Spectrum Of Mild Cognitive Impairment Research Articles

Multimodal classification of Alzheimer's disease and mild cognitive impairment using custom MKSCDDL kernel over CNN with transparent decision-making for explainable diagnosis

The study presents an innovative diagnostic framework that synergises Convolutional Neural Networks (CNNs) with a Multi-feature Kernel Supervised within-class-similar Discriminative Dictionary Learning (MKSCDDL). This integrative methodology is designed to facilitate the precise classification of individuals into categories of Alzheimer's Disease, Mild Cognitive Impairment (MCI), and Cognitively Normal (CN) statuses while also discerning the nuanced phases within the MCI spectrum. Our approach is distinguished by its robustness and interpretability, offering clinicians an exceptionally transparent tool for diagnosis and therapeutic strategy formulation. We use scandent decision trees to deal with the unpredictability and complexity of neuroimaging data. Considering that different people's brain scans are different, this enables the model to make more detailed individualised assessments and explains how the algorithm illuminates the specific neuroanatomical regions that are indicative of cognitive impairment. This explanation is beneficial for clinicians because it gives them concrete ideas for early intervention and targeted care. The empirical review of our model shows that it makes diagnoses with a level of accuracy that is unmatched, with a classification efficacy of 98.27%. This shows that the model is good at finding important parts of the brain that may be damaged by cognitive diseases.

Feasibility and Effects of Cognitive Training with the COGNIPLAT Game Platform in Elderly with Mild Cognitive Impairment: Pilot Randomized Controlled Trial.

This study examines the effectiveness of a new multi-domain multimodal cognitive training game platform, COGNIPLAT, in improving cognitive performance in elderly with mild cognitive impairment (MCI). The platform combines standard serious games and cognitive stimulation leveraging virtual and augmented reality technologies. A double-arm, evaluator-blinded randomized controlled trial was conducted with 21 elderly participants in the MCI spectrum, with 11 in the intervention group (INT) and 10 in the control group (CTL). Feasibility was assessed in terms of adherence, effective learning, and perceived usefulness. The INT attended 24 training sessions, 60 minutes long, twice a week, whereas the CTL engaged in normal daily activities and usual care. Results showed that the INT had a statistically significant change in the Montreal Cognitive Assessment score, stages List B Recall, Short-term delayed Recall, and Long-term delayed Recall of the Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test-A and B test scores, Digit Span Test (DST) Forward Span, and Functional Activities Questionnaire score. A trend level difference was also found for the RAVLT Recognition and the DST Backward Span. No significant differences were found for the CTL in any of the metrics. The completion rate of the INT was 91%, and the attendance rate was 100% for participants who completed the follow-up segment of the study. The engagement level was high, and effective learning was observed between the participants. The perceived usability and usefulness of the game platform was assessed as high. This study provides evidence of a positive effect of a multi-domain multimodal-based cognitive training program in elderly with MCI, with broader benefits on cognition by inducing more cooperative transfer effects over different domains.

Neuropsychological Correlates of Anosognosia for Objective Functional Difficulties in Older Adults on the Mild Cognitive Impairment Spectrum.

To examine the neuropsychological correlates of anosognosia for instrumental activities of daily living (IADLs) in older adults with mild cognitive impairment (MCI) and mild dementia. Participants (n=103; age range=54-88, 52% female) with MCI and mild dementia were recruited from neurology and geriatrics clinics for cross-sectional analysis. They completed neuropsychological tests along with subjective and performance-based assessments of six IADLs: financial management, driving, grocery shopping, nutrition evaluation, telephone use, and medication management. For each IADL, participants were classified as having anosognosia when there was objective difficulty but no subjective complaints. Depending on functional domain, 13-39% of the sample had objective IADL difficulty, and of those, 65-93% lacked insight into these deficits. Binomial logistic regression models controlling for demographic variables revealed that measures of global cognition, executive function, visual attention, and verbal memory predicted classification of anosognosia, and these relationships varied across IADLs. In contrast, basic auditory attention, working memory, depressive symptoms, nor cognitive reserve were significantly related to anosognosia for any IADL. Results support the Conscious Awareness Model, which theorizes that accurate metacognitive output is reliant on attentional, memory, and executive functioning systems. Findings from this study suggest that anosognosia for different IADLs may arise from breakdowns at varying points in this model, explaining both inter- and intra-patient variability in self-awareness of functional deficits.

Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence.

ObjectivesTo review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment.DesignScoping review of empirical literature focused on primary studies of any design.SettingPrimary care practice.ParticipantsPCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia.MeasurementsSystematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes.ResultsEighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient’s quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations.ConclusionThe increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessation.

Cardiorespiratory Fitness and Cognitive Function are Positively Related Among Participants with Mild and Subjective Cognitive Impairment.

By 2030, about 74 million people will be diagnosed with dementia, and many more will experience subjective (SCI) or mild cognitive impairment (MCI). As physical inactivity has been identified to be a strong modifiable risk factor for dementia, exercise and physical activity (PA) may be important parameters to predict the progression from MCI to dementia, but might also represent disease trajectory modifying strategies for SCI and MCI. A better understanding of the relationship between activity, fitness, and cognitive function across the spectrum of MCI and SCI would provide an insight into the potential utility of PA and fitness as early markers, and treatment targets to prevent cognitive decline. 121 participants were stratified into three groups, late MCI (LMCI), early MCI (EMCI), and SCI based on the Montreal Cognitive Assessment (MoCA). Cognitive function assessments also included the Trail Making Test A+B, and a verbal fluency test. PA levels were evaluated with an interviewer-administered questionnaire (LAPAQ) and an activity monitor. An incremental exercise test was performed to estimate cardiorespiratory fitness and to determine exercise capacity relative to population normative data. ANCOVA revealed that LMCI subjects had the lowest PA levels (LAPAQ, p = 0.018; activity monitor, p = 0.041), and the lowest exercise capacity in relation to normative values (p = 0.041). Moreover, a modest correlation between MoCA and cardiorespiratory fitness (r = 0.25; p < 0.05) was found. These findings suggest that during the earliest stages of cognitive impairment PA and exercise capacity might present a marker for the risk of further cognitive decline. This finding warrants further investigation using longitudinal cohort studies.

Mild Cognitive Impairment: A Brief Review and Suggested Clinical Algorithm.

Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI.

P3‐272: Longitudinal profiling of mild congitive impairment subtypes

Mild Cognitive Impairment (MCI) was originally conceptualized as a condition that manifested prior to the onset of clinical dementia, particularly Alzheimer’s disease. However, longitudinal studies show that MCI has an unstable course and may lead to various outcomes including dementia, but also stability of cognitive deficits or recovery to age appropriate levels of functioning. As a result, the status of MCI as a genuine diagnostic entity remains questionable. The aim of the present thesis was to examine the validity of the MCI concept by tracking groups of individuals classified into one of the MCI subtypes and to monitor their neuropsychological profiles over time. To avoid previous criticisms of circularity, participants were classified as MCI on a neuropsychological test battery and then reassessed longitudinally using an alternate battery of neuropsychological tests. At each stage of testing, participants were assessed on a comprehensive neuropsychological test battery tapping the cognitive domains implicated in MCI. Findings from this thesis indicate that multiple domain amnestic MCI may be the most valid subtype of MCI due to consistently poor performance over time on a range of neuropsychological measures. Results also demonstrate that those who are likely to remain on the MCI spectrum can be differentiated from healthy older adults using reliable and valid measures of sustained attention, semantic memory, verbal episodic memory, visual and verbal working memory, selective attention and strategy use. Despite these findings, evidence from this thesis indicates that existing MCI clinical criteria lack sufficient sensitivity and specificity. Although the concept of MCI remains useful, it cannot be considered a clinical diagnostic entity. Future research should prioritize the observation of those presenting with a multiple domain amnestic profile as these individuals may have the poorest prognosis. Further, studies must utilize comprehensive testing protocols to increase the sensitivity and specificity of identifying those with genuine subclinical impairments.

Plasma Amyloid β 42 and Amyloid β 40 Levels Are Associated With Early Cognitive Dysfunction After Cardiac Surgery

Decreased cognitive function associated with coronary artery bypass graft surgery is common. These deficits may be similar to the cognitive dysfunction seen in the spectrum of mild cognitive impairment to Alzheimer's disease, which are believed to result from the accumulation of amyloid beta (Abeta) peptide in the brain. We measured cognition both before and after coronary artery bypass graft surgery and assayed Abeta levels to investigate whether the cognitive dysfunction of cardiac surgery was associated with Abeta levels. The plasma of 332 patients, who had undergone neuropsychological testing before and 3 and 12 months after coronary artery bypass graft surgery, was analyzed for Abeta(42) and Abeta(40). Patients were classified as having preexisting cognitive impairment if cognitive function was decreased in two or more tests compared with a healthy control group, and postoperative cognitive dysfunction was defined as a decline in two or more tests compared with the group mean baseline score. Preexisting cognitive impairment was present in 117 patients (35.2%), and postoperative cognitive dysfunction was present in 40 (12%) at 3 months and 41 (13%) at 12 months after surgery. Both plasma Abeta(42) and Abeta(40) levels assessed before the surgery were significantly lower in patients who later had postoperative cognitive dysfunction at 3 months. Decreased preoperative plasma levels of Abeta(42) and Abeta(40) in patients who exhibit postoperative cognitive dysfunction at 3 months suggest that postoperative cognitive dysfunction at this time may share a common mechanism with mild cognitive impairment and Alzheimer's disease. This process may be exacerbated by anesthesia.

Plasma amyloid β 42 and amyloid β 40 levels are associated with early cognitive dysfunction after cardiac surgery

Background Decreased cognitive function associated with coronary artery bypass graft surgery is common. These deficits may be similar to the cognitive dysfunction seen in the spectrum of mild cognitive impairment to Alzheimer's disease, which are believed to result from the accumulation of amyloid beta (Aβ) peptide in the brain. We measured cognition both before and after coronary artery bypass graft surgery and assayed Aβ levels to investigate whether the cognitive dysfunction of cardiac surgery was associated with Aβ levels. Methods The plasma of 332 patients, who had undergone neuropsychological testing before and 3 and 12 months after coronary artery bypass graft surgery, was analyzed for Aβ 42 and Aβ 40 . Patients were classified as having preexisting cognitive impairment if cognitive function was decreased in two or more tests compared with a healthy control group, and postoperative cognitive dysfunction was defined as a decline in two or more tests compared with the group mean baseline score. Results Preexisting cognitive impairment was present in 117 patients (35.2%), and postoperative cognitive dysfunction was present in 40 (12%) at 3 months and 41 (13%) at 12 months after surgery. Both plasma Aβ 42 and Aβ 40 levels assessed before the surgery were significantly lower in patients who later had postoperative cognitive dysfunction at 3 months. Conclusions Decreased preoperative plasma levels of Aβ 42 and Aβ 40 in patients who exhibit postoperative cognitive dysfunction at 3 months suggest that postoperative cognitive dysfunction at this time may share a common mechanism with mild cognitive impairment and Alzheimer's disease. This process may be exacerbated by anesthesia.

Patterns of correlation between Aβ deposition and glucose metabolism across the spectrum of mild cognitive impairment to Alzheimer's disease

Patterns of correlation between Aβ deposition and glucose metabolism across the spectrum of mild cognitive impairment to Alzheimer's disease

Working criteria of mild cognitive impairment in community: findings from Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS)

AbstractIntroduction: The clinical determination of relative severity of impairment along the spectrum of mild cognitive impairment (MCI) may be valuable for the prediction of dementia. The purpose of the present study is to suggest the working criteria of MCI based on severity in the community sample.Methods: The MCI group was divided into three groups by severity according to cognitive and functional status. The grade I MCI group was based on the original concept of Petersen's MCI. The grade II MCI group was in the same condition as grade I MCI, except that the general cognitive function was not intact. The grade III MCI group was defined as the condition not essentially preserved instrumental to the activity of daily living, but not definite in dementia regardless of general cognitive and functional state.Results: A total of 38.5% of the subjects were classified as not cognitively impaired (NCI), 41.4% as MCI, and 10.3% as having dementia. Preliminary results showed that the grades I, II, and III MCI groups had a tendency to lie between the NCI and dementia groups.Discussion: Prospective cohort studies with clinical correlations are needed to determine whether our working criteria of MCI considering characteristics of the rural elderly, such as low education and less comprehensive activities of daily living (ADL), would be useful.

Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment.

To determine whether clinical assessment methods that grade the severity of impairments within the spectrum of mild cognitive impairment (MCI) can predict clinical course, particularly among very mildly impaired individuals who do not meet formal MCI criteria as implemented in clinical trials. Cohort. Community volunteers. From a longitudinal study of normal (Clinical Dementia Rating [CDR] = 0; n = 77) and mildly impaired (CDR = 0.5; n = 167) participants with 5 or more annual clinical assessments, baseline level of cognitive impairment in daily life was graded using CDR sum of boxes (CDR-SB) and level of cognitive performance impairment was graded using neuropsychological test scores. Five-year outcome measures included (1) probable Alzheimer disease (AD) diagnosis and (2) clinical "decline" (CDR-SB increase > or = 1.0). Logistic regression models were used to assess the ability of baseline measures to predict outcomes in the full sample and separately in the subjects who did not meet formal MCI criteria as implemented in a multicenter clinical trial (n = 125; "very mild cognitive impairment" [vMCI]). The presence of both higher CDR-SB and lower verbal memory and executive function at baseline predicted greater likelihood of probable AD and decline. Five-year rates of probable AD and decline in vMCI (20%, AD; 49%, decline) were intermediate between normal participants (0%, AD; 28%, decline) and participants with MCI (41%, AD; 62%, decline). Within vMCI, likelihood of probable AD was predicted by higher CDR-SB and lower executive function. Even in very mildly impaired individuals who do not meet strict MCI criteria as implemented in clinical trials, the degree of cognitive impairment in daily life and performance on neuropsychological testing predict likelihood of an AD diagnosis within 5 years. The clinical determination of relative severity of impairment along the spectrum of MCI may be valuable for trials of putative disease-modifying compounds, particularly as target populations are broadened to include less impaired individuals.

From Normal to Pathological Ageing - The Spectrum of Mild Cognitive Impairment and Alzheimer’s Disease

From Normal to Pathological Ageing - The Spectrum of Mild Cognitive Impairment and Alzheimer’s Disease

Mild cognitive impairment in the elderly

The present review on mild cognitive impairment (MCI) concerns preclinical Alzheimer's disease (no cognitive impairment but neuropathological changes typical for Alzheimer's disease), subjective cognitive/memory complaints with and without verified neuropsychological deficit, and the validity of amnestic MCI. The following were shown to be predictors of Alzheimer's disease: measures of episodic memory; presence of the apolipoprotein E e4 allele; reduced cerebral temporo-parietal glucose metabolism and blood flow; neuronal loss in the entorhinal cortex, and in layer II and CA1 of the hippocampus; brain activation of the hippocampus through cognitive stress tests (as measured using structural and functional magnetic resonance imaging); and purely subjective cognitive impairment and features of age-associated cognitive decline. Furthermore, the distinction of MCI from both healthy and demented status, and the role of activities of daily living in MCI are emphasized. Early predictors and three stages (MCI spectrum disorder) in the development of Alzheimer's disease are discussed: asymptomatic Alzheimer's disease (including preclinical Alzheimer's disease), purely subjective cognitive complaints, and objective evidence of MCI.