Major Neurocognitive Disorder Research Articles

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

A neuropsychological profile for high-grade primary central nervous system neuroendocrine tumor (CNS NET): a single-case study.

Objective: Neuroendocrine tumors (NETs) are neoplasms that primarily occur in the lungs, appendix, small intestine, pancreas, and rectum, and typically metastasize to the liver or lymph nodes. However, in rare cases NETs can originate in the central nervous system (CNS). Understanding primary CNS NET neuropsychological manifestations aids in recommendations for neurocognitive follow-up, treatment and lifestyle planning, and future research. Method: Given the dearth of neuropsychological research for CNS NETs, we present a case seen in a 43-year-old woman. Results: Initial and 8-month follow-up neuropsychological evaluations of the patient revealed a Major Neurocognitive Disorder where the pattern of findings was consistent with tumor location and additional treatment-related factors. Reliable change indices at her re-evaluation revealed declines in verbal and visual memory, with statistical, yet not clinical, improvements in different domains. Follow-up monitoring of comprehensive care continued to occur after neuropsychological evaluations. Conclusions: This case study assists in the characterization of initial and follow-up neuropsychological presentation of a primary CNS NET, where evaluations helped inform clinical care and functional recommendations. This case demonstrates the importance for neuropsychologists to have awareness of various conditions, even rare conditions, which can inform a systematic approach to research and clinical care with neuro-oncological populations.

The relationship between dehydration and etiologic subtypes of major neurocognitive disorder in older patients.

Studies investigating associations between etiologic subtypes of major neurocognitive disorder (MND) and dehydration frequency are lacking. The aim of this study was to investigate the prevalence and risk factors of dehydration among older adults with and without MND (dementia), and across different etiologic subtypes of MND. This cross-sectional study included adults aged ≥ 65years old from one geriatric outpatient clinic. Dehydration was defined as a calculated [1,86 × (Na + K) + 1,15 × glucose + urea + 14] plasma osmolarity of > 295mOsm/L.Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. MND was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria. The underlying etiologic subtypes were determined by specific diagnostic criteria. Of the 1377 patients 72% were female, the mean age was 80 ± 8years, and 575 had dementia. Dehydration was more common in patients with dementia than those without dementia (58% vs. 53%, p = 0.044). The prevelance of dehydration was 57%, 62%, 54%, 57% and 68% in Alzheimer's disease, Parkinson's disease dementia, fronto-temporal dementia, dementia with Lewy bodies, and vascular dementia, respectively (p ≥ 0.05). MND was associated with dehydration (OR 1.26, 95% CI 1.01-1.57; p = 0.037) after adjustment for age and sex. In multivariable analysis, among patients with dementia, hypertension, DM, CKD, and dysphagia were more common while mean Mini-Mental State Examination score was lower in those who had dehydration versus no dehydration in older patients with dementia (p < 0.05). Dehydration is slightly associated with the presence of MND independent of age and sex. However, dehydration is also quite common in older patients without cognitive disorders. Therefore, hydration status should be monitored in older adults irrespective of neurocognitive status. Hypertension, DM, CKD, dysphagia and severity of cognitive dysfunction were associated with dehydration in patients with dementia. The prevalence of dehydration is highest in patients with vascular dementia.

A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions.

Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

Lithium Exposure and Risk of Major Neurocognitive Disorders: A Systematic Review and Meta-analysis.

Published studies on the association between lithium use and the decreased risk of major neurocognitive disorders (MNCDs) have shown disparities in their conclusions. We aimed to provide updated evidence of this association. A comprehensive literature search was performed in PubMed, EMBASE, and Cochrane Library from inception until August 31, 2023. All the observational studies evaluating the association between lithium use and MNCD risk were eligible for inclusion. Pooled odds ratios (ORs) and 95% prediction intervals were computed using random-effects models. Eight studies with 377,060 subjects were included in the analysis. In the general population on the association between lithium use versus nonuse and dementia, the OR was 0.94 (95% confidence interval [CI] = 0.77-1.24). Further analysis also demonstrated that lithium use was not associated with an increased risk of Alzheimer's disease (OR = 0.69, 95% CI: 0.31-1.65). When the analysis was restricted to individuals with bipolar disorder to reduce the confounding by clinical indication, lithium exposure was also not associated with a decreased risk of MNCD (OR = 0.9, 95% CI = 0.71-1.15). The results of this systematic review and meta-analysis do not support a significant association between lithium use and the risk of MNCD.

Functional Status in Relation to Common Geriatric Syndromes and Sociodemographic Variables - A Step Forward Towards Healthy Aging.

Geriatric syndromes (GS) are prevalent in the older population, with an impact on morbidity and disability. This study aimed to investigate the prevalence of functional dependence and ten GS in community older adults and to examine the different associations between these syndromes and sociodemographic variables and their impact on functional dependence. A cross-sectional study of 342 outpatients seen at the geriatric clinic in the period 2015-2023. The mean age was 75±7.4. One-third had functional dependence and 96.2% had at least one GS. The mean number of GS was 3.11±1.74, ranging from 2.56±1.67 in the 60s to 3.55±1.70 in octogenarians. The most common GS found were polypharmacy (79.5%), musculoskeletal pain (49.7%), and Major Neurocognitive Disorder (MND) (32.7%). Polypharmacy was significantly associated with female sex and chronic pain, whereas sensory impairment was associated with male sex. MND, dizziness, and urinary incontinence were the only GS that significantly predicted functional dependence and were typically associated with increasing age. Functional dependence increases as individuals age, paralleled by increases in MND, urinary incontinence, dizziness, sensory impairment, and constipation. Notably, only MND, incontinence, depression, and dizziness were significant predictors of functional dependence. Consequently, it is imperative to screen older adults presenting with these syndromes for early signs of functional decline to optimize their function and avert subsequent dependence, morbidity, and mortality.

Interest of a hospital-based geriatric living lab among inpatients with neurocognitive disorders: the ALLEGRIA cross-sectional study.

The objectives of this study were to determine the participation rates, levels of engagement and abilities to answer User eXperience (UX) questionnaires according to the presence and severity of major neurocognitive disorders (MNCD) among participants involved in gerontechnological experimentations within a hospital-based geriatric clinical living lab. Cross-sectional analysis examining all consecutive geriatric patients involved in the Allegro living lab experimentations, separated according to the presence and severity of MNCD. Participation rates were assessed using the "Task-Based Experiment"-type User eXperience (TBE-UX). Participation was considered successful if patients fully completed the TBE-UX experimental procedure. Engagement level was characterized using a five-point scale: Interactive, Constructive, Active, Passive and Disengaged. The abilities to answer UX questionnaires were characterized using a five-point scale from "no completion" to "completion in autonomy". 313 patients were included. All patients without MNCD and with mild MNCD fully completed the TBE-UX procedures. Their engagement behaviors were rather active and constructive. All patients without MNCD and 88% of those with mild MNCD were able to fully complete the UX questionnaires. 96.2% of the patients with moderate MNCD fully followed the TBE-UX procedures. Their engagement behaviors were mainly active or passive. 64.2% were able to fully complete the UX questionnaires. 76.5% of the patients with severe MNCD fully followed the TBE-UX procedures. Their engagement behaviors were mainly passive or disengaged. 35.3% were able to fully complete the UX questionnaires. Living lab experimentations appear feasible with older adults, even with those with MNCD. Task support can be offered to those with severe MNCD.

Cluster analysis dissecting cognitive deficits in older adults with major depressive disorder and the association with neurofilament light chain

BackgroundCognitive impairment is a growing problem with increasing burden in global aging. Older adults with major depressive disorder (MDD) have higher risk of dementia. Neurofilament light chain (NfL) has been proven as a potential biomarker in neurodegenerative disease, including dementia. We aimed to investigate the association between cognitive deficits and NfL levels in older adults with MDD.MethodsIn this cross-sectional study, we enrolled 39 MDD patients and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer’s type, as controls, from a tertiary psychiatric hospital. Both groups were over age 65 and with matched Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and each cognitive domain.ResultsIn the MDD group, participants had higher rate of family psychiatry history and current alcohol use habit compared with controls. Control group of neurocognitive disorders showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits clustered with that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster.ConclusionsWe noted the negative correlation between NfL levels and cognition in MDD patients clustered with neurodegenerative disorder, Alzheimer’s type. NfL could be a promising candidate as a biomarker to predict subtype of patients in MDD to develop cognitive decline. Further longitudinal studies and within MDD cluster analysis are required to validate our findings for clinical implications.

Catatonia in patients with dementia: A descriptive study of clinical profiles and treatment response

BackgroundCatatonia is a highly prevalent syndrome in patients presenting with major neurocognitive disorders (dementia). In this study, we aim to provide a comprehensive description of the clinical and therapeutic aspects of catatonia in patients with dementia. MethodThis descriptive study, conducted between September 2015 and June 2022, collected data from 25 patients diagnosed with dementia, out of 143 patients treated for catatonia in our specialized psychiatry department. We collected sociodemographic, clinical and treatment data for each patient. ResultsDementia patients constituted 17% of the catatonic cases. Predominantly female, the cohort had a mean age of 65. Diagnoses included Alzheimer’s (4 patients, 17%) and Parkinson’s (1 patient, 4%) diseases, Lewy body dementia (5 patients, 21%), vascular dementia (4 patients, 17%) and frontotemporal lobar degeneration (10 patients, 41%). The mean Bush-Francis Catatonia Rating Scale score upon admission was 20/69. Overall, complete remission of catatonia was achieved in 75% of patients (n=18), with only 13% (n=3) responding to lorazepam alone, while others required additional interventions such as electroconvulsive therapy (ECT) and/or amantadine. Vascular dementia was predominantly observed in cases resistant to treatment. ConclusionThe findings indicate a frequent co-occurrence of catatonia and dementia, highlighting treatability yet suggesting a potential for resistance to lorazepam, which varies by dementia diagnosis. Investigating the mechanisms underlying this resistance and the variability in treatment response is crucial for developing more precise therapeutic strategies.

Assessment of Behavioral and Psychological Symptoms in Dementia, Associated Risk Factors and Clinical Correlates

Background: The presence of behavioral and psychological symptoms in dementia (BPSD) are associated with hospitalization, rapid cognitive decline, poor quality of life and higher caregiver burden. Thus, we aim to characterize the BPSD symptoms, its relationship to dementia-related risk factors and their predictive value, if any.Methodology: In 48 adults (mean age: 70.27 ± 10.08) with major neurocognitive disorder (MNCD) as per diagnostic and statistical manual of mental disorders, 5th edition and with Hindi mental status examination scores less than or equal to 23 were recruited. Patients were assessed for cognition by hindi Montreal cognitive assessment (HMOCA) and the clinical dementia rating scale (CDR). BPSD and caregiver burden were assessed using the neuropsychiatric inventory (NPI) and burden assessment schedule (BAS). The correlation of NPI scores with socio-demographic variables and clinical variables was assessed. A forward stepwise linear regression (using p-value &lt; .05) was used to identify possible predictors of the NPI scores.Results: The majority of participants were predominantly males, 25 (52.1%), from urban regions, belonged to middle-class socio-economic status and had severe grading (HMOCA (&lt; 10) of MNCD (25 (52.2%) but had moderate caregiver burden (25 (52.2%)). The most common MNCD type was due to Alzheimer’s disease (22 (45.8%)). Cortical atrophy and ischemic infarcts were the most common neuroimaging abnormalities reported (7 (14.9%)). Mean HMOCA, clinical dementia rating scale (CDR), NPI and BAS scores were 9.13 ± 6.96, 1.50 ± 1.05, 41.79 ± 27.06 and 68.65 ± 22.84, respectively. The most common BPSD domains were sleep disturbance (60.4%) and hallucinations (56.25%). Among the established risk factors, hypertension was present in the highest proportion (21 (43.8%)). As per the stepwise logistic regression model CDR scores, smoking status and HTN were predicted risk factors (R²: 0.452; p = 0.045).Conclusion: Irritability/agitation is most prevalent BPSD. The severity of MNCD, smoking and hypertension may help in the prediction of BPSD and their role may have to be explored in further studies.

Utility of learning ratio scores from the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word List Memory Test in distinguishing patterns of cognitive decline in veterans referred for neuropsychological evaluation

Background: The Learning Ratio (LR) is a novel learning score that has shown improved utility over other learning metrics in detecting Alzheimer’s disease (AD) across multiple memory tasks. However, its utility on the Consortium to Establish a Registry for Alzheimer’s Disease Word List Memory Test (CERAD WLMT), a widely used list learning measure sensitive to decline in neurodegenerative disease, is unknown. The goal of the current study was to determine the utility of LR on the CERAD WLMT in differentiating between diagnostic (MiNCD vs MaNCD) and etiologic groups (VaD vs AD) in a veteran sample. Methods: Raw learning slope (RLS) and LR scores were examined in 168 veterans diagnosed with major neurocognitive disorder (MaNCD), mild neurocognitive disorder (MiNCD), or normal aging following neuropsychological evaluation. Patients with MaNCD were further classified by suspected etiology (i.e. microvascular disease vs AD). Results: Whereas RLS scores were not significantly different between MiNCD and MaNCD, LR scores were significantly different between all diagnostic groups (p’s < .05). Those with AD had lower LR scores and RLS scores compared to those with VaD (p’s < .05). LR classification accuracy was acceptable for MiNCD (AUC = .76), excellent for MaNCD (AUC = .86) and VaD (AUC = .81), and outstanding for AD (AUC = .91). Optimal cutoff scores for WLMT LR were derived from Youden’s index. Conclusion: Results support the use of LR scores over RLS when interpreting the CERAD WLMT and highlight the clinical utility of LR in differentiating between diagnostic groups and identifying suspected etiology.

Neuropsychiatric Symptoms are Related to Blood-biomarkers in Major Neurocognitive Disorders.

Neuropsychiatric symptoms (NPS) are highly prevalent among individuals with major neurocognitive disorders (MNCD). Here, we characterized blood biomarkers (metabolic, inflammatory, neurotrophic profiles and total antioxidant), body composition, physical fitness and quality of life (QoL) in individuals with MNCD according to NPS. The sample comprised 34 older adults (71.4% women; 74.06±6.03 yrs, with MNCD diagnosis) categorized according to 50th percentile [Low (≤12) or High (≥13)] for NPS (Neuropsychiatric Inventory Questionnaire). Sociodemographic, clinical data, body composition, anthropometric, cognitive assessment (ADAS-Cog), physical fitness (Senior Fitness Test), QoL (QoL-Alzheimer's Disease scale) were evaluated, and blood samples were collected for biochemical analysis. Low compared to high NPS group showed higher levels of IL-6, IGF-1and neurotrophic zscore (composite of IGF-1, VEGF-1, BDNF). Additionally, low compared to high NPS group have higher QoL, aerobic fitness and upper body and lower body strength. The severity of NPS seems to be related to modified neurotrophic and inflammatory outcomes, lower physical fitness, and poor QoL. Strategies to counteract NPS development may preserve the physical and mental health of individuals with MNCD.

The Relationships between Caregiver Burden, Physical Frailty, Race, Behavioral and Psychological Symptoms (BPSD), and Other Associated Variables: An Exploratory Study.

Background and Objectives: For persons with dementia, the relationships between caregiver burden, physical frailty, race, behavioral and psychological symptoms (BPSD), and other associated variables are poorly understood. Only one prior study examined the relationships among these variables but did not include race, which is an important social determinant of health outcomes in the United States. To examine these interactions, we conducted a cross-sectional exploratory study based on a model by Sugimoto and colleagues. Materials and Methods: The sample comprised 85 patient-caregiver dyads (58% White) seen in four centers in diverse regions of New York State. All patients met DSM5 criteria for a major neurocognitive disorder, had a Clinical Dementia Rating sum score of ≥3, and Mini-Mental State Examination (MMSE) score of 10 to 26. Other measures included the SHARE-Frailty Instrument(FI), the Neuropsychiatric Inventory (NPI) to assess BPSD, Zarit's Caregiver Burden Interview (CBI), Lawton's Activities of Daily Living (ADL) Scale, the MMSE, the Cumulative Illness Rating Scale for Geriatrics (CIRSG), age, and gender. Results: In our sample, 59% met the criteria for prefrail/subsyndromal or frail/syndromal (SSF) on the SHARE-FI. SSF had significant direct effects on the NPI and significant indirect effects on the CBI mediated through the NPI; the NPI had significant direct effects on the CBI. Race (White) had significant direct effects on the CBI (higher) and SSF (lower) but did not have significant indirect effects on the CBI. MMSE, ADL, and CIRSG were not significantly associated with the NPI or the CBI. Conclusions: Our analysis demonstrated that frailty, race, BPSD, and caregiver burden may directly or indirectly influence one another, and therefore should be considered essential elements of dementia assessment, care, and research. These results must be viewed as provisional and should be replicated longitudinally with larger samples.

Technology and physical activity for preventing cognitive and physical decline in older adults: Protocol of a pilot RCT.

Cognitive frailty, defined as having both physical frailty and cognitive impairment that does not satisfy the criteria for Major Neurocognitive Disorder, represents an elevated risk for morbidity. Hence, it is crucial to mitigate such risks. Physical activity interventions have been found effective in protecting against physical frailty and cognitive deterioration. This pilot RCT examines if smartwatches and mobile phone applications can help to increase physical activity, thereby improving physical and cognitive outcomes. Older individuals (n = 60) aged 60 to 85 years old will have their physical activity tracked using a smartwatch. The subjects will be randomized into two arms: one group will receive daily notification prompts if they did not reach the recommended levels of PA; the control group will not receive prompts. Outcome variables of physical activity level, neurocognitive scores, and physical frailty scores will be measured at baseline, T1 (3 months), and T2 (6 months). Sleep quality, levels of motivation, anxiety, and depression will be controlled for in our analyses. We hypothesize that the intervention group will have higher levels of physical activity resulting in improved cognitive and physical outcomes at follow-up. This study was approved by the National University of Singapore's Institutional Review Board on 17 August 2020 (NUS-IRB Ref. No.: H-20-038). Wearable sensors technology could prove useful by facilitating self-management in physical activity interventions. The findings of this study can justify the use of technology in physical activity as a preventive measure against cognitive frailty in older adults. This intervention also complements the rapidly rising use of technology, such as smartphones and wearable health devices, in our lives today. This study has been retrospectively registered on clinicaltrials.gov on 5th January 2021 (NCT Identifier: NCT04692974), after the first participant was recruited.

Long-Term Longitudinal Course of Cognitive and Motor Symptoms in Patients With Cerebral Small Vessel Disease.

Patients with cerebral small vessel disease (SVD) show a heterogenous clinical course. The aim of the current study was to investigate the longitudinal course of cognitive and motor function in patients who developed parkinsonism, dementia, both, or none. Participants were from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study, a prospective cohort of patients with SVD. Parkinsonism and dementia were, respectively, diagnosed according to the UK Parkinson's Disease Society brain bank criteria and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for major neurocognitive disorder. Linear and generalized linear mixed-effect analyses were used to study the longitudinal course of motor and cognitive tasks. After a median follow-up of 12.8 years (interquartile range 10.2-15.3), 132 of 501 (26.3%) participants developed parkinsonism, dementia, or both. Years before diagnosis of these disorders, participants showed distinct clinical trajectories from those who developed none: Participant who developed parkinsonism had an annual percentage of 22% (95% CI 18%-27%) increase in motor part of the Unified Parkinson's Disease Rating Scale score. This was significantly higher than the 16% (95% CI 14%-18%) of controls, mainly because of a steep increase in bradykinesia and posture and gait disturbances. When they developed dementia as well, the increase in Timed Up and Go Test time of 0.73 seconds per year (95% CI 0.58-0.87) was significantly higher than the 0.20 seconds per year increase (95% CI 0.16-0.23) of controls. All groups, including the participants who developed parkinsonism without dementia, showed a faster decline in executive function compared with controls: Annual decline in Z-score was -0.07 (95% CI -0.10 to -0.05), -0.09 (95% CI -0.11 to -0.08), and -0.11 (95% CI -0.14 to -0.08) for participants who developed, respectively, parkinsonism, dementia, and both parkinsonism and dementia. These declines were all significantly faster than the annual decline in Z-score of 0.07 (95% CI -0.10 to -0.05) of controls. A distinct pattern in deterioration of clinical markers is visible in patients with SVD, years before the diagnosis of parkinsonism and dementia. This knowledge aids early identification of patients with a high risk of developing these disorders.

Prevalence of DSM-5 mild and major neurocognitive disorder in India: Results from the LASI-DAD.

India, with its rapidly aging population, faces an alarming burden of dementia. We implemented DSM-5 criteria in large-scale, nationally representative survey data in India to characterize the prevalence of mild and major Neurocognitive disorder. The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) (N = 4,096) is a nationally representative cohort study in India using multistage area probability sampling methods. Using neuropsychological testing and informant reports, we defined DSM-5 mild and major neurocognitive disorder, reported its prevalence, and evaluated criterion and construct validity of the algorithm using clinician-adjudicated Clinical Dementia Ratings (CDR)®. The prevalence of mild and major neurocognitive disorder, weighted to the population, is 17.6% and 7.2%. Demographic gradients with respect to age and education conform to hypothesized patterns. Among N = 2,390 participants with a clinician-adjudicated CDR, CDR ratings and DSM-5 classification agreed for N = 2,139 (89.5%) participants. The prevalence of dementia in India is higher than previously recognized. These findings, coupled with a growing number of older adults in the coming decades in India, have important implications for society, public health, and families. We are aware of no previous Indian population-representative estimates of mild cognitive impairment, a group which will be increasingly important in coming years to identify for potential therapeutic treatment.

Validity and reliability of the Persian version of Mini-Addenbrooke’s Cognitive Examination among Iranian highly educated older adults

Background Limited studies have examined psychometric properties of dementia screening tools in university-educated older adults. We aimed to examine this population’s diagnostic accuracy of the Iranian version of Mini-Addenbrooke’s Cognitive Examination (M-ACE). Materials & methods Eighty-seven participants with over 60 years with university education were divided into three groups: Major neurocognitive disorder, mild neurocognitive disorder, and healthy control. The Iranian version of M-ACE, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale and Diagnostic and Statistical Manual of Mental Disorders 5th edition-Text Revision (DSM-5) were used. Results A high internal reliability of questionnaire was confirmed by Cronbach’s alpha coefficient. One-way ANOVA and post hoc analysis confirmed a significant difference between study groups. The scores of M-ACE were found to have a high positive correlation with MMSE, IADL, ADL, and a moderate correlation with GDS. The optimal cutoff score of M-ACE to screen for mild and major neurocognitive disorders were 27.5 and 20.5, respectively. Conclusion The M-ACE was a concise and reliable tool used to identify neurocognitive disorders in highly educated older adults, but they should be evaluated at a higher traditional cut score in earlier stages.

Turkish adaptation, reliability, and validity of the detection test for language impairments in adults and the aged

There is no quick, valid, and reliable screening tool in Turkish that can be used for screening language disorders associated with major neurocognitive disorders (MND). To fill this gap, we designed three distinct studies. In the first study, we adapted the Detection Test for Language Impairments in Adults and the Aged into the Turkish language (DTLA-Tr). In the second study, we collected data from 175 Turkish individuals to determine the normative data of the DTLA-Tr. In the last study, we investigated the psychometric properties of the DLTA-Tr by comparing 17 healthy individuals with 17 patients with Alzheimer’s disease and determining its test–retest reliability. As a result of Study 1, the DTLA was adapted to the Turkish adult population. In Study 2, the normative data of the DTLA-Tr were provided. The results of this study indicated a positive correlation between educational level and DTLA-Tr total score. The results of Study 3 showed that the DTLA-Tr has high predictive validity and good test–retest reliability. The DTLA-Tr is a valid and reliable tool for assessing language abilities in both adults and the elderly. The findings of this study have significant implications for the evaluation of language in Turkish-speaking patients with MND.

Diagnostic accuracy of the Clock Drawing Test in screening for early post-stroke neurocognitive disorder: the Nor-COAST study

BackgroundPost-stroke neurocognitive disorder, though common, is often overlooked by clinicians. Moreover, although the Montreal Cognitive Assessment (MoCA) has proven to be a valid screening test for neurocognitive disorder, even more time saving tests would be preferred. In our study, we aimed to determine the diagnostic accuracy of the Clock Drawing Test (CDT) for post-stroke neurocognitive disorder and the association between the CDT and MoCA.MethodsThis study is part of the Norwegian Cognitive Impairment After Stroke study, a multicentre prospective cohort study following patients admitted with acute stroke. At the three-month follow-up, patients were classified with normal cognition, mild neurocognitive disorder, or major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Any neurocognitive disorder compromised both mild- and major neurocognitive disorder. The CDT at the three-month assessment was given scores ranging from 0 to 5. Patients able to complete the CDT and whose cognitive status could be classified were included in analyses. The CDT diagnostic accuracy for post-stroke neurocognitive disorder was identified using receiver operating characteristic curves, sensitivity, specificity, positive predictive value, and negative predictive value. The association between the MoCA and CDT was analysed with Spearman’s rho.ResultsOf 554 participants, 238 (43.0%) were women. Mean (SD) age was 71.5 (11.8) years, while mean (SD) National Institutes of Health Stroke Scale score was 2.6 (3.7). The area under the receiver operating characteristic curve of the CDT for major neurocognitive disorder and any neurocognitive disorder was 0.73 (95% CI, 0.68–0.79) and 0.68 (95% CI, 0.63–0.72), respectively. A CDT cutoff of < 5 yielded 68% sensitivity and 60% specificity for any neurocognitive disorder and 78% sensitivity and 53% specificity for major neurocognitive disorder. Spearman’s correlation coefficient between scores on the MoCA and CDT was 0.50 (95% CI, 0.44–0.57, p < .001).ConclusionsThe CDT is not accurate enough to diagnose post-stroke neurocognitive disorder but shows acceptable accuracy in identifying major neurocognitive disorder. Performance on the CDT was associated with performance on MoCA; however, the CDT is inferior to MoCA in identifying post-stroke neurocognitive disorder.Trial registrationClinicalTrials.gov (NCT02650531). Retrospectively registered January 8, 2016.

Psychometric Evaluation of the A-NKS: A Diagnostic Instrument to Assess Impairment of Activities of Daily Living in Mild and Major Neurocognitive Disorder According to DSM-5.

Activities of daily living (ADL) functioning are important in the diagnosis of neurocognitive disorders (NCD), yet no standardized and validated instrument exist based on international classification systems. We aimed to psychometrically evaluate the differentiated assessment of ADL and instrumental ADL (IADL) impairments due to NCD according to DSM-5 criteria (Instrument für die Erfassung von Alltagsbeeinträchtigungen bei Neurokognitiven Störungen; A-NKS). We conducted a pilot study involving 92 participant-informant dyads of participants with mild or major NCDs, cognitively healthy individuals, and an informant, to test acceptability, internal consistency, and convergent validity with similar measures. Both A-NKS versions demonstrated excellent internal consistency (α= 0.95 -0.99) and correlate with other instrumental ADL instruments (participant [informant]: Barthel Index: rs = -0.26, p≤0.05 [rs = -0.30, p≤0.01]; Amsterdam IADL: rs = 0.59, p≤0.01 [rs = 0.48, p≤0.01]; SIDAM ADL: rs = 0.46, p≤0.001 [rs = 0.47, p≤0.001]). Additionally, there are correlations with the scale autonomy of the WHOQOL-OLD (rs = -0.50, p≤0.001 [rs = -0.37, p≤0.001]) and physical, as well as cognitive activities (rs = -0.39, p≤0.001 [rs = -0.50, p≤0.001]). They were well-accepted by participants and informants. The A-NKS is an instrument with acceptable psychometric properties to assess ADL due to neurodegenerative decline in healthy individuals, and those with mild or major NCD. Further research is needed to confirm reliability and validity and investigate the factor structure.