.5%, with a likelihood ratio of 99.3 for the detection of dementia. The ACE-R showed higher sensitivity than the MMSE for the detection of dementia. Conclusions The Spanish version of the ACE-R is a brief yet reliable screening tool for the detection of early cognitive impairment and has shown to discriminate between bvFTD and AD.

A Preliminary Study of Speech Prosody-Based Relationship with HDS-R Scores Toward Early Detection of Cognitive Impairment in Elderly Using Speech Prosody

This paper presents a new trial approach to early detection of cognitive impairment in the elderly with the use of speech sound analysis and multivariate statistical technique. In this paper, we focus on the prosodic features from speech sound. Japanese 115 subjects (32 males and 83 females between ages of 38 and 99) participated in this study. We collected speech sound in a few segments of dialogue of HDS-R examination. The segments corresponds to speech sound that is answering for questions on time orientation and number backward count. Firstly, 130 prosodic features have been extracted from each of the speech sounds. These prosodic features consist of spectral and pitch features (53), formant features (56), intensity features (19), and speech rate and response time (2). Secondly, these features are refined by principal component analysis and/or feature selection. Lastly, we have calculated speech prosody-based cognitive impairment rating (SPCIR) by multiple linear regression analysis. The results indicated that there is moderately significant correlation between HDS-R score and synthesis of several selected prosodic features. Consequently, adjusted coefficient of determination R2=0.50 suggests that prosody-based speech sound analysis has possibility to screen the elderly with cognitive impairment.

Validation of the Spanish Version of the Addenbrooke's Cognitive Examination-Revised (ACE-R)

Background The Addenbrooke's Cognitive Examination Revised (ACE-R) is an improved version of the earlier brief screening test which has been validated in English with high sensitivity and specificity to detect cognitive dysfunction. The aim of this study was to validate the Spanish version of the ACE-R in an Argentine population. Methods A group of patients with Alzheimer Disease (AD) and patients with behavioural variant Frontotemporal Dementia (bvFTD) paired by age, sex, and years of education with healthy controls were assessed using the ACE-R. Stage of dementia was measured with the Clinical Dementia Rating Scale (CDR). The English version of the ACE-R was first translated into Spanish and then back-translated into English by two blind independent experts. Results Internal reliability was very good (Cronbach's alpha=0.89). Concurrent validity, determined by the correlation between total ACE-R and CDR was significant ( P<.001) and inter-rater reliability was excellent (Cohen's kappa=0.98). Controls significantly outperformed AD and bvFTD patients on most subdomains of the ACE-R, with significant differences between the dementia groups. With a cut-off score of 85 points, sensitivity was 97.5% and specificity was 88.5%, with a likelihood ratio of 99.3 for the detection of dementia. The ACE-R showed higher sensitivity than the MMSE for the detection of dementia. Conclusions The Spanish version of the ACE-R is a brief yet reliable screening tool for the detection of early cognitive impairment and has shown to discriminate between bvFTD and AD.

Treatment options of cognitive impairment in multiple sclerosis

Multiple sclerosis (MS) is a progressive disease of the CNS, characterized by the production of widespread lesions in the brain and spinal cord. Inflammatory demyelination has traditionally been seen as the main disease process in MS; however, axonal damage or loss is increasingly being documented to occur early in the disease. Cognitive deficits can occur independently of physical disability, which complicates their identification and recognition. More recently, cortical demyelination has been identified among possible causes of cognitive impairment in MS. Neuropsychological studies have consistently demonstrated that 40-65% of patients with MS experience cognitive dysfunction, particularly in recent memory, information processing speed, and sustained attention. Early detection of cognitive impairment is essential to enable therapeutic intervention to alleviate symptoms or prevent further cognitive decline, although how best to manage MS-related cognitive impairment is currently unclear. Treatment strategies for cognitive impairment in MS are still in their infancy. This article will summarize several pharmacological attempts to enhance cognitive performances in people with MS.

Diffusion Tensor Imaging Changes Correlate with Cognition Better than Conventional MRI Findings in Patients with Subcortical Ischemic Vascular Disease

Background/Aims: To investigate whether diffusion tensor imaging (DTI) is more sensitive than conventional MRI at detecting cognitive deterioration in patients with subcortical ischemic vascular disease (SIVD). Methods: Forty-two SIVD patients had a diagnosis of no cognitive impairment (NCI), vascular cognitive impairment/no dementia or vascular dementia (VaD). Whole-brain DTI histography and routine MRI were performed on these participants. Results: There were significant differences between cognitively impaired patients and NCI subjects in mean diffusivity and fractional anisotropy in either whole-brain white matter (WBWM) or in normal-appearing white matter (NAWM). All DTI indices within either WBWM or NAWM were found to be significantly correlated with both the attention-executive and memory measures in SIVD subjects. Lacune numbers and T₂-weighted lesions correlated only with attention-executive measures, whereas hippocampal volumes correlated only weakly with memory measures. Whole-brain gray matter volumes correlated with Z scores for all cognitive domains but language. After VaD patients had been excluded from the analysis, cognitive measures remained significantly correlated with some of the DTI indices, but not with conventional MRI findings. Conclusions: Compared with conventional MRI, whole-brain DTI is a more reliable and sensitive technique for the early detection of cognitive impairment in SIVD patients.

The Computerized Self Test (CST): An Interactive, Internet Accessible Cognitive Screening Test For Dementia

The computer self test (CST) is an interactive, internet-based instrument designed to assess functional cognitive domains impaired by Alzheimer's disease (AD) and mild cognitive impairment (MCI). This study consisted of 215 total subjects with a mean age of 75.24. The 84 cognitively impaired patients (excluding patients diagnosed as MCI) met all criteria set forth by NINCDS/ADRDA for the diagnosis of AD. Control participants consisted of 104 age-matched individuals who were cognitively unimpaired. All patients completed the CST prior to other routine neurocognitive procedures. The CST accurately classified 96% of the cognitively impaired individuals as compared to controls, while the Mini-Mental Status Examination (MMSE) accurately classified 71% and the Mini-Cog 69% in the same respect. In addition, the CST accurately classified 91% of the six experimental groups (control, MCI, early AD, mild to moderate, moderate to severe, and severe) as compared to 54% for the MMSE and 48% for the Mini-Cog. In conclusions, the CST demonstrates a high degree of sensitivity and specificity and is capable of accurately identifying cognitive impairment in patients with variable degrees of cognitive abnormality. This interactive internet-based cognitive screening tool may aid in early detection of cognitive impairment in the primary care setting. The ease of use and interpretation may also provide the means to obtain an accurate baseline from which to monitor cognitive changes over time.

Plasma Pentraxin 3, but not High-sensitivity C-reactive Protein, is a Useful Inflammatory Biomarker for Predicting Cognitive Impairment in Elderly Hypertensive Patients

Due to the increasing longevity of human populations worldwide, there is need of a useful biomarker for the early detection of cognitive impairment in elderly persons. Both high blood pressure (BP) and inflammatory processes have been reported to be involved in cognitive impairment via cerebrovascular atherosclerosis or neuronal cell damage. In this cross-sectional study of 210 ambulatory elderly hypertensive patients without clinically evident dementia (mean age: 74 years; 44% men), we measured 24-hour BP, circulatory pentraxin 3 (PTX3) and high-sensitivity C-reactive protein (hs-CRP) levels, and cognitive function (Mini-Mental State Examination [MMSE]). A high plasma PTX3 level was observed in lean subjects, especially in those whose current body weight was lower than that measured 5 years earlier, whereas a high hs-CRP level was associated with obesity (all p < .05). Both PTX3 and hs-CRP levels were significantly associated with the MMSE score (r = -.248, p<0.001 and r = -.153, p<0.05, respectively); however, in multiple regression analysis, the PTX3 level, but not the hs-CRP level, was inversely associated with the MMSE score independently of patient demographics, glucose and lipid metabolic parameters, 24-hour systolic BP (SBP) level, and the atherosclerotic burden (all p < .05). Moreover, there was a significant interaction between the PTX3 and 24-hour SBP levels in the determinants of MMSE score (p < .05). A high plasma PTX3 level in elderly hypertensive patients, particularly in those with a high 24-hour BP level, could be a significant predictor of cognitive impairment. A high PTX3 level may be a marker of frailty in elderly hypertensive patients.

Early detection of cognitive impairment in type 2 diabetes mellitus

Objective To explore the methods for early detection of cognitive impairment in type 2 diabetic patients. Methods With the results from the mini-mental state examination (MMSE) ,48 patients of type 2 diabetes mellitus with cognitive impairment (group B) and 52 without cognitive impairment (group A) wereenrolled. And 40 healthy subjects served as control. The clinical, laboratory, and imaging data of these subjects were compared. Results No differences in the prevalence of carotid atherosclerosis, serum HbA_1C, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesteroi, body mass index, and waist-to-hip ratio were found between groups A and B. Atrophy of temporal lobe and hippocampus was more marked in group A than that in group B by MRI. The demyelinating changes were found both in group B (35%)and A (12%). Among 3 groups, group B had the longest latency of mismatch negativity (MMN) and P300 and the lowest amplitude of MMN ; the order was followed by group A and control group (all P<0.05). Logistic regression analysis showed that the findings in MRI, P300, MMN were negatively correlated with cognitive impairment in type 2 diabetes mellitus. Conclusion MRI, MMN, and P300 are helpful in detecting cognitive impairment in type 2 diabetic patients. MMN seems to be more sensitive in early detection of the impairment. Key words: Diabetes mellitus, type 2 ; Cognitive impairment; Mismatch negativity

Carotid artery intima media thickness a predictor of cognitive impairment

The conversion rate of cognitive impairment to Alzheimer's disease is 1 to 25% per year. Early detection of cognitive impairment will thus become a major concern, particularly when pharmacological intervention for preventing or delaying conversion will prove effective. If simple carotid artery intima media thickness (IMT) measurements were to predict cognitive impairment, IMT could become one of the detection tools, as it is inexpensive, reliable and non-invasive. Since no review paper on this subject is available, a systematic review of the literature was performed. Twenty studies were identified evaluating the association between IMT and cognitive impairment and fourteen found a significant association after multivariate analysis. However, currently no definitive evidence of an association between increased IMT and cognitive impairment can be established. A consensus regarding the precise definition of cognitive impairment, and standardized methods to assess early cognitive impairment alongside a consensus for IMT measurement are needed in future epidemiological studies on the relationship between IMT and cognitive impairment.

The exploration & forensic analysis of computer usage data in the elderly.

Unobtrusive in-home computer monitoring could one day be used to deliver cost-effective diagnostic information about the cognitive abilities of the elderly. This could allow for early detection of cognitive impairment and would additionally be coupled with the cost advantages that are associated with a semi-automated system. Before using the computer usage data to draw conclusions about the participants, we first needed to investigate the nature of the data that was collected. This paper represents a forensics style analysis of the computer usage data that is being collected as part of a larger study of cognitive decline, and focuses on the isolation and removal of non user-generated activities that were recorded by our computer monitoring software (CMS).

Unobtrusive assessment of activity patterns associated with mild cognitive impairment

Background Timely detection of early cognitive impairment is difficult. Measures taken in the clinic reflect a single snapshot of performance that might be confounded by the increased variability typical in aging and disease. We evaluated the use of continuous, long-term, and unobtrusive in-home monitoring to assess neurologic function in healthy and cognitively impaired elders. Methods Fourteen older adults 65 years and older living independently in the community were monitored in their homes by using an unobtrusive sensor system. Measures of walking speed and amount of activity in the home were obtained. Wavelet analysis was used to examine variance in activity at multiple time scales. Results More than 108,000 person-hours of continuous activity data were collected during periods as long as 418 days (mean, 315 ± 82 days). The coefficient of variation in the median walking speed was twice as high in the mild cognitive impairment (MCI) group (0.147 ± 0.074) as compared with the healthy group (0.079 ± 0.027; t 11 = 2.266, P < .03). Furthermore, the 24-hour wavelet variance was greater in the MCI group (MCI, 4.07 ± 0.14; healthy elderly, 3.79 ± 0.23; F = 7.58, P ≤ .008), indicating that the day-to-day pattern of activity of subjects in the MCI group was more variable than that of the cognitively healthy controls. Conclusions The results not only demonstrate the feasibility of these methods but also suggest clear potential advantages to this new methodology. This approach might provide an improved means of detecting the earliest transition to MCI compared with conventional episodic testing in a clinic environment.

Influence of chronic use of betablockers on cognitive function of chronic heart failure patients

Background: Cognitive impairment is a common condition in chronic heart failure (CHF), and is a marker of poor outcome and disability. Although the cause of this condition is not clear, previous studies have shown that mental status could improve with medical treatment, however there is little information about the effect of betablockers on cognitive function of CHF patients. Aims and Methods: To evaluate the influence on cognitive function of chronic use of betablockers (defined as >3 months of therapy with this drugs), 77 consecutive patients followed in our nurse-led HF clinic underwent clinical and psychosocial examination, blood chemistry, echocardiography, and mini mental state examination (MMSE). Patients with chronic use of betablockers were designed as group A and patients with less than 3 months or no use were designed as group B. Results: Baseline characteristics were: mean age 69.5±8.8 years, 56% were men, 44% had NYHA functional class III-IV, impaired left ventricular ejection fraction was present in 75% and heart failure etiology was ischemic in 50% of patients, mental status evaluation was abnormal (MMSE 70% low risk of having abnormal cognitive function. Conclusions: Chronic use of betablockers is associated with better cognitive function in patients with CHF, the high rate of prescription of these drugs and early detection of cognitive impairment should be fundamental tasks in HF units.

Cholinergic stimulation improves autonomic balance and hemodynamic profile during dynamic exercise in heart failure

Background: Cognitive impairment is a common condition in chronic heart failure (CHF), and is a marker of poor outcome and disability. Although the cause of this condition is not clear, previous studies have shown that mental status could improve with medical treatment, however there is little information about the effect of betablockers on cognitive function of CHF patients. Aims and Methods: To evaluate the influence on cognitive function of chronic use of betablockers (defined as >3 months of therapy with this drugs), 77 consecutive patients followed in our nurse-led HF clinic underwent clinical and psychosocial examination, blood chemistry, echocardiography, and mini mental state examination (MMSE). Patients with chronic use of betablockers were designed as group A and patients with less than 3 months or no use were designed as group B. Results: Baseline characteristics were: mean age 69.5±8.8 years, 56% were men, 44% had NYHA functional class III-IV, impaired left ventricular ejection fraction was present in 75% and heart failure etiology was ischemic in 50% of patients, mental status evaluation was abnormal (MMSE 70% low risk of having abnormal cognitive function. Conclusions: Chronic use of betablockers is associated with better cognitive function in patients with CHF, the high rate of prescription of these drugs and early detection of cognitive impairment should be fundamental tasks in HF units.

Screening of Mild Cognitive Impairment in Chinese Older Adults – A Multistage Validation of the Chinese Abbreviated Mild Cognitive Impairment Test

Objective: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. Methods: The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months’ follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. Results: The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (χ² test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. Conclusion: The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.

Adherence to Medication in Patients with Dementia

Measures to facilitate patient medication adherence should be considered an integral part of the comprehensive care of older patients with multiple diseases. However, impairment of cognitive functions and dementia, in particular, may substantially compromise adherence behaviour. Therefore, a literature review was performed to identify factors associated with adherence to medication in patients with cognitive impairment or dementia, and to discuss strategies for improvement of non-adherence. Evidence-based information on how to deal with adherence to medication in patients with dementia is scarce because of a lack of specific studies. However, there is increasing knowledge about factors influencing medication adherence behaviour in older age, and emerging insight into the relationships between adherence behaviour and cognitive capacity, memory and executive function, in particular. Nevertheless, understanding elderly persons' strategies for maintaining regular use of even complex drug regimens is still limited. Progress of research in this field is needed. It is notable that measures to improve adherence consist of combinations of educational interventions and cognitive support but assessment of study participants' cognitive function is rare. In clinical practice, awareness of non-adherence as a result of cognitive impairment is relatively low. The most important step is early detection of cognitive impairment when this is impacting negatively on medication management. A practical geriatric screening test is recommended to identify memory problems and further functional impairments associated with cognitive impairment. Performance-based assessments might be useful for screening medication management capacity, in addition to a careful drug history, inspection of all medicines used (including over-the-counter drugs) and proxy information. However, no feasible screening methods have as yet found their way into clinical practice. Patients with impaired executive function, lack of awareness of illness and personality traits such as independency and high self-confidence may be at particular risk of non-adherence. The question is when to switch patient medication self-management to another person's responsibility if cognitive decline progresses. Further research is needed on measures to differentiate cognitive function and the relationships between memory concerns, memory strategy use and medication management. Also, studies evaluating the influence of personal support, health status and depression on the memory strategies used are needed. It is important to assess patients' attitudes toward medication and their relationship with proxies. Strategies for facilitating medication adherence in patients with dementia include prescribing as few medicines as possible, tailoring dose regimens to personal habits, and coordinating all drug dosing schedules as much as possible. When providing medication organizers, it is important to observe the patient's ability to use devices appropriately. In addition, automated computer-based reminding aids, online medication monitoring and telemonitoring may be helpful for patients with mild dementia. The decision as to when assistance with medication self-management is needed has to be made taking into account patient independency and safety aspects. This holds true for medicines with a narrow therapeutic range, in particular. Interactions among the individual patient's cognitive status, mood, level of self-efficacy and particular living situation must also be taken into consideration when searching for the optimal medication adherence strategy. No evidence-based recommendations can be given as yet. However, comprehensive assessment of the individual patient and careful consideration of all potential drug-related problems will probably help facilitate adherence and prevent compromised health outcomes in patients with dementia.

Cognitive impairment in Aboriginal people with heavy episodic patterns of alcohol use

With chronic alcohol abuse, cognitive studies suggest that progressive cognitive decline may precede more serious and irreversible neurological syndromes. The early detection of cognitive impairment may therefore aid in the prevention of permanent brain damage. Despite the devastating consequences of alcohol abuse among Aboriginal Australians, the effects on brain function have never been studied in this population and a lack of appropriate assessment tools has prevented the development of such research. To determine the impact of long-term and heavy episodic alcohol use on cognitive function in Aboriginal people. Cross-sectional comparing heavy episodic alcohol users with non-alcohol users. Two remote Aboriginal communities in north-east Arnhem Land, northern Australia. The control group consisted of 24 non-drinkers (15 males, nine female) and the heavy episodic group consisted of 20 people (19 males, one female) who had been drinking alcohol in a heavy episodic style (median 14 drinks per occasion) for a mean of 8.9 years (SD = 5.0). Interview to obtain demographic information, substance abuse history and symptoms of mental health and wellbeing, together with a computerized cognitive assessment battery (CogState Ltd). Compared with non-drinkers, heavy episodic drinkers showed reduced psychomotor speed (P = 0.04) and reduced accuracy when performing tasks of attention (P = 0.045), working memory (P = 0.04), implicit memory (P = 0.03) and associate learning and memory (P = 0.001). Specific cognitive abnormalities that suggest frontostriatal abnormalities and have been observed in association with chronic alcoholism in other populations were observed among Aboriginal Australians who were heavy episodic alcoholic users.

Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications. Four primary care clinics in a university-affiliated primary care network. A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data. Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age. Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients.

P2-188: Prediction of cognitive impairment among elderly persons using a brief cognitive screening battery

Early detection of cognitive impairment among the elderly is becoming increasingly important. There is a need for brief measures that can reliably predict the presence of clinically significant cognitive impairment. To decipher which brief cognitive tests most reliably predict cognitive impairment, particularly amnestic Mild Cognitive Impairment (aMCI), among elderly persons. Participants aged 70+ with normal baseline cognitive functioning were subsequently administered yearly 30–35 minute cognitive screening batteries, including the Modified Mini Mental State Examination (3MSE), generative verbal fluency (supermarket items), Narratives from the Rivermead Behavioral Memory Test (RBMT), Brief Visuospatial Memory Test, Revised (BVMT–R), Hopkins Verbal Learning Test, Revised (HVLT–R), digit span (DS), and the Geriatric Depression Scale (GDS). When participants' scores on these measures fell below pre–specified cut points, a more expansive dementia evaluation was triggered to assist in diagnosing the presence and extent of cognitive impairment. Scores on the cognitive screening measures were entered into a stepwise logistic regression analysis to predict outcome of the dementia evaluation. The 3MSE, RBMT delay, HVLT–R delay, DS backward, and GDS were identified as significant predictors of normal versus impaired cognitive functioning. However, when participants with normal cognitive functioning were compared only to those with aMCI, the 3MSE and RBMT delay were the only significant predictors. Furthermore, only the 3MSE was identified as a significant predictor of aMCI versus Alzheimer's disease (AD). Brief cognitive screening measures are capable of differentiating between normal and impaired cognitive functioning upon more in–depth cognitive evaluation. The fact that fewer and less diverse measures reliably predicted cognitive impairment when the outcome was narrowed to normal versus aMCI supports the notion that diverse cognitive impairment can result from a variety of factors among the elderly. This finding also highlights the benefit of using certain screening measures to assist in differentiating aMCI from other forms of cognitive impairment. Results of this study further suggest that some measures are not helpful in predicting dementia evaluation outcome. Thus, their utility in triggering a dementia evaluation should be further examined. Overall results of this study have implications for the effective early evaluation and diagnosis of aMCI.

Screening for Cognitive Impairment: A Triage for Outpatient Care

The current increase in aged individuals in number and proportionof the general population warrants dependable strategies to improve early detection of cognitive impairment. It was the goal of the present study to develop a triage for bedside testing and outpatient ser vices. In a prospective clinical cohort study at the outpatient Memory Clinic, University of Ulm, Germany, 232 subjects were diagnosed with Alzheimer’s disease [AD; NINCDS-ADRDA criteria; n = 66; age 65.9 ± 7.3 years (mean ± SD); Mini Mental State Examination (MMSE) score 23.4 ± 4.1], mild cognitive impairment (MCI; criteria of Petersen et al.; n = 48; age 66.4 ± 7.1 years; MMSE score 28.3 ± 1.5), and major depressive disorder (DSM-IV criteria; n = 61; age 63.4 ± 8.0 years; MMSE score 28.6 ± 1.6). Diagnosis was secured with extensive neuropsychological, clinical, radiological, and laboratory investigations. Six brief screening tests including the Memory Impairment Screen (MIS), Letter Sorting Test (LST), Verbal Fluency (VF), and Clock Drawing Test (CDT) were assessed independently from the diagnostic procedure. We compared single items and composite scores. LST yielded a diagnostic accuracy of 0.81 and 0.62 for AD and MCI patients versus controls, respectively. With the MIS, diagnostic accuracy was 0.89 and 0.71, respectively. With a combination of LST, MIS, VF, and CDT, a sensitivity for AD and MCI patients of 1.00 and 0.83 was achieved. Thus, single-item screening (e.g. LST, VF) taking little more than 1 min and suitable for bedside testing or brief screening in the general practitioner’s office yields diagnostic accuracy comparable to standard laboratory tests for other diseases. A composite of screening tests suitable for application in general outpatient care in neurological and psychiatric services reliably detects patients with AD and MCI.

Clinical identification of cognitive impairment in ICU survivors: insights for intensivists.

BackgroundA growing body of research has demonstrated the presence of ongoing cognitive impairment in large numbers of ICU survivors.ObjectiveThis review offers a practical framework for practicing intensivists and those following patients after their ICU stay for the identification of cognitive impairment in ICU survivors.ConclusionsEarly detection of cognitive impairment in critically ill patients is an important and achievable goal, but overt cognitive impairment remains unrecognized in most cases. However, it can be identified by objective (test scores) or subjective evidence (clinical judgment, patient observation, family interaction).