Single-domain Mild Cognitive Impairment Research Articles

Reversal of the concreteness effect can be detected in the natural speech of older adults with amnestic, but not non-amnestic, mild cognitive impairment.

Patients with Alzheimer's disease present with difficulty in lexical retrieval and reversal of the concreteness effect in nouns. Little is known about the phenomena before the onset of symptoms. We anticipate early linguistic signs in the speech of people who suffer from amnestic mild cognitive impairment (MCI). Here, we report the results of a corpus-linguistic approach to the early detection of cognitive impairment. One hundred forty-eight English-speaking Singaporeans provided natural speech data, on topics of their choice; 74 were diagnosed with single-domain MCI (38 amnestic, 36 non-amnestic), 74 cognitively healthy. The recordings yield 267,310 words, which are tagged for parts of speech. We calculate the per-minute word counts and concreteness scores of all tagged words, nouns, and verbs in the dataset. Compared to controls, subjects with amnestic MCI produce fewer but more abstract nouns. Verbs are not affected. Slower retrieval of nouns and the reversal of the concreteness effect in nouns are manifested in natural speech and can be detected early through corpus-based analysis. Reversal of the concreteness effect is manifested in patients with Alzheimer's disease (AD) and semantic dementia.The paper reports a corpus-based analysis of natural speech by people with amnestic and non-amnestic mild cognitive impairment (MCI) and cognitively healthy controls.People with amnestic MCI produce fewer and more abstract nouns than people with non-amnestic MCI and healthy controls. Verbs appear to be unaffected.The imageability problem can be detected in natural everyday speech by people with amnestic MCI, which carries a higher risk of conversion to AD.

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.

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.

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.

Practice Effects in Mild Cognitive Impairment Increase Reversion Rates and Delay Detection of New Impairments.

ObjectiveCognitive practice effects (PEs) can delay detection of progression from cognitively unimpaired to mild cognitive impairment (MCI). They also reduce diagnostic accuracy as suggested by biomarker positivity data. Even among those who decline, PEs can mask steeper declines by inflating cognitive scores. Within MCI samples, PEs may increase reversion rates and thus impede detection of further impairment. Within an MCI sample at baseline, we evaluated how PEs impact prevalence, reversion rates, and dementia progression after 1 year.MethodsWe examined 329 baseline Alzheimer’s Disease Neuroimaging Initiative MCI participants (mean age = 73.1; SD = 7.4). We identified test-naïve participants who were demographically matched to returnees at their 1-year follow-up. Since the only major difference between groups was that one completed testing once and the other twice, comparison of scores in each group yielded PEs. PEs were subtracted from each test to yield PE-adjusted scores. Biomarkers included cerebrospinal fluid phosphorylated tau and amyloid beta. Cox proportional models predicted time until first dementia diagnosis using PE-unadjusted and PE-adjusted diagnoses.ResultsAccounting for PEs increased MCI prevalence at follow-up by 9.2% (272 vs. 249 MCI), and reduced reversion to normal by 28.8% (57 vs. 80 reverters). PEs also increased stability of single-domain MCI by 12.0% (164 vs. 147). Compared to PE-unadjusted diagnoses, use of PE-adjusted follow-up diagnoses led to a twofold increase in hazard ratios for incident dementia. We classified individuals as false reverters if they reverted to cognitively unimpaired status based on PE-unadjusted scores, but remained classified as MCI cases after accounting for PEs. When amyloid and tau positivity were examined together, 72.2% of these false reverters were positive for at least one biomarker.InterpretationEven when PEs are small, they can meaningfully change whether some individuals with MCI retain the diagnosis at a 1-year follow-up. Accounting for PEs resulted in increased MCI prevalence and altered stability/reversion rates. This improved diagnostic accuracy also increased the dementia-predicting ability of MCI diagnoses.

Correlates of Conversion from Mild Cognitive Impairment to Dementia with Lewy Bodies: Data from the National Alzheimer's Coordinating Center.

Many patients with dementia with Lewy bodies (DLB) miss out on the best standards of care and psychosocial support due to diagnostic delays or inaccuracies following symptom onset. This study seeks to identify baseline characteristics in individuals with mild cognitive impairment (MCI) that correlate with eventual conversion to DLB or Alzheimer's disease (AD). Baseline neuropsychological and neuropsychiatric data were analyzed in National Alzheimer's Coordinating Center participants who completed the Uniform Data Set between 2006 and 2020 and subsequently converted from MCI to DLB or AD (n = 1632). Only 6% of participants with MCI converted to DLB. Among those who converted to DLB, multidomain amnestic MCI (aMCI) was the most common subtype at study entry. As part of logistic regression analyses, odds ratios (ORs) were estimated for conversion to DLB versus AD based on study-entry characteristics, adjusting for age, sex, education, and years to diagnosis. The strongest predictors of conversion to DLB (p≤0.0001) were nonamnestic MCI versus aMCI (OR 8.2, CI [5.0, 14]), multidomain MCI versus single-domain MCI (OR 2.7, CI [1.7. 4.2]), male sex (OR 4.2, CI [2.5, 7.1]), and presence of nighttime behaviors (OR 4.4 CI [2.8, 6.9]). A diagnosis of prodromal DLB should be considered in individuals with MCI who present with prominent executive/visuospatial deficits, neuropsychiatric symptoms, and less memory impairment. Early diagnosis of DLB may guide treatment planning, including the avoidance of antipsychotic medications in patients who develop psychotic symptoms, caregiver support, and initiation of early treatment(s) once medications become available.

Lessons from SPRINT‐MIND on interventions to prevent dementia

AbstractBackgroundThe Systolic Blood Pressure Intervention Trial (SPRINT) and the Systolic Blood Pressure Intervention Trial: Memory and cognition IN Decreased hypertension (SPRINT‐MIND) have contributed substantially to recent advances in the fields of hypertension, cardiovascular disease prevention, and prevention of cognitive decline.MethodRandomized clinical trial of 9,361 adults (mean age, 67.9 years) with hypertension and increased risk for cardiovascular disease with a mean follow‐up of 5.5 years. Participants were from diverse communities in the United States and were 27.8% black and 10.5% Hispanic.ResultSPRINT‐MIND has already demonstrated in this randomized trial that intensive blood pressure control significantly reduces the risk of incident overall mild cognitive impairment (HR, 0.81; 95% CI, 0.69‐0.95). However results related to subtype of MCI have not been released. This presentation will expand on findings related to intensive blood pressure control and the incidence of mild cognitive impairment (MCI) and Probable Dementia. The beneficial effect on MCI largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66‐0.92]) and multi‐domain MCI subtypes (HR, 0.78 [95% CI, 0.65‐0.93]), with no significant differences for non‐amnestic and single domain MCI subtypes. Data on the the mean scores each component of the cognitive battery according to adjudicated participant classification of 1) No impairment, 2) MCI or 3)Probable dementia will also be presented.ConclusionFindings from the SPRINT‐MIND trial continue to enhance understanding of the importance of cardiovascular disease prevention approaches as a pathway for also reducing the burden of cognitive impairment and dementia.

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.

Mild Cognitive Impairment as an Early Landmark in Huntington's Disease.

As one of the clinical triad in Huntington's disease (HD), cognitive impairment has not been widely accepted as a disease stage indicator in HD literature. This work aims to study cognitive impairment thoroughly for prodromal HD individuals with the data from a 12-year observational study to determine whether Mild Cognitive Impairment (MCI) in HD gene-mutation carriers is a defensible indicator of early disease. Prodromal HD gene-mutation carriers evaluated annually at one of 32 worldwide sites from September 2002 to April 2014 were evaluated for MCI in six cognitive domains. Linear mixed-effects models were used to determine age-, education-, and retest-adjusted cut-off values in cognitive assessment for MCI, and then the concurrent and predictive validity of MCI was assessed. Accelerated failure time (AFT) models were used to determine the timing of MCI (single-, two-, and multiple-domain), and dementia, which was defined as MCI plus functional loss. Seven hundred and sixty-eight prodromal HD participants had completed all six cognitive tasks, had MRI, and underwent longitudinal assessments. Over half (i.e., 54%) of the participants had MCI at study entry, and half of these had single-domain MCI. Compared to participants with intact cognitive performances, prodromal HD with MCI had higher genetic burden, worsened motor impairment, greater brain atrophy, and a higher likelihood of estimated HD onset. Prospective longitudinal study of those without MCI at baseline showed that 48% had MCI in subsequent visits and data visualization suggested that single-domain MCI, two-domain MCI, and dementia represent appropriate cognitive impairment staging for HD gene-mutation carriers. Findings suggest that MCI represents an early landmark of HD and may be a sensitive enrichment variable or endpoint for prodromal clinical trials of disease modifying therapeutics.

Cognition function and its influencing factors among people aged 55 and above in 4 provinces of China from 2018 to 2019

To analyze the current situation of cognition function of people aged 55 and above in 4 provinces of China, and to explore its influencing factors of demographic characteristics. Using the baseline data of the "Community-based Cohort Study on Nervous System Diseases", middle-aged and older populations aged ≥55 years with completed data on demographic and economic factors and the cognitive function scale were selected as study subjects. A total of 5103 subjects were included in the study(male 2294, female 2809, 55-64 years old 1875, 65-74 years old 2197, 75-94 years old 1031). Multi-stage stratified cluster random sampling was adopted, and survey subjects were selected from a total of 32 communities in Hebei, Zhejiang, Shaanxi and Hunan provinces. The baseline data obtained from a face-to-face questionnaire survey was entered using electronic tablets on the spot. Montreal cognitive assessment(MoCA) and activities of daily living scale(ADL) were used to determine mild cognitive impairment(MCI) and its subtypes. Multiple linear regression and multiple Logistic regression model were used to analyze the influencing factors of cognitive function in populations. Among middle-aged and elderly Chinese populations, the score of overall cognitive function and its sub-domains were 21. 79±6. 17, 11. 20±4. 18(memory), 8. 81±3. 31(execution), 5. 33±1. 76(visual-spatial ability), 4. 53±1. 40(language), 13. 32±3. 98(attention) and 5. 54±0. 95(orientation). The prevalence of MCI and its subtypes were 35. 86%, 4. 57%(amnestic MCI single domain, aMCI-SD), 3. 64%(nonamnestic MCI single domain, naMCI-SD), 6. 68%(amnestic MCI multiple domains, aMCI-MD) and 3. 94%(nonamnestic MCI multiple domains, naMCI-MD). Subjects aged ≥55 years, living in rural areas, or with per capita monthly household income less than 1000 yuan had lower score of overall cognitive function and its sub-domains(P&lt;0. 05), and also had lower prevalence of MCI and its subtypes. The OR of MCI, naMCI-SD, aMCI-MD and naMCI-MD was 2. 38(95% CI 1. 98-2. 86), 1. 54(95% CI 1. 01-2. 34), 2. 30(95% CI 1. 65-3. 20) and 3. 11(95% CI 2. 07-4. 69) respectively in subjects aged ≥75 years versus those aged 55-64 years, and of MCI, naMCI-SD and aMCI-MD was 3. 02(95%CI 2. 48-3. 66), 4. 30(95%CI 2. 69-6. 88) and 2. 62(95%CI 1. 81-3. 79) respectively in those living in rural areas versus those living in city areas. Subjects with higher per capita monthly household income had lower ORs of MCI and its subtypes. The prevalence rate of MCI among people aged 55 and above in four provinces in China is at a relatively high level. In the studied 4 provinces of China, about 35% of Chinese middle-aged and elderly populations are affected by MCI. The status of overall cognitive function and its sub-domains of subjects aged 75 years and above, living rural areas and with lower per capita monthly household income are poor, and they may have a higher risk of MCI and its subtypes.

Effects of gender on cognitive and behavioral manifestations in multiple system atrophy

Gender differences have been described in several neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. The effects of gender on cognitive and behavioral manifestations in multiple system atrophy and the changes of cognitive functions over time according to gender have not been investigated so far. Fifty-five patients with a diagnosis of multiple system atrophy underwent a comprehensive neuropsychological and neuropsychiatric battery at baseline and 26 of them could be re-evaluated at 1-year follow-up. At baseline women with multiple system atrophy had poorer global cognitive state and visuo-spatial abilities, and a higher prevalence of depression and apathy than males. At follow-up, female patients deteriorated more than males on attention abilities and motor functions, and had a higher prevalence of depression than men. Executive functions and visuo-spatial abilities significantly worsened over time in both groups. Mild Cognitive Impairment single domain was significantly more frequent in females than males. Cognitive and behavioral differences between genders in multiple system atrophy involve global cognition, planning, attention, visual-perceptive skills, and depression, with female patients more compromised than males. Female patients deteriorated more than men over time as for motor functions and attention. Further longitudinal studies are deserved to confirm gender differences in progression of cognitive and behavioral features of multiple system atrophy.

Prevalence and Incidence of Mild Cognitive Impairment across Subtypes, Age, and Sex

Objective: The purpose of this study was to report on the prevalence and incidence of mild cognitive impairment (MCI) across age, sex, and subtypes according to various criteria in a population-based sample. Methods: The sample was drawn from the Swedish Good Aging in Skåne (GÅS) population study, and data from 3,752 participants aged 60 years and more were used to calculate the MCI prevalence. The incidence was calculated using 2,093 participants with 6-year follow-up data. MCI was defined according to the expanded Mayo Clinic criteria: cognitive complaint, objective cognitive impairment (two different criteria depending on the severity of impairment), preserved functional abilities, and no dementia. Results: The prevalence estimates ranged from 5.13 to 29.9% depending on age and severity of impairment. The incidence rates of overall MCI were 22.6 (95% confidence interval [CI]: 19.6–25.9) and 8.67 (95% CI: 7.0–10.7) per 1,000 person-years for less severe and severe cognitive impairment, respectively. The highest prevalence and incidence estimates were found for “non-amnestic MCI single domain.” The older age groups had a higher prevalence, and no sex or age differences in MCI incidence were detected. Conclusion: Our findings concur with previous research advocating that MCI is a heterogeneous concept, since the prevalence and incidence estimates differed substantially according to age, MCI subtype, and severity of cognitive impairment.

Mild cognitive impairment in long-term brain tumor survivors following brain irradiation.

There is no accepted classification of cognitive impairment in cancer survivors. We assess the extent of mild cognitive impairment (MCI) syndrome in brain tumor survivors using criteria adapted from the National Institute on Aging and the Alzheimer's Association (NIA-AA). We retrospectively reviewed the cognitive data of brain tumor survivors post-radiation therapy (RT) enrolled from 2008 to 2011 in a randomized trial of donepezil versus placebo for cognitive impairment. One hundred and ninety eight adult survivors with primary or metastatic brain tumors who were ≥ 6months post RT were recruited at 24 sites in the United States. Cognitive function was assessed at baseline, 12 and 24weeks post-randomization. For this analysis, we used baseline data to identify MCI and possible dementia using adapted NIA-AA criteria. Cases were subtyped into four groups: amnestic MCI-single domain (aMCI-sd), amnestic MCI-multiple domain (aMCI-md), non-amnestic MCI-single domain (naMCI-sd), and non-amnestic MCI-multiple domain (naMCI-md). One hundred and thirty one of 197 evaluable patients (66%) met criteria for MCI. Of these, 13% were classified as aMCI-sd, 58% as aMCI-md, 19% as naMCI-sd, and 10% as naMCI-md. Patients with poorer performance status, less education, lower household income and those not working outside the home were more likely to be classified as MCI. Two-thirds of post-RT brain tumor survivors met NIA-AA criteria for MCI. This taxonomy may be useful when applied to brain tumor survivors because it defines cognitive phenotypes that may be differentially associated with course, treatment response, and risk factor profiles.

The role of social frailty in explaining the association between hearing problems and mild cognitive impairment in older adults

BackgroundWe examined the role of social frailty in the association between hearing problems and mild cognitive impairment (MCI), and investigated which cognitive impairment domains are most strongly involved. MethodsParticipants were 4251 older adults (mean age 72.5 ± 5.2 years, 46.1% male) who met the study inclusion criteria. Hearing problems were measured using the Hearing Handicap Inventory for the Elderly. Social frailty was identified using responses to five questions. Participants were divided into four groups depending on the presence of social frailty and hearing problems: control, social frailty, hearing problem, and co-occurrence. We assessed memory, attention, executive function, and processing speed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Participants were categorized into normal cognition, single- and multiple-domain MCI, depending on the number of impaired cognitive domains. ResultsParticipants with multiple-domain MCI exhibited the highest odds ratios (OR) of the co-occurrence group (OR: 3.89, 95% confidence intervals [CI]: 1.96–7.72), followed by the social frailty (OR: 2.65, 95% CI: 1.49–4.67), and hearing problem (OR: 1.90, 95% CI: 1.08–3.34) groups, compared with the control group. However, single-domain MCI was not significantly associated with any group. Cognitive domain analysis revealed that impaired executive function and processing speed were associated with the co-occurrence, hearing problem, and social frailty groups, respectively. ConclusionsSocial frailty and hearing problems were independently associated with multiple-domain MCI. Comorbid conditions were more strongly associated with multiple-domain MCI. Longitudinal studies are needed to elucidate the causal role of social frailty in the association between hearing impairment and MCI.

Application of the DSM-5 Criteria for Major Neurocognitive Disorder to Vascular MCI Patients

Aims: The DSM-5 introduced the term “major neurocognitive disorders” (NCDs) to replace the previous term “dementia.” However, psychometric and functional definitions of NCDs are missing. We aimed to apply the DSM-5 criteria for diagnosing the transition to NCD to patients with mild cognitive impairment (MCI) and small vessel disease (SVD), and to define clinically significant thresholds for this transition. Methods: The functional and cognitive features of the NCD criteria were evaluated as change from baseline and operationalized according to hierarchically ordered psychometric rules. Results: According to the applied criteria, out of 138 patients, 44 were diagnosed with major NCD (21 with significant cognitive worsening in ≥1 additional cognitive domain), 84 remained stable, and 10 reverted to normal. Single-domain MCI patients were the most likely to revert to normal, and none progressed to major NCD. The amnestic multiple-domain MCI patients had the highest rate of progression to NCD. Conclusion: We provide rules for the DSM-5 criteria for major NCD based on cognitive and functional changes over time, and define psychometric thresholds for clinically significant worsening to be used in longitudinal studies. According to these operationalized criteria, one-third of the MCI patients with SVD progressed to major NCD after 2 years, but only within the multiple-domain subtypes.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Characterising omission errors in everyday task completion and cognitive correlates in individuals with mild cognitive impairment and dementia

ABSTRACTObjective: Functional ability declines with age and cognitive impairment. This study investigated errors of omission made by community-dwelling older adults completing everyday tasks in a naturalistic setting.Method: Sixty-five cognitively healthy older adults (HOA), 19 individuals with single domain mild cognitive impairment (sdMCI), 33 individuals with multi-domain MCI (mdMCI), and 13 individuals with dementia completed measures of memory, processing speed, working memory, and executive functioning, as well as eight different activities of daily living in a naturalistic environment. Task steps were divided into preparatory, action-oriented, and concluding steps.Results: For action-oriented steps, the number of omission errors increased with level of cognitive impairment beyond sdMCI (i.e., HOA = sdMCI < mdMCI < dementia). In contrast, for preparatory and concluding steps, the dementia group committed more omission errors than the HOA, sdMCI, and mdMCI groups, which did not differ.Conclusions: The results suggest that the more complex and integrative action-oriented steps may be the first type of everyday task step to be affected in the process of cognitive decline, with preparatory and concluding steps being preserved longer and only showing decline in later stages of impairment (i.e., dementia). Individuals with sdMCI may use other intact abilities to compensate for task omission errors.

Pupillary Responses as a Biomarker ofEarly Risk for Alzheimer's Disease.

Task-evoked pupillary responses may be a psychophysiological biomarker of early risk for mild cognitive impairment (MCI) and Alzheimer's disease (AD). Pupil dilation during cognitive tasks reflects cognitive effort until compensatory capacity is surpassed and performance declines are manifest, and reflects activation in the locus coeruleus, where degenerative changes have been found in the earliest stages of AD. We recorded pupillary responses during digit span recall in 918 participants ages 56-66. Despite normal performance, amnestic single-domain MCI (S-MCI) participants showed greater pupil dilation than non-amnestic S-MCI and cognitively normal (CN) participants at lower cognitive loads. Multi-domain MCI (M-MCI) participants failed to modulate effort across cognitive loads and showed poorer performance. Pupillary responses differentiated MCI and CN groups. Amnestic S-MCI participants required compensatory effort to maintain performance, consistent with increased risk for decline. Greater effort in CN individuals might indicate risk for MCI. Results are consistent with dysfunction in locus coeruleus-linked brain systems. This brief task shows promise as a biomarker for early MCI and AD risk prediction.