MCI Group Research Articles

Characterizing Magnitude and Selectivity of Attrition in a Study of Mild Cognitive Impairment.

Attrition is one of the greatest difficulties in longitudinal studies on cognitive ageing because of the associated risk of underestimating declines. The aims of this paper were to characterize the magnitude and selectivity of attrition in a study of mild cognitive impairment. Forty two patients with multiple-domain amnestic MCI, 71 with single-domain amnestic MCI, 35 with non-amnestic MCI and 318 healthy controls were recruited from primary care centers and assessed at baseline. All participants underwent extensive neuropsychological evaluation, including the Mini-Mental State Examination, the Californian Verbal Learning Test, the CAMCOG-R battery, the Counting Span task and Listening Span task, and the Subjective Memory Complaints Questionnaire. 21.5% of the participants at baseline did not participate in the follow-up assessment. Comparison between respondents and non-returners did not reveal differences in cognitive performance in the MCI group. Data obtained at the initial assessment regarding comorbidity, social activities and attention given to memory training enabled prediction of the status of the participants in the follow-up assessment. Identification of potential non- returners is relevant, especially in MCI studies, in order to develop retention strategies to minimize attrition.

Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.

Is the Electroencephalogram Power Spectrum Valuable for Diagnosis of the Elderly with Cognitive Impairment?

To study the changes of electroencephalogram (EEG) power spectrum in the elderly with mild cognitive dysfunction in resting and working memory task states. In this study, 40 patients with mild Alzheimer's disease (AD group), 40 patients with mild cognitive impairment (MCI group), and 40 normal controls (NC group) were enrolled. Their EEGs were recorded in resting and working memory task states. The EEG power spectrum, including δ, θ, α1, α2, β1, and β2, were analyzed from 10 channels: right and left frontal (F3, F4), central (C3, C4), parietal (P3, P4), temporal (T3, T4), and occipital (O1, O2). In the resting state, the δ and θ powers from some regions in the AD group were higher than those in the NC group and the MCI group ( p < 0.05). The δ powers from some regions in the MCI group were higher than those in the NC group ( p < 0.05). During the working memory task, the δ, θ, and α1 powers from some regions in the MCI and AD groups were higher than those in the NC group ( p < 0.05). The slow EGG waves and increased δ and θ power spectrum from some regions in patients with mild AD and MCI could be found during the resting state. The increased δ, θ, and α1 powers from some regions in AD and MCI patients were obvious in the working memory task. It can thus be postulated that the EEG power spectrum may have a certain value in the diagnosis of elderly patients with mild cognitive dysfunction.

Equilíbrio, quedas e funcionalidade em idosos com alteração da função cognitiva

Objetivos: Avaliar a relação entre a função cognitiva, equilíbrio, risco de quedas e funcionalidade em idosos com alteração da função cognitiva e verificar se os idosos com comprometimento cognitivo leve apresentam melhor equilíbrio, funcionalidade e menor risco de quedas em relação aos idosos com demência.Métodos: Estudo transversal analítico realizado com 33 idosos, ambos os gêneros, com idade igual ou superior a 60 anos, avaliados por meio dos testes: Miniexame do Estado Mental (MEEM), Timed Up and Go (TUG), Escala de Equilíbrio Funcional de Berg (EEFB), Escala de Avaliação Clínica da Demência (CDR) e Índice de Barthel. Foram considerados quatro grupos: comprometimento cognitivo leve (CCL; n=9), demência leve (DL; n=12), demência moderada (DM;: n=7) e demência grave (DG; n=5). A comparação dos dados foi realizada pelo teste de U Mann Whitney e a correlação, pelo Coeficiente de Correlação de Spearman, com nível de significância de 5% (p&lt;0,05). Resultados: Ocorreu diferença estatística significativa no risco de quedas e funcionalidade entre os grupos DL e DM; funcionalidade entre os grupos DM e DG; equilíbrio, funcionalidade e risco de quedas entre os grupos DL e DG. Observou-se correlação moderada do MEEM e EEFB (r=0,543; p=0,006) no grupo CCL, correlação moderada negativa entre o MEEM e TUG (r=-0,685; p&lt;0,001) e forte correlação do MEEM e Barthel (r=0,708; p&lt;0,001) no grupo demência.Conclusão: A piora da função cognitiva esteve associada ao maior comprometimento da funcionalidade, equilíbrio e aumento do risco de quedas nos idosos com demência em comparação aos idosos com comprometimento cognitivo leve.

Mild Cognitive Impairment, Slow Gait, and Risk of Disability: A Prospective Study

ObjectivesMild cognitive impairment (MCI) may be a risk for disability, and co-occurrence of slow gait (SG) and MCI may increase this risk. DesignProspective study. SettingGeneral community. ParticipantsThe study included 3482 older adults (mean age: 71.4 years) without disability at baseline. MeasurementsWe collected information on demographic variables, measured gait speed and cognitive function to diagnose MCI at baseline. During the follow-up period, the incident disability was monitored. Participants were divided into groups without MCI and SG (control), with SG without MCI (SG), without SG and with MCI in single (sMCI) or multiple (mMCI) domains, and with SG and MCI in single (sMCI + SG) and multiple (mMCI + SG) domains. ResultsDuring follow-up, 134 participants developed disability (mean follow-up: 29.4 months). The proportions of incident disability were higher in the MCI with SG, MCI, and SG groups, compared with the control group. SG [hazard ratio 2.27 (95% confidence interval: 1.38–3.73)], mMCI [2.56 (1.31–5.02)], sMCI + SG [2.46 (1.21–5.00)], and mMCI + SG [3.48 (1.79–6.76)] participants had risks for disability. ConclusionsCo-occurrence of SG and MCI in multiple domains has a higher risk of disability than each condition alone.

Differences in prefrontal cortex activation and deactivation during strategic episodic verbal memory encoding in mild cognitive impairment.

In this study we examined differences in fMRI activation and deactivation patterns during episodic verbal memory encoding between individuals with MCI (n = 18) and healthy controls (HCs) (n = 17). Participants were scanned in two different sessions during the application of self-initiated or directed instructions to apply semantic strategies at encoding of word lists. MCI participants showed reduced free recall scores when using self-initiated encoding strategies that were increased to baseline controls' level after directed instructions were provided. During directed strategic encoding, greater recruitment of frontoparietal regions was observed in both MCI and control groups; group differences between sessions were observed in the ventromedial prefrontal cortex and the right superior frontal gyrus. This study provides evidence suggesting that differences of activity in these regions may be related to encoding deficits in MCI, possibly mediating executive functions during task performance.

The utility of the Dementia Severity Rating Scale in differentiating mild cognitive impairment and Alzheimer disease from controls.

The current study investigated the utility of the Dementia Severity Rating Scale (DSRS) total score to identify individuals at the earliest stage of impairment (ie, mild cognitive impairment/MCI). In addition, the authors sought to investigate how well the measure correlates with an expanded battery of cognitive tests and other measures of functional abilities. Of the 320 participants included in this study, 85 were normal controls, 96 had single-domain or multiple-domain amnestic MCI, and 139 had possible or probable Alzheimer disease (AD). Each participant underwent a thorough cognitive, neurological, and physical examination. Results from this study indicated that the DSRS total scores differed significantly between the 3 groups (P<0.001) and accurately identified 81% of the control group, 60% of the MCI group, and 78% of the AD group in a post hoc discriminant analysis. When combined with a brief cognitive measure (ie, Consortium to Establish a Registry for Alzheimer's Disease Word List 5 min recall test), the DSRS accurately identified 98% of the control group, 76% of the MCI group, and 82% of the AD group. Implications for clinical practice and proposed areas of future research are discussed.

Can Studies of Neuroinflammation in a TSPO Genetic Subgroup (HAB or MAB) Be Applied to the Entire AD Cohort?

Neuroinflammation plays a significant role in Alzheimer disease (AD), and translocator protein (TSPO) PET imaging allows us to quantify this process. However, the binding of second-generation TSPO tracers depends on the TSPO genotype coded by the rs6971 single-nucleotide polymorphism, with a 40%-50% increase in BP in high-affinity binders (HABs) compared with mixed-affinity binders (MABs), whereas low-affinity binders (LABs) are unsuitable for evaluation. Hence, several studies are using either HAB alone or HAB and MAB subjects. To translate the findings of neuroinflammation studies to the entire population, it is crucial to establish the influence of TSPO genotypes on AD. Here, we investigated whether different TSPO genotypes influence cognitive function, amyloid load, and disease progression over time. We evaluated 798 subjects (225 control, 388 with mild cognitive impairment [MCI], and 185 with AD) from the Alzheimer's Disease Neuroimaging Initiative database at baseline and during follow-up. All subjects were screened for TSPO genotype and underwent detailed clinical and neuropsychologic assessments yearly for 4 y. Of the 798 subjects, 255 also had T1- and T2-weighted MR imaging and amyloid PET with (11)C-Pittsburgh compound B or (18)F-florbetapir. We demonstrated that all TSPO binding groups (HAB, MAB, and LAB) have same level of amyloid load in AD and MCI subjects. We also demonstrated that the prevalence is 50.3% for HAB, 41.2% for MAB, and 8.5% for LAB, without a statistical difference among the AD, MCI, and control groups. During longitudinal follow-up, the mean change in neuropsychometric test scores on the Mini-Mental State Examination, the cognitive and modified Alzheimer Disease Assessment Scales (ADASs), and the Geriatric Depression Scale over time were similar in AD and MCI subjects among the 3 TSPO binding groups. Analysis of the covariates showed that diagnostic group (control, MCI, AD), apolipoprotein E4 status, and sex had a significant effect on decline on the modified Alzheimer Disease Assessment Scale (>3 points of the scale), but age and TSPO genotype did not. This study suggests that information obtained from evaluating a subgroup of AD or MCI subject using second-generation TSPO tracers can be translated to the entire AD and MCI population. Thus, we can study fewer AD subjects in evaluating new antineuroinflammatory and antimicroglial agents in intervention studies and in observational studies evaluating the role of neuroinflammation.

The Efficacy of Cognitive Stimulation on Depression and Cognition in Elderly Patients with Cognitive Impairment: A Retrospective Cohort Study

Cognitive decline due to neurodegenerative diseases is a prevalent worldwide problem. Both pharmacological and non-pharmacological treatments to improve, delay or stop disease progression are of vital importance. Cognitive stimulation is frequently used in clinical practice; however, there are few studies that demonstrate its efficacy. Aim: To evaluate the efficacy of cognitive stimulation in patients with mild cognitive impairment (CDR = 0.5) and dementia (CDR = 1). Methods: A retrospective cohort study was performed. Patients with cognitive impairment receiving weekly cognitive stimulation (16 or 24 sessions) were evaluated with a complete neuropsychological battery before and after the stimulation program. Each stimulation session was carried out by a trained neuropsychologist. Results: Forty two patients receiving cognitive stimulation were evaluated over a period of 12.53 months (SD 5.5). Patients were grouped as 11 amnesic mild cognitive impairment (aMCI), 23 multi domain mild cognitive impairment (mMCI) and 8 Mild Alzheimer's Dementia (CDR 1). None of the groups improved their cognitive functions after the cognitive stimulation program. MCI group was also divided according to their global intelligence quotient (IQ) into two groups: low (IQ &lt; 98.5) and high (IQ &gt; 98.5). Each group was compared before and after the stimulation program and no significant difference was found (<em>p</em> ≥ 0.05). Moreover, MCI group was also analyzed according to the duration of the stimulation program: less than 9, between 9 and 13 and more than 13 months. Different duration groups were compared before and after the cognitive stimulation program and no significant differences were found. Depression, anxiety and subjective memory symptoms were also analysed and neither improvement nor worsening could be demonstrated. Conclusions: Patients remained stable, both in cognitive and behavioural domains, for more than 18 months. However, no significant cognitive or behavioural improvement can be reported in these patients after the stimulation program (duration time: 12.53 months SD 5.5).

Study of cognitive profile in the elderly presenting with both depressive and cognitive symptoms

Background: Elderly patients presenting with cognitive and depressive symptoms often create a diagnostic challenge between depression and the dementing process. Various screening and diagnostic instruments have been developed for differentiating the two, one of which is Addenbrooke's cognitive examination (ACE). However, results have not been consistent across various studies, and not much data is available in the Indian context. Aims and Objectives: To study cognition in elderly patients presenting with both cognitive and depressive symptoms at the baseline and at 3 months follow-up after starting antidepressants, and to compare the two profiles. Materials and Methods: It was a follow-up study with 70 participants who had presented with both depressive and cognitive symptoms. Tablet escitalopram was given and ACE was performed at the baseline and at 3 months after starting antidepressants. Improvement on ACE was present in 37 participants and absent in 33 participants. The cognitive profile of these two groups was subjected to statistical analysis. Wilcoxon signed-rank test was used to study the difference between the full and domain ACE scores between the preintervention phase and postintervention phase within each group. Results: There is a significant difference between preintervention and postintervention full ACE scores and different domain scores in the depression group unlike in the MCI group. Conclusion: Diagnostic tools such as ACE can be utilized for differentiating mood disorder with an actual dementing process. It also reveals the need for periodic assessments of such patients.

White matter integrity determined with diffusion tensor imaging in older adults without dementia: influence of amyloid load and neurodegeneration.

Pathophysiologic mechanisms leading to loss of white matter integrity and the temporal positioning of biomarkers of white matter integrity relative to the biomarkers of gray matter neurodegeneration and amyloid load in the course of Alzheimer disease (AD) are poorly understood. To investigate the effects of AD-related gray matter neurodegeneration and high β-amyloid on white matter microstructure in older adults without dementia. A population-based, longitudinal cohort study was conducted. Participants included in the Mayo Clinic Study of Aging (N = 701) who underwent magnetic resonance imaging, diffusion tensor imaging (DTI), and positron emission tomography studies with diagnoses of cognitively normal ([CN] n = 570) or mild cognitive impairment ([MCI] n = 131) were included. Both groups were divided into biomarker-negative, amyloid-positive-only, neurodegeneration-positive-only, and amyloid plus neurodegeneration-positive groups based on their amyloid load shown on carbon 11-labeled Pittsburgh Compound B positron emission tomography, AD hypometabolic pattern shown on fludeoxyglucose F 18 positron emission tomography, and/or hippocampal atrophy shown on magnetic resonance imaging. Fractional anisotropy (FA) determined using DTI. No FA alterations were observed in biomarker-negative MCI and amyloid-positive-only CN and MCI groups compared with biomarker-negative CN participants on voxel-based analysis (P < .05; familywise error corrected). Conversely, the neurodegeneration-positive-only and amyloid plus neurodegeneration-positive CN and MCI groups consistently had decreased FA in the fornix, which correlated with cognitive performance (ρ = 0.38; P < .001). Patients with MCI had more extensive white matter involvement than did those with CN, and the greatest FA decreases were observed in the amyloid plus neurodegeneration-positive MCI group (P < .05; familywise error corrected). A high amyloid load does not influence diffusion tensor imaging-based measures of white matter integrity in the absence of coexistent gray matter neurodegeneration in older adults without dementia.

Assessment of functional change and cognitive correlates in the progression from healthy cognitive aging to dementia.

There is currently limited understanding of the course of change in everyday functioning that occurs with normal aging and dementia. To better characterize the nature of this change, we evaluated the types of errors made by participants as they performed everyday tasks in a naturalistic environment. Participants included cognitively healthy younger adults (YA; n = 55) and older adults (OA; n = 88), and individuals with mild cognitive impairment (MCI: n = 55) and dementia (n = 18). Participants performed 8 scripted everyday activities (e.g., filling a medication dispenser) while under direct observation in a campus apartment. Task performances were coded for the following errors: inefficient actions, omissions, substitutions, and irrelevant actions. Performance accuracy decreased with age and level of cognitive impairment. Relative to the YAs, the OA group exhibited more inefficient actions which were linked to performance on neuropsychological measures of executive functioning. Relative to the OAs, the MCI group committed significantly more omission errors which were strongly linked to performance on memory measures. All error types were significantly more prominent in individuals with dementia. Omission errors uniquely predicted everyday functional status as measured by both informant-report and a performance-based measure. These findings suggest that in the progression from healthy aging to MCI, everyday task difficulties may evolve from task inefficiencies to task omission errors, leading to inaccuracies in task completion that are recognized by knowledgeable informants. Continued decline in cognitive functioning then leads to more substantial everyday errors, which compromise ability to live independently.

Development and psychometric properties of the instrumental activities of daily living: compensation scale.

The Instrumental Activities of Daily Living - Compensation (IADL-C) scale was developed to capture early functional difficulties and to quantify compensatory strategy use that may mitigate functional decline in the aging population. The IADL-C was validated in a sample of cognitively healthy older adults (N=184) and individuals with mild cognitive impairment (MCI; N=92) and dementia (N=24). Factor analysis and Rasch item analysis led to the 27-item IADL-C informant questionnaire with four functional domain subscales (money and self-management, home daily living, travel and event memory, and social skills). The subscales demonstrated good internal consistency (Rasch reliability 0.80 to 0.93) and test-retest reliability (Spearman coefficients 0.70 to 0.91). The IADL-C total score and subscales showed convergent validity with other IADL measures, discriminant validity with psychosocial measures, and the ability to discriminate between diagnostic groups. The money and self management subscale showed notable difficulties for individuals with MCI, whereas difficulties with home daily living became more prominent for dementia participants. Compensatory strategy use increased in the MCI group and decreased in the dementia group.

A-10 * Differential Simulator Driving Patterns among Community-Dwelling Healthy and Mildly Neurologically Impaired Adults during Driver Distraction Conditions

Objective: We explored driving patterns under conditions with and without driver distraction in a community sample of adults. Method: We recruited 100 community-dwelling participants who were current drivers (65 men, healthy: n = 52, mild cognitive impairment [MCI]: n = 22, Alzheimer's disease [AD]: n = 8, Parkinson's disease [PD]: n = 11, other: n = 7). Participants drove in a simulator under four rural driving conditions: low vs. high speed and with vs. without distraction (conversation). Driving variables included: lateral position of vehicle from the right road border (m), average speed (km/h), and average time to collision with vehicle ahead (sec). Results: Repeated measures ANCOVAs (covariate: age) showed a group distraction interaction in the high speed condition on average speed, F(3, 74) = 4.251, p = .008, η2 = .147, and time to collision, F(3, 74) = 4.280, p = .008, η2 = .148; the AD group adjusted driving speed and distance given distraction. The only group distraction interaction in the low speed condition was on time to collision, F(3, 70) = 3.656, p = .016, η2 = .135; AD and MCI groups demonstrated more time to collision than PD and control groups. A group main effect on average speed in the low speed condition indicated that all groups but controls decreased speed in the distraction, relative to the no distraction simulation. Conclusion(s): Healthy and MCI groups drove consistently despite distraction factors, while those with AD compensated by driving more slowly and further away from the preceding vehicle. Individuals with PD reacted in counterintuitive ways.

MicroRNA-135a and -200b, potential Biomarkers for Alzheimer׳s disease, regulate β secretase and amyloid precursor protein

Amyloid precursor protein (APP) and β-site amyloid precursor protein cleaving enzyme (BACE-1) play important roles in the generation of Alzheimer׳s disease (AD), a progressive neurodegenerative disorder. In the present study, microRNA (miR) microarray was used to analyze the miR expression profiles in the hippocampi from APP/PS1 transgenic and wild type mice. The miRs with significant alteration and putative targets on APP or BACE-1 were retrieved (miR-135a, -200b and -429). The deregulations of these miRs were confirmed in mice and further verified in AD patient samples by qPCR. Primary mouse hippocampal neurons, SH-SY5Y and HEK293 cells were used to study the function of miRs on APP and BACE-1. We found that miR-135a, which was downregulated significantly in hippocampi from APP/PS1 transgenic mice compared with the wild type control, directly interacted with the 3′–UTR of BACE-1 and repressed its expression and activity. On the other hand, miR-200b and -429, which were downregulated significantly in hippocampi from APP/PS1 transgenic mice compared with the wild type control, targeted the 3′–UTR of APP and repressed its expression. Furthermore, Aβ42 could downregulate miR-200b expression which may generate a vicious cycle resulted in accumulating Aβ42. The levels of miR-135a and -200b in the serum of DAT group were significantly lower than that of control groups (P<0.05). The serum miR-200b level of MCI group was higher than that of DAT group (P<0.05) and lower than that of control group (P<0.05). We also found decreased miR-135a and -200b levels in the cerebrospinal fluid of DAT group compared with the control group (P<0.05). In conclusion, these findings showed that miR-135a, -200b and -429 may take part in the progress of AD; miR-200b was of great potential as noninvasive and easily detected blood-based biomarkers of MCI and DAT patients.

Abnormal MoCA and normal range MMSE scores in Parkinson disease without dementia: cognitive and neurochemical correlates.

The Montreal Cognitive Assessment (MoCA) is increasingly being used as a cognitive screening test in Parkinson disease (PD). The MoCA's popularity likely reflects its ability to detect executive dysfunction, a relative deficiency of the Mini-Mental State Examination (MMSE). To compare neurochemical and neuropsychological functions in non-demented PD patients with mild cognitive impairment (PD-MCI) and without, as defined by MoCA (PD-MCI = MoCA<26). Non-demented PD subjects underwent combined MoCA and MMSE, detailed cognitive testing and [¹¹C]methyl-4-piperidinyl propionate acetylcholinesterase and [¹¹C]dihydrotetrabenazine monoaminergic PET imaging. Eighteen subjects met MoCA PD-MCI criteria but had MMSE scores in the normal range, compared to 29 subjects with normal MoCA and MMSE scores. The MoCA-defined PD-MCI group had reduced performance in global cognition (t = 2.91, P = 0.0056), most significantly in executive function (t = 3.18, P = 0.002), as well as significant reduction in dorsal caudate nucleus dopaminergic innervation (t = 2.72, P = 0.009) compared to the PD without MCI group. Both MoCA and MMSE had poor diagnostic accuracy for PD-MCI (65.3%) when using the Level 2 Movement Disorder Society Task Force definition. PD subjects with normal range MMSE but abnormal MoCA scores had evidence of caudate nucleus dopaminergic denervation and mild cognitive changes, predominantly in executive function. The MoCA may be able to preferentially detect executive dysfunction compared to the MMSE, but the MoCA has limited diagnostic accuracy for PD-MCI, and should not be used alone to make this diagnosis.

CORRELATION OF WALKING SPEED AND TIME UP TO GO (TUG) WITH DEMENTIA

It's commonly known that gait disturbance is related with Alzheimer's disease in its late stage. But studies showed that gait disturbance may start in the early stage of AD or even MCI. We aim to explore the walking speed and time up to go (TUG) in patients with Alzheimer's disease and mild cognitive impairment. 18 patients with AD, 20 with MCI and 20 control subjects were enrolled into this study. All subjects were diagnosed by NINCDS-ADRDA criteria 2011and examined by MOCA, MMSE, WAIS and designed to walk in two assigned conditions: si ngle task (free gait) and dual task (walking and counting down). The gait parameters in two conditions were measured. The subjects were followd every 6 months within 2 years. In free walking condition, both step velocity and TUG were significantly lower in AD group and MCI group than in the controls group, while there was no significant difference between AD and MCI group. In dual task condition, the step velocity and TUG decreased significantly in AD but there was no significant decrease in MCI. Compared with free and dual task, there was no difference between control group, but gate velocity decreased significantly in AD group with dual task whilst TUG decreased significantly in MCI group with counting down. There was decrease tendency of speed velocity and TUG with time went on in MCI and AD group. Gait disturbance can be found even in early stage of dementia and decreses with time. The TUG and gait speed are reliable parameters to use with people with AD, even with MCI.

SCHELTENS’ VISUAL RATING SCALE IN ALZHEIMER'S DEMENTIA: ARE WE AFFECTED BY THE DEGREE OF GENERALIZED CORTICAL ATROPHY WHILE RATING?

globus pallidus. Across groups, all deep gray matter structures besides globus pallidus showed positive correlation with cognitive function, presented by MMSE score (0.16<r<0.28, p<0.05). Hippocampus and amygdala volumes were significantly smaller in p-MCI compared to s-MCI. Within the MCI group, Cox proportional hazards analyses showed that the smallest quartile of hippocampal volume compared to the largest quartile yielded a hazards ratio of 6.0 (95% confidence interval, 1.3-27.2) after controlling for age, sex and baseline MMSE. Neither atrophy of thalamus nor any of the basal ganglia predicted progression to AD in MCI. Conclusions: In this study, no deep gray matter structure other than hippocampus predicted progression from MCI to AD. Deep gray matter volumes were correlated with cognitive function as assessed by MMSE.

FUNCTIONAL PERFORMANCE IN THE COMPLEX ACTIVITIES OF DAILY LIVING: CHANGE AND LOSS PROFILE IN A HEALTHY AGED POPULATION

female and 78 male (age 72,31 Std 8,29 , instruction 8,6 Std 3.9) of which 104 have no cognitive pathology (control group); 49 subjects withMCI clinical diagnosis and 66 with mild/ moderate AD.The control group was evaluated with a General Cognitive Screening (Adas Cog) and MMSS. We established a cut point of 26 for the MMSS and normal performance in Adas Cog.An Anova analysis has been carried out considering the number of clusters, number of switching, number of exemplars and clusters size in the three groups.Results:The ANOVA analysis showed that: exemplars number, cluster and switching number are significant variables to identify the EA, MCI and Control groups. It was significant (Pr (>F) 1⁄4 .001) to distinguish between the means of the Control Group (8.23), MCI (5.18) and EA (3.64). It was also relevant the ANOVA of switchings (Pr (>F) 1⁄4 .001): Control Group (10.1), MCI (6.59) and EA (5.36). The cluster size distinguished the control group from MCI and EA , but not between them. Conclusions: The results obtained constitute a significant contribution to the knowledge of the normal and pathological lexical processing. The study of the clusters’organization in semantic fluency tasks might provide a new important marker in the clinical diagnosis profile of MCI patients.

OLFACTORY DYSFUNCTION AND ITS PATTERN IN ALZHEIMER DISEASE

Patients with Alzheimer disease (AD) are reported to have olfactory dysfunction due to amyloid deposition in the olfactory bulb. This study examined the features and danger in daily life of olfactory dysfunction in AD and amnestic MCI patients. Data were drawn from the medical records of 79 consecutive patients (19 men, 60 women, 65 to 93 years old) who were admitted to the Department of Geriatric Medicine, The University of Tokyo Hospital, Tokyo, Japan, from January 2010 to December 2013 for evaluation of cognitive impairment. Olfactory function was examined using an odor stick identification test for Japanese (OSIT-J). Patients with nasal disease diagnosed by an otorhinolaryngologist were excluded. The data were analyzed in three groups: normal group, amnestic MCI (aMCI) group and AD group. The number of correct answers was significantly lower in the AD group 3.6±2.6 (n=48, mean age 80±6 years) than in the normal group 7.4±3.1 (n=8, 76±6 years), and aMCI group 5.0±3.4 (n=23, 80±6 years). There was a significant difference in the identification ratio of cooking gas between the normal group (71%), aMCI group (19.5%), and AD group (27%). On the other hand, curry, sweaty socks and roasted garlic could be detected in over 45% of AD patients.The score of recall of MMSE showed a positive relationship with the number of correct answers in OSIT-J. Olfactory function evaluated by OSIT-J showed a relationship with cognitive function, especially recall. It was found that some smells could be detected even in patients with Alzheimer disease.