Multiple-domain Mild Cognitive Impairment Research Articles

Exploring heterogeneity in mild cognitive impairment.

Mild cognitive impairment (MCI) is a heterogeneous diagnostic entity, without a clear prognosis, often accompanied by psychiatric symptomatology and physical frailty. Understanding the heterogeneity within MCI is a critical step in improving the early detection of cognitive decline and developing effective interventions. Cross-sectional multivariate latent mixture analyses of data from patients evaluated between 2015 and 2019, who were routinely entered into a multidisciplinary database for research purposes. A sample of 538 community-dwelling older adults drawn from a large academic medical center, referred from within the Department of Neurology (63.7% Female, Mage = 67.8, SDage = 10.6). Participants completed comprehensive neuropsychological assessments, psychiatric symptom measures, and frailty evaluations. Latent profile analyses supported five profiles of cognitive impairment: At-Risk, Pre-MCI, Amnestic MCI, Multiple Domain MCI, and Major Cognitive Impairment. The inclusion of concomitant psychiatric symptoms and frailty criteria revealed two additional profiles: Psychiatric/Frail, without cognitive impairments, and Multiple Cognitive Domains/Psychiatric/Frail. Critically, 55% of those classified as Healthy based on cognitive data alone were reclassified. Significant profile-wise differences emerged across auxiliary variables of brief cognitive screening, sociodemographics, and medical and psychosocial risk. Results highlight heterogeneity represented by neurologic patients referred for neuropsychological evaluation that include key physical and emotional symptoms known to increase the risk of cognitive decline. Findings are in alignment with more recent research suggesting that the traditional paradigm cognitive impairment may need to be expanded to improve diagnostic accuracy and to develop more tailored, precision-driven interventions.

Global Processing Deficit in Amnestic Mild Cognitive Impairment.

Visuo-perceptual and visuo-attentional disorders, such as global processing deficit and simultanagnosia, are not routinely investigated in prodromal forms of typical Alzheimer's disease, as amnestic mild cognitive impairment (MCI). This study evaluated global processing abilities through Navon's classical paradigm in individuals with amnestic MCI and investigated the related visuo-perceptual and attentional components involved in simultanagnosia. Sixteen consecutive patients with amnestic MCI (6 single-domain, 10 multiple-domain) and 16 matched controls were requested to identify global and local elements of hierarchical Navon letters, and to name large and small solid letters. While correctly identifying solid letters, patients with multiple-domain amnestic MCI were less accurate in processing the global level of hierarchical stimuli compared to controls. Single-case analyses suggested that global processing may also be impaired in single-domain amnestic MCI. In addition, patients with pathological performance in the Navon task showed perceptual and/or visual focal attention deficits. Early dysfunction of holistic processing can be detected in amnestic MCI. Visuo-perceptual and/or visual focal attention mechanisms, which have been shown to be damaged in Posterior Cortical Atrophy patients with simultanagnosia, may be impaired in individuals with amnestic MCI. Investigation and identification of global processing deficits in MCI could contribute to early diagnosis and longitudinal monitoring of the disease.

Biopsychosocial frailty and mild cognitive impairment subtypes: Findings from the Italian project on the epidemiology of Alzheimer's disease (IPREA).

Frailty is a critical intermediate status of the aging process including physical, cognitive, and psychosocial phenotypes. We operationalized a biopsychosocial frailty construct, estimating its association with mild cognitive impairment (MCI) and its subtypes. In 1980, older individuals from the population-based Italian PRoject on the Epidemiology of Alzheimer's disease (IPREA), we investigated cross-sectional associations among biopsychosocial frailty, MCI, and its subtypes. Participants with biopsychosocial frailty showed an increased odds ratio (OR) of MCI [OR: 4.36; 95% confidence interval (CI): 2.60-7.29; Fisher's exact p<0.01], particularly for nonamnestic MCI single domain (naMCI-SD, OR:3.28; 95% CI: 1.35-7.97; Fisher's exact p=0.02) and for nonamnestic MCI multiple domain (naMCI-MD, OR:6.92; 95% CI: 3.37-14.21; Fisher's exact p<0.01). No statistically significant associations between amnestic MCI single or multiple domain and biopsychosocial frailty were observed. In a large, older Italian cohort, a biopsychosocial frailty phenotype was associated with MCI, in particular, could be associated with some of its subtypes, that is, naMCI-SD, and naMCI-MD.

Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches.

As mild cognitive impairment (MCI) is typically used to identify prodromal stages of dementia, it is essential to identify MCI criteria with high diagnostic stability and prediction of dementia. Moreover, further investigation into pinpointing key factors for reversion is required to foresee future prognosis of MCI patients accurately. To explore disparities in diagnostic stability by examining reversion rates produced by two operationalizations of the MCI definition: the widely applied Petersen criteria and a version of the Neuropsychological (NP) criteria and to identify cognitive, lifestyle, and health related factors for reversion. MCI was retrospectively classified in a sample from the Swedish community-based study Good Aging in Skåne with the Petersen criteria (n = 744, median follow-up = 7.0 years) and the NP criteria (n = 375, median follow-up, 6.7 years), respectively. Poisson regression models estimated the effect of various factors on the likelihood of incident reversion. Reversion rates were 323/744 (43.4%, 95% confidence intervals (CI): 39.8; 47.0) and 181/375 (48.3% 95% CI: 43.2; 53.5) for the Petersen criteria and NP criteria, respectively. Participants with impairment in a single cognitive domain, regular alcohol consumption, living with someone, older age, and lower body mass index had a higher likelihood of reverting to normal. Reversion rates were similar for Petersen and NP criteria indicating that one definition is not superior to the other regarding diagnostic stability. Additionally, the results highlight important aspects such as multiple domain MCI, cohabitation, and the role of alcohol on predicting the trajectory of those diagnosed with MCI.

Kinematic strategies for obstacle-crossing in older adults with mild cognitive impairment.

Mild cognitive impairment (MCI) is considered a transitional stage between soundness of mind and dementia, often involving problems with memory, which may lead to abnormal postural control and altered end-point control when dealing with neuromechanical challenges during obstacle-crossing. The study aimed to identify the end-point control and angular kinematics of the pelvis-leg apparatus while crossing obstacles for both leading and trailing limbs. 12 patients with MCI (age: 66.7 ± 4.2 y/o; height: 161.3 ± 7.3 cm; mass: 62.0 ± 13.6 kg) and 12 healthy adults (age: 67.7 ± 2.9 y/o; height: 159.3 ± 6.1 cm; mass: 61.2 ± 12.0 kg) each walked and crossed obstacles of three different heights (10, 20, and 30% of leg length). Angular motions of the pelvis and lower limbs and toe-obstacle clearances during leading- and trailing-limb crossings were calculated. Two-way analyses of variance were used to study between-subject (group) and within-subject (obstacle height) effects on the variables. Whenever a height effect was found, a polynomial test was used to determine the trend. A significance level of α = 0.05 was set for all tests. Patients with MCI significantly increased pelvic anterior tilt, hip abduction, and knee adduction in the swing limb during leading-limb crossing when compared to controls (p < 0.05). During trailing-limb crossing, the MCI group showed significantly decreased pelvic posterior tilt, as well as ankle dorsiflexion in the trailing swing limb (p < 0.05). Patients with MCI adopt altered kinematic strategies for successful obstacle-crossing. The patients were able to maintain normal leading and trailing toe-obstacle clearances for all tested obstacle heights with a specific kinematic strategy, namely increased pelvic anterior tilt, swing hip abduction, and knee adduction during leading-limb crossing, and decreased pelvic posterior tilt and swing ankle dorsiflexion during trailing-limb crossing. The current results suggest that regular monitoring of obstacle-crossing kinematics for reduced toe-obstacle clearance or any signs of changes in crossing strategy may be helpful for early detection of compromised obstacle-crossing ability in patients with single-domain amnestic MCI. Further studies using a motor/cognitive dual-task approach on the kinematic strategies adopted by multiple-domain MCI will be needed for a complete picture of the functional adaptations in such a patient group.

Coping in Mid- to Late Life and Risk of Mild Cognitive Impairment Subtypes and Dementia: A JPHC Saku Mental Health Study.

The relationship between coping in mid- to late life and cognitive functions remains unclear. To investigate the relationship between habitual coping behaviors of a large Japanese population in their mid- to late-lives and their risk of cognitive decline 15 years later. Overall 1,299 participants were assessed for coping behaviors (in 2000) and cognition (2014-2015). We used the Stress and Coping Inventory to assess the frequency of six coping behaviors (i.e., consulting, planning, positive reappraisal, avoidance, fantasizing, and self-blame). Logistic regression analyses were conducted to examine odds ratios (ORs) for the diagnosis of mild cognitive impairment (MCI), MCI subtypes (single- and multiple-domain MCI), and dementia for coping behaviors. Among the eligible 1,015 participants (72.6 [SD = 5.5] years old in 2014-2015), the numbers for cognitively normal, single-domain MCI, multiple-domain MCI, and dementia were 650 (64.0%), 116 (11.4%), 213 (21.0%), and 36 (3.5%), respectively. Among the six coping behaviors, avoidant coping was significantly associated with noticeable cognitive decline (multiple-domain MCI and dementia). This association remained significant after adjusting for sex, age, education, diagnosis of current major depressive disorder, past history of ischemic heart disease, diabetes, regular alcohol consumption, and smoking (OR = 2.52, 95% CI = 1.23 to 5.15). No significant association with other coping behaviors was found. Avoidant coping in mid- and late life is associated with cognitive decline among older people.

Neuropsychological Features in Patients with General Paresis of the Insane at an Early Stage.

BACKGROUND This study aimed to explore the features of cognitive impairment in patients with neurosyphilis at the early stage of mild cognitive impairment (MCI). MATERIAL AND METHODS A total of 18 patients with asymptomatic neurosyphilis (ANS), 19 patients with neurosyphilis at the MCI stage (neurosyphilis-MCI), and 15 patients with neurosyphilis at the dementia stage (neurosyphilis-dementia) were enrolled. Cognitive function was evaluated using comprehensive rating scales. Tests of syphilis in blood and cerebrospinal fluid (CSF) were conducted, and white blood cell (WBC) counts and protein levels in CSF were measured. RESULTS Overall cognitive function and individual cognitive domains, including memory, language, visuospatial skill, and attention/executive function, were all significantly impaired in the neurosyphilis-MCI group compared with the ANS group, and were further impaired in the neurosyphilis-dementia group. Although there was no difference in serum rapid plasma regain (RPR) titer among the 3 groups, the number of patients with serum RPR titer ≥1: 32 in the neurosyphilis-MCI group was much higher than that in the ANS group. CSF RPR positive rate in the neurosyphilis-MCI group was significantly higher than that in the ANS group. The WBC count, protein level, and the rate of elevated protein level or increased WBC count in CSF did not differ among the 3 groups. CONCLUSIONS The feature of cognitive impairment of neurosyphilis-MCI patients displayed multiple-domain amnestic MCI. Perhaps there were extensive brain areas involved at the early stage, and a continuous neuroinflammatory process was through the different stages of neurosyphilis. Early diagnosis and treatment are very important for preventing the progression of general paresis of the insane.

Olfactory dysfunction is associated with mild cognitive impairment in community-dwelling older adults.

BackgroundOlfactory impairment is aging related and is associated with cognitive decline in older adults. However, it remains unclear if an olfactory impairment is associated with mild cognitive impairment (MCI) and the degree of impairment in the MCI subtypes.Materials and methodsIn a cohort of community-living older adults aged 60 years and above, 670 participants were recruited from the Community Health and Intergenerational (CHI) Study. Olfactory function was assessed using a locally developed nine-item smell test in association with neurocognitive assessments. Analysis of covariance (ANCOVA) was used to examine the association of smell identification score and clinical cognitive status while considering demographic, clinical, and neuropsychological factors with Bonferroni correction for group comparisons.ResultsAge-related smell detection between normal aging (NA) and MCI participants had no significant difference. The overall mean smell identification score in older adults was negatively correlated with age. The mean smell identification score of MCI participants was also not significantly different as compared with NA, but an amnestic MCI multiple domain (aMCI_MD) subgroup had significantly lower (impaired) mean smell identification scores compared with the NA and MCI single domain (amnestic and non-amnestic) group.ConclusionThis study demonstrated that olfactory identification impairment is a comorbidity in older adults with amnestic MCI (aMCI) and is a potential marker associated with an early stage of a neurocognitive disorder. The smell test could act as a screening tool to help in the early detection of smell impairment for heterogeneous syndromes of MCI among community-dwelling older adults. Clinicians and researchers could benefit from utilizing the locally developed smell test to screen their patients or research participants before the initiation of an appropriate health intervention or in a clinical trial.

Association of Dual Sensory Impairment with Cognitive Decline in Older Adults

Introduction: The prevalence of hearing and visual impairment (HI and VI) and dual sensory impairment (DSI), which is a combination of both, is increasing as the population ages. These sensory impairments are expected to increase the cognitive load of information processing from hearing and vision and impair appropriate cognitive processing. Although an association between DSI and cognitive decline has been reported, a more detailed study of the effects on each cognitive domain is required. This study aimed to investigate the prevalence of self-reported sensory impairment in community-dwelling older adults and to examine the impact of DSI on the severity of mild cognitive impairment (MCI) and on each cognitive domain (memory, attention, executive function, and processing speed). Methods: The participants were recruited from a sub-cohort of the National Center for Geriatric Gerontology-Study on Geriatric Syndromes (NCGG-SGS) conducted by the National Center for Geriatrics and Gerontology. We included 4,471 community-dwelling older adults (age: 75.9 ± 4.3 years; females: 52.3%) who fulfilled the inclusion criteria. The HI and VI were identified using a self-report questionnaire. Cognitive and other parameters were also assessed by trained staff. Logistic regression analysis was used to evaluate the relationship between the presence of HI and VI and the severity of MCI, and functional decline in each cognitive domain. Results: DSI was identified in 11.4% of community-dwelling older adults. Regarding sensory impairment and MCI severity, the odds ratio (OR) for single-domain MCI was significantly higher in VI (OR: 1.31; 95% CI: 1.06–1.61), and the OR for multiple-domain MCI was significantly higher in DSI (OR: 1.58; 95% CI: 1.10–2.29). In relation to the four cognitive domains, ORs for impaired executive function were higher for VI and DSI (VI, OR: 1.37; 95% CI: 1.09–1.72. DSI, OR: 1.39; 95% CI: 1.06–1.81). DSI also exhibited a higher odds ratio for reduced processing speed (OR: 2.03; 95% CI: 1.42–2.91). Discussion/Conclusion: DSI is predicted to increase as the population ages and is associated with various health problems. Further, DSI has been reported to decrease quality of life, which needed to establish appropriate treatment and prevention measures.

Fist-Palm Test (FiPaT): a bedside motor tool to screen for global cognitive status

ObjectiveThe Fist-Palm Test (FiPaT) is a novel non-verbal task to be used at the patient’s bedside for a cognitive functions screening. The aims of this study are to analyze (I) the qualitative and quantitative performance features at FiPaT, (II) the psychometric characteristics of FiPaT, and (III) the correlation between FiPat and traditional cognitive assessments in subjects with normal cognition (NC), Mild Cognitive Impairment-single domain (MCI-sd), and Mild Cognitive Impairment-multiple domain (MCI-md).MethodsOne hundred-thirteen subjects (53M/60F), with a mean age of 66.28 ± 7.22 years and 11.08 ± 4.93 years of education, were recruited and underwent a complete neuropsychological battery and FiPaT.ResultsWe found 68 subjects with NC, 31 with MCI-sd, and 14 with MCI-md and a high reliability of the FiPaT (alpha =0.762). The number of FiPaT errors correlated with age and all neuropsychological tests, except for the memory recall test. Subjects with MCI had greater FiPaT errors than subjects with NC. The FiPaT, used with the MOCA test, predicted the presence of MCI, with a variance of 44%.ConclusionThe FiPaT is an acceptable and reliable non-verbal test, able to screen for global cognitive status, attention, and executive functions, and to predict the MCI. Future studies will validate this initial findings as well as the discriminatory role of the FiPaT in detecting specific types of cognitive impairment.

The discriminant validity of Rey Complex Figure Test (RCFT) in subjective cognitive decline, mild cognitive impairment (multiple domain) and Alzheimer’s disease dementia (ADD; mild stage) in Greek older adults

Aim: The goal of this study was to determine the discriminant potential of the Rey Complex Figure Test (RCFT) in older adults with Mild Cognitive Impairment multiple domain (mdMCI) and Alzheimer’s Disease Dementia (ADD; mild subtype) as compared to older adults with Subjective Cognitive Decline (SCD). Materials and methods: We administered RCFT in 608 older adults, dividing them in three groups (217 individuals with SCD; 304 mdMCI population; 106 people with mild ADD, aged 50–90 years; M = 66.9, SD = 8.4) and a mean education of 10.20 (SD 4.3) years. Results: RCFT subtests have excellent discriminant validity, mainly between people with SCD and those with mild ADD. However, its discriminant validity in detecting older adults with SCD among mdMCI population is still questionable. Discussion: The use of RFCT in discriminating older adults with SCD from those with mild ADD both in research as well as in clinical practice is highly recommended.

Subjective sleep parameters in prodromal Alzheimer's disease: a case-control study.

Objective:People with Alzheimer’s disease (AD) dementia have impaired sleep. However, the characteristics of sleep in the early stages of AD are not well known, and studies with the aid of biomarkers are lacking. We assessed the subjective sleep characteristics of non-demented older adults and compared their amyloid profiles.Methods:We enrolled 30 participants aged ≥ 60 years, with no dementia or major clinical and psychiatric diseases. They underwent [11C]PiB-PET-CT, neuropsychological evaluations, and completed two standardized sleep assessments (Pittsburgh Sleep Quality Inventory and Epworth Sleep Scale).Results:Comparative analysis of subjective sleep parameters across the two groups showed longer times in bed (p = 0.024) and reduced sleep efficiency (p = 0.05) in individuals with positive amyloid. No differences in other subjective sleep parameters were observed. We also found that people with multiple-domain mild cognitive impairment (MCI) had shorter self-reported total sleep times (p = 0.034) and worse overall sleep quality (p = 0.027) compared to those with single-domain MCI.Conclusions:Older adults testing positive for amyloid had a longer time in bed and lower sleep efficiency, regardless of cognitive status. In parallel, individuals with multiple-domain MCI reported shorter sleep duration and lower overall sleep quality.

The Effect of Cerebral Small Vessel Disease on the Subtypes of Mild Cognitive Impairment.

Objectives: Cerebral small vessel disease (CSVD) is the most common vascular cause of dementia, and mild cognitive impairment (MCI) is an intermediate state between dementia and normal cognitive aging. The present study investigated the main imaging features of CSVD on different MCI subtypes in memory clinics.Methods: A total of 236 patients with MCI and 85 healthy controls were included. One hundred nine amnestic MCI-multiple domains (amMCI), 38 amnestic MCI-single domain (asMCI), 36 non-amnestic MCI-multiple domains (namMCI), and 53 non-amnestic MCI-single domain (nasMCI) patients were diagnosed. All participants were evaluated with the cognitive assessments and imaging features including white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and cerebral atrophy according to a standard procedure.Results: The patients with amMCI, namMCI, and nasMCI had more high-grade basal ganglia EPVS compared with healthy controls, while the percentages of high-grade basal ganglia EPVS in the patients with amMCI were also more than those in patients with asMCI, namMCI, and nasMCI. There were more high-grade centrum semiovale EPVS in patients with amMCI in comparison with all other groups. The patients with amMCI and namMCI had more percentages of severe deep and periventricular WMH and deep CMBs compared with healthy controls. All MCI groups had higher scores of the medial temporal lobe atrophy than healthy controls, whereas the scores of the amMCI group were also higher than those of the namMCI and nasMCI groups.Conclusions: There were varied neuroimaging features of CSVD including cerebral atrophy in different MCI groups, which meant that vascular mechanism contributed to the prodromal stage of dementia.

Subjective organization in the episodic memory of individuals with Parkinson's disease associated with mild cognitive impairment.

Word clustering (i.e., the ability to reproduce the same word pairs in consecutive recall trials of an unrelated word list) has been extensively investigated as a proxy of subjective organization (SO) of memorandum. In healthy subjects and in groups of brain-damaged patients, the rate of SO generally predicts accuracy of word list recall. This study aimed at evaluating SO in the performance of patients with Parkinson's disease (PD) on a word list recall task in order to investigate the basic mechanisms of episodic memory impairment that are frequently observed in these patients. For this purpose, 56 PD patients, who were stratified according to the presence and quality of mild cognitive impairment (MCI), and a group of healthy controls (HCs) were administered a word list task and an extensive battery of neuropsychological tests. Results showed that recall accuracy on the word list task progressively decreased passing from HC to PD patients without cognitive impairment, to patients with single-domain dysexecutive MCI and to patients with multiple-domain dysexecutive and amnesic MCI. Conversely, only the latter PD group showed a lower SO score than that achieved by the other groups. In the overall PD group, correlational and regression analyses demonstrated that SO scores and a composite score of executive functions were not reciprocally related, but both provided an independent and significant contribution to the prediction of word list recall accuracy. These data are discussed in terms of the contribution of executive functions and hippocampal storage processes to the onset of memory impairment in PD.

Expanded Exploration of the Auditory Naming Test in Patients with Dementia.

Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.

Sleep-Dependent Memory in Older People With and Without MCI: The Relevance of Sleep Microarchitecture, OSA, Hippocampal Subfields, and Episodic Memory

This study aimed to determine if, relative to cognitively healthy controls, sleep-dependent memory consolidation (SDMC) is diminished in mild cognitive impairment (MCI), a group at high risk of conversion to dementia. We also sought to determine whether SDMC is associated with sleep characteristics, daytime episodic memory, and hippocampal integrity. Participants with MCI (n = 43) and controls (n = 20) underwent clinical and neuropsychological profiling. From polysomnography, apnea hypopnea index (AHI) and non-REM sleep spindle characteristics were derived. From magnetic resonance imaging, hippocampal subfield volumes were computed. Participants learned a novel 32-item word-pair prior to sleep; morning retention of the word-pairs was used to determine SDMC. Results showed that SDMC did not differ between MCI and controls, but there was a large effect size decrement in SDMC in those with multiple domain MCI (Hedge's g = 0.85). In MCI, poorer SDMC was correlated with CA1 and CA3 hippocampal atrophy, shorter spindle duration, and worse daytime episodic memory. In controls, poorer SDMC was associated with higher AHI. Impaired daytime memory consolidation, reduced hippocampal volumes, shorter sleep spindles, and greater sleep apnea severity are indicators of diminished SDMC in older adults and should be explored in future studies.

Evaluation of sensitivity and specificity of the INECO Frontal Screening and the Frontal Assessment Battery in mild cognitive impairment.

ABSTRACT.The Frontal Assessment Battery (FAB) and the INECO Frontal Screening (IFS) are two instruments frequently used to explore cognitive deficits in different diseases. However, studies reporting their use in patients with mild cognitive impairment (MCI) are limited.Objective:To compare the sensitivity and specificity of FAB and IFS in mild cognitive impairment (multiple-domain amnestic MCI subtype — md-aMCI).Methods:IFS and FAB were administered to 30 md-aMCI patients and 59 healthy participants. Sensitivity and specificity were investigated using the Receiver Operating Characteristic (ROC) analysis.Results:The area under the ROC curve (AUC) of IFS for MCI patients was .82 (sensitivity=0.96; specificity=0.76), whereas the AUC of FAB was 0.74 (sensitivity=0.73; specificity=0.70).Conclusions:In comparison to FAB, IFS showed higher sensitivity and specificity for the detection of executive dysfunctions in md-aMCI subtype. The use of IFS in everyday clinical practice would allow detecting the frontal dysfunctions in MCI patients with greater precision, enabling the early intervention and impeding the transition to more severe cognitive alterations.

The Destiny of Multiple Domain Amnesic Mild Cognitive Impairment: Effect of Alternative Neuropsychological Definitions and Their Adjunctive Role in Respect of Memory Impairment.

Mild cognitive impairment is the main risk factor of dementia. Previous evidence has claimed that subjects with memory disturbances associated with impairment of other cognitive domains (multiple domain amnesic MCI) are at the highest risk of developing dementia. To date, a shared definition of amnesic MCI multiple domain (aMCI-MD) is still lacking. 163 subjects with aMCI were enrolled and followed-up for 2 years. They underwent a baseline comprehensive neuropsychological battery. The cut-off point for each test was set at 1, 1.5, and 2 SD below the mean obtained in normative studies; aMCI-MD was defined as the occurrence of abnormal scores on at least one, two, or three tests not assessing memory. The Episodic Memory Score (EMS), that measures the severity of memory impairment, was determined. Logistic regressionand Cox's proportional hazard risk models were carried out. The adjunctive effect of the definitions of aMCI-MD on the severity of memory impairment was assessed. Fifty-four subjects progressed to dementia. Only restrictive definitions of aMCI-MD (at least three tests below 1.5 SD; at least two tests below 2 SD) predicted conversion to dementia in both logistic regression and survival analysis. None of the conditions showed a significant adjunctive effect on the EMS. The predictive effect of impairment in tests assessing cognitive domains other than memory depends on its psychometric definition. The use of a restrictive definition would be of some usefulness, but the adjunctive effect of such a definition on an integrated analysis of memory impairment may be questionable.

Cognitive performance of a Brazilian sample of patients with multiple domain mild cognitive impairment and healthy elderly

AbstractBackgroundMild cognitive impairment (MCI) is associated with cognitive alterations, usually related to memory, but may affect other domains. It is an intermediate condition between healthy aging and dementia and does not significantly affect an individual's activities of daily living (ADL) (Petersen,2016). This study aimed to investigate the cognitive performance of a Brazilian sample of elderly people with multiple domain MCI (mdMCI) compared to healthy controls (HC) using a comprehensive neuropsychological assessment.MethodWe included 54 subjects, 36 MCImd and 18 HC. The neuropsychological comprehensive protocol included total estimated IQ [Vocabulary (VC) and Matrix Reasoning (MR)], Digit Span (DS) from the WAIS‐III, Trail Making Test (TMT), Stroop Test (ST), Logical Memory (LM) and Visual Reproduction (VR) , Phonemic Verbal Fluency (FAS), Semantic Verbal Fluency (SVF), Boston Naming Test (BNT), Rey Auditory Verbal Learning Test (RAVLT) and Rey–Osterrieth Complex Figure Test.ResultWe observed significant differences between the groups (p&lt;0,05) in the following cognitive domains: episodic memory [Logical Memory delayed recall (t(52)= ‐2,081; p 0,048); Visual Memory immediate recall (t(50,8)= ‐3,345; p 0,002); Visual Memory delayed recall (t(51)= ‐2,858; p 0,006); RAVLT immediate recall (t(50)= ‐2,414; p 0,19); RAVLT delayed recall (t(50)= ‐2,844; p 0,006); RAVLT recognition (t(49,3)= ‐3,408; p 0,001)]; and executive functions [Semantic Verbal Fluency (t(25,7)= ‐2,582; p 0,016)].ConclusionmdMCI patients obtained a lower cognitive profile in neuropsychological tests involving episodic memory (verbal and visual) and executive functions, usually affected in this population. These findings corroborate the international literature indicating similar impairments in those cognitive domains in mdMCI patients and the possibility to identify differential cognitive alterations with a comprehensive protocol of cognitive tests.

Late-Onset Epilepsy With Unknown Etiology: A Pilot Study on Neuropsychological Profile, Cerebrospinal Fluid Biomarkers, and Quantitative EEG Characteristics.

Introduction: Despite the fact that epilepsy has been associated with cognitive decline, neuropsychological, neurobiological, and neurophysiological features in patients with late-onset epilepsy of unknown etiology (LOEU) are still unknown. This cross-sectional study aims to investigate the neuropsychological profile, cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD), and resting-state quantitative electroencephalographic (qEEG) cortical rhythms in LOEU patients with mild cognitive impairment (LOEU-MCI) and with normal cognition (LOEU-CN), compared to non-epileptic MCI (NE-MCI) and cognitively normal (CN) controls.Methods: Consecutive patients in two clinical Units diagnosed with LOEU-CN (19), LOEU-MCI (27), and NE-MCI (21) were enrolled, and compared to age and sex-matched cognitively normal subjects CN (11). Patients underwent standardized comprehensive neuropsychological evaluation and CSF core AD biomarkers assessment (i.e., CSF Aβ42, phospho-tau and total tau, classified through A/T/(N) system). Recordings of resting-state eyes-closed electroencephalographic (EEG) rhythms were collected and cortical source estimation of delta (<4 Hz) to gamma (>30 Hz) bands with exact Low Resolution Electromagnetic Tomography (eLORETA) was performed.Results: Most LOEU patients had an MCI status at seizure onset (59%). Patients with LOEU-MCI performed significantly worse on measures of global cognition, visuo-spatial abilities, and executive functions compared to NE-MCI patients (p < 0.05). Regarding MCI subtypes, multiple-domain MCI was 3-fold more frequent in LOEU-MCI than in NE-MCI patients (OR 3.14, 95%CI 0.93–10.58, p = 0.06). CSF Aβ42 levels were lower in the LOEU-MCI compared with the LOEU-CN group. Finally, parietal and occipital sources of alpha (8–12 Hz) rhythms were less active in the LOEU-MCI than in the NE-MCI and CN groups, while the opposite was true for frontal and temporal cortical delta sources.Discussion: MCI status was relatively frequent in LOEU patients, involved multiple cognitive domains, and might have been driven by amyloidosis according to CSF biomarkers. LOEU-MCI status was associated with abnormalities in cortical sources of EEG rhythms related to quiet vigilance. Future longitudinal studies should cross-validate our findings and test the predictive value of CSF and EEG variables.