Neuropsychological Examination Research Articles

Social Loneliness in Older Adults with Mild Cognitive Impairment: Predictive Factors and Associated Clinical Characteristics.

Loneliness and social isolation are considered public health problems among older individuals. In addition, both increase the risk of developing cognitive impairment and dementia. The Social Loneliness construct has been proposed to refer to these harmful social interaction-related factors. To define the risk factors of Social Loneliness in individuals with mild cognitive impairment (MCI) and to analyze cognitive, emotional, and functional differences according to the participant's degree of Social Loneliness. Through convenience sampling, 105 participants over 60 diagnosed with MCI were selected. The evaluation consisted of anamnesis and a comprehensive neuropsychological examination. The ESTE-II questionnaire was used to assess Social Loneliness and its three factors: perceived social support, social participation, and use of communication technologies. Personality was measured with the NEO-FFI questionnaire. The predictors of the Social Loneliness factors were as follows; 1) perceived social support (R2 = 0.33): Neuroticism (β= 0.353), depression (β= 0.205), and perceived health (β= 0.133); 2) social participation (R2 = 0.24): Conscientiousness (β= -0.344) and Extraversion (β= -0.263); 3) use of communication technologies (R2 = 0.44): age (β= 0.409), type of cohabitation (β= 0.331), cognitive reserve (β= -0.303), and Conscientiousness (β= -0.247); all p < 0.05. The participants with a higher degree of Social Loneliness showed more depressive symptoms (R2 = 0.133), more memory complaints (R2 = 0.086), worse perceived health (R2 = 0.147), lower attentional performance/processing speed (R2 = 0.094), and more naming difficulties (R2 = 0.132); all p < 0.05. This research represents an advance in detecting individuals with MCI and an increased risk of developing Social Loneliness, which influences the configuration of the clinical profile of MCI.

Adaptive behavior assessed by Vineland-3 as comprehensive outcome measure in vanishing white matter.

Investigate the results and usability of the Vineland-3 as an outcome measure in vanishing white matter patients. A cross-sectional investigation of the Vineland-3 based on interviews with caregivers, the Health Utilities Index, and the modified Rankin Scale in 64 vanishing white matter patients. Adaptive behavior measured with the Vineland-3 is impaired in the vast majority of vanishing white matter patients and significantly impacts daily life. Typically, the daily living skills domain is most severely affected and the socialization domain is the least affected. Based on the metric properties and the clinical relevance, the standard scores for the daily living skills domain and Adaptive Behavior Composite have the best properties to be used as an outcome measure. The Vineland-3 appears to be a useful outcome measure to explore and quantify complex cognitive, behavioral, and psychiatric impairments affecting daily functioning in vanishing white matter. Further research should address the longitudinal evaluation of this tool and its additional value to standard neuropsychological and clinical examination.

Facial emotion recognition deficits are associated with hypomimia and related brain correlates in Parkinson's disease.

Hypomimia is a frequent manifestation in Parkinson's disease (PD) that can affect interpersonal relationships and quality of life. Recent studies have suggested that hypomimia is not only related to motor dysfunction but also to impairment in emotional processing networks. Therefore, we hypothesized that the severity of hypomimia could be associated with performance on a task aimed at assessing facial emotion recognition. In this study, we explored the association between hypomimia, recognition of facial expressions of basic emotions using the Ekman 60 Faces Test (EF), and brain correlates of both hypomimia and performance on the EF. A total of 94 subjects underwent clinical assessments (neurological and neuropsychological examinations), and 56 of them participated in the neuroimaging study. We found significant correlation between hypomimia, EF Disgust (r = -0.242, p = 0.022) and EF Happiness (r = -0.264, p = 0.012); an independent reduction in Cortical Thickness (Cth) in the postcentral gyrus, insula, middle and superior temporal gyri, supramarginal gyrus, banks of the superior temporal sulcus, bilateral fusiform gyri, entorhinal cortex, parahippocampal gyrus, inferior and superior parietal cortex, and right cuneus and precuneus; and multiple correlations between negative emotions such as EF Disgust or EF Anger and a reduced Cth in fronto-temporo-parietal regions. In conclusion, these results suggest that the association between hypomimia and emotion recognition deficits in individuals with PD might be mediated by shared circuits, supporting the concept that hypomimia is not only the result of the dysfunction of motor circuits, but also of higher cognitive functions.

Frontal allographic agraphia in a patient with behavioral variant frontotemporal dementia

ABSTRACT We report a patient with behavioral variant frontotemporal dementia who developed agraphia, irritability, perseverative and stereotyped behavior, and dietary changes. MRI revealed bilateral frontal convexity atrophy. Neuropsychological examination showed fluent aphasia with perseverative allographic agraphia, mild semantic impairment, and dysexecutive syndrome. Allographic agraphia featured unidirectional conversion from hiragana (cursive form of Japanese phonograms) and kanji (Japanese morphograms) to katakana (square form of Japanese phonograms), as opposed to mutual (bidirectional) conversion between hiragana and katakana in parieto-occipital gyri lesions. Furthermore, all letters of the word were converted and this whole-word conversion may be characteristic of perseverative behavior in frontotemporal dementia.

The Association of Neighborhood Socioeconomic Status with Executive Function and Processing Speed in Cognitively Normal Mexican American Elders from the Health and Aging Brains Study: Health Disparities Cohort

Introduction: Neighborhood socioeconomic status (NSES) has been linked with overall health, and this study will evaluate whether NSES is cross-sectionally associated with cognition in non-Hispanic whites (NHWs) and Mexican Americans (MAs) from the Health and Aging Brain: Health Disparities Study (HABS-HD). Methods: The HABS-HD is a longitudinal study conducted at the University of North Texas Health Science Center. The final sample analyzed (n = 1,312) were 50 years or older, with unimpaired cognition, and underwent an interview, neuropsychological examination, imaging, and blood draw. NSES was measured using the national area deprivation index (ADI) percentile ranking, which considered socioeconomic variables. Executive function and processing speed were assessed by the trail making tests (A and B) and the digit-symbol substitution test, respectively. Linear regression was used to assess the association of ADI and cognitive measures. Results: MAs were younger, more likely to be female, less educated, had higher ADI scores, performed worse on trails B (all p < 0.05), and had lower prevalence of APOE4 + when compared to NHWs (p < 0.0001). A higher percentage of MAs lived in the most deprived neighborhoods than NHWs. For NHWs, ADI did not predict trails B or DSS scores, after adjusting for demographic variables and APOE4. For MAs, ADI predicted trails A, trails B, and DSS after adjusting for demographic covariates and APOE4 status. Conclusion: Our study revealed that living in an area of higher deprivation was associated with lower cognitive function in MAs but not in NHWs, which is important to consider in future interventions to slow cognitive decline.

Structural and microstructural predictors of cognitive decline in deep brain stimulation of subthalamic nucleus in Parkinson’s disease

Background and objectivesThe intricate relationship between deep brain stimulation (DBS) in Parkinson’s disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients. MethodsPre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population – Dementia Rating Scale 2. ResultsPD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups. ConclusionsOur findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.

Cognitive effects of brief and intensive neurofeedback treatment in schizophrenia: a single center pilot study.

Schizophrenia is characterized by significant cognitive impairments and affects up to 98% of patients. Neurofeedback (NF) offers a means to modulate neural network function through cognitive processes such as learning and memorization, with documented structural changes in the brain, most notably an increase in grey matter volume in targeted regions. The present 2-week, open-label, preliminary study aims to evaluate the efficacy on cognition of an adjunctive short and intensive (8 daily sessions lasting 30 minutes) alpha/theta NF training in a sample of subjects affected by schizophrenia on stabilized treatment with atypical antipsychotic drugs. The efficacy was measured at baseline and at the end of the study by the Brief Neuropsychological Examination 2 (ENB 2), the Mini Mental State Examination (MMSE), and the Stroop color-word interference test; the clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). A final sample of nine patients completed the study. Regarding the cognitive performance, at the final assessment (week 2), the NF treatment significantly improved the performance in the "Story Recall Immediate" (p = 0.024), "Story Recall Delayed" (p = 0.007), "Interference Memory 30 s" (p = 0.024), "Clock Test" (p = 0.014) sub-tests, and the ENB2 Total Score (p = 0.007). Concerning the clinical symptoms, no significant changes were observed in the PANSS subscales and the PANSS Total score. NF could represent an adjunctive treatment strategy in the therapeutic toolbox for schizophrenia cognitive symptoms.

Indicators of cognitive impairment of varying severity in the acute period of ischemic stroke

To assess phenotype and identify biomarkers of cognitive impairment (CI) of varying severity in patients in the acute period of ischemic stroke (IS) based on the analysis of clinical and paraclinical indicators. Two hundred and forty patients with diagnosed IS and presence of CI were examined. Depending on the scores on the Montreal Cognitive Assessment Scale, patients were divided into two groups: group 1 (n=182) with mild CI, group 2 (n=58) with dementia. On admission, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), activities of daily living assessed by the Barthel Scale and patient independence assessed by the modified Rankin Scale (mRS) were determined. Neuropsychological examination was performed on day 14 and included investigation of episodic memory, executive functions, speech, gnosis, praxis, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) parameters. Immunological diagnostics included a study of the concentration of cytokines of various groups (interleukin (IL)-1b, IL-6, IL-16, granulocyte-macrophage colony-stimulating factor (GM-CSF), chemokines CXCL10, CXCL11, CXCL9, tumor necrosis factor α (TNFα)). Neuroimaging parameters were assessed using brain MRI data with verification of the STRIVE criteria and the medial temporal lobe atrophy scale (MTA). The standard application software package SPSS Statistics, Pandas and SciPy libraries were used for statistical analysis. Patients of group 2 had lower scores in all cognitive domains with the greatest reduction in perception, constructive praxis, semantic information processing and mnestic function. These analyses revealed a higher degree of IQCODE, prevalence of features corresponding to STRIVE/MTA criteria in patients of group 2, while patients of group 1 had higher NIHSS and mRS scores. When serum concentrations of cytokines were assessed, patients of group 1 showed higher concentrations of IL-1b, IL-6, GM-CSF and TNFα, while group 2 patients had higher concentrations of cytokine CXCL10. The presence of pre-stroke CI, baseline indicators of the patient's functional status, neuroimaging parameters of MTA/STRIVE and age are reflected in the structure and severity of cognitive deficit in the acute period of IS. Investigation of the role of interleukins, GM-CSF, TNFα and CXCL10 in the pathogenesis of IS and their association with the progression of post-stroke CI requires further studies with a larger sample size and longer follow-up period.

Comparative characteristics of neuropsychological and neurometabolic changes in patients with Alzheimer's disease and vascular cognitive impairment

To investigate the pattern and connections of neuropsychological and metabolic indices in patients with cognitive disorders of Alzheimer's and vascular (subcortical-cortical) types of different severity. A total of 177 patients were examined, including 85 patients with Alzheimer's disease (AD) and 92 patients with vascular cognitive impairment (VCI). All patients underwent complex neuropsychological examination; 18F-FDG PET was performed in 17 patients with AD and 15 patients with VCI. The greatest changes in patients with AD were noted in the mnestic sphere, and the indicators significantly differed from the results of the study of patients with VCI already at the pre-dementia stage. Neurodynamic and dysregulatory disorders prevailed in patients with VCI. Patients with AD showed bilateral symmetrical reduction of metabolic activity in the cortex of parietal and temporal lobes, often in combination with marked hypometabolism in the hippocampal region. In patients with VCI, there were areas of decreased brain tissue metabolism of different localization and size, mainly in the projection of the basal ganglia and in the prefrontal and parietal cortex, as well as in the cingulate gyrus, which indirectly confirms the mechanism of disconnection of subcortical and cortical structures. In AD, impaired metabolic activity in the hippocampal region correlated with impaired temporal and spatial orientation (ρ=-0.54, p<0.05), memory impairment (ρ=-0.71, p<0.005). Hypometabolism of the parietal lobe cortex was associated with total MMSE score (ρ=-0.8, p<0.001), 10-word test (ρ=-0.89, p<0.001 and ρ=-0.82, p<0.001), visual-spatial impairment (ρ=-0.64, p<0.01), categorical association test (ρ=-0.73, p<0.005). In patients with VCI, dysregulatory disorders correlated with hypometabolism in the thalamic projection (ρ=-0.56, p<0.05), prefrontal cortex (ρ=-0.64, p<0.05) and in the cingulate gyrus (anterior regions) (ρ=-0.53, p<0.05). The results indicate the presence of differences in cognitive impairment and cerebral metabolism in patients with AD and VCI.

Treatment of patients with ishemic stroke in the vertebral-basilar system in acute period: experience of using the neuroprotective drug Mexidol

To assess the clinical efficacy and safety of Mexidol in patients in acute period of ishemic stroke in the vertebral-basilar system (iiVBS). An open randomized comparative study involved 52 patients. 32 of them received Mexidol (mail group, MG) and 20 received therapy without neuroprotective drugs. Assessment of the severity of clinical manifestations of iiVBS was performed using the Hoffenberth scale, stroke severity was assessed using the NIHSS, the modified Rankin Scale was used to assess the degree of disability in patients after stroke, neuropsychological examination of patients was performed using the Montreal Cognitive Assessment (MoCA), dynamics were compared on the Hospital Anxiety and Depression Scale (HADS), Subjective assessment scale for asthenia (MFI-20), the patients' quality of life was assessed using the EQ-5D. The use of Mexidol in the form of long-term sequential therapy in the patients of the MG led to a 53.3% decrease in the severity of clinical manifestations of iiVBS and a 59.5% decrease in neurological deficit according to the NIHSS scale. By the end of Mexidol therapy, 96.9% of patients MG were able to manage their own affairs without assistance (modified Rankin Scale), which was accompanied by regression of emotional disturbances and improved quality of life of patients. Administration of Mexidol in therapy of patients with acute iiVBS can be considered the most justified, since it contributes to an earlier and more significant reduction of neurological deficit and improvement of patients' quality of life.

Особенности криминального поведения обвиняемых в совершении особо тяжких преступлений с различными нарушениями функций программирования, регуляции и контроля психической деятельности (Часть 1)

&lt;p style="text-align: justify;"&gt;The purpose of our study was the features of criminal behavior of the accused in the commission of particularly serious crimes in the context of the formation functions of programming and control. The sample consisted of 59 men aged 18&amp;mdash;60 years, of those accused of committing particularly serious crimes aimed at a forensic psychiatric examination, the average age was 33.7 years. The methods of neuropsychological examination and psychological analysis of criminal cases were used. Syndrome of defeat of the basal divisions of the frontal lobes, prefrontal syndrome, syndrome of defeat of the medial divisions of the frontal lobes, Postfrontal (premotor) syndrome is most often seen among persons accused of particularly serious crimes. The criminal behavior of the accused in the Commission of particularly serious crimes was characterized by uncritical damage to the basal parts of the frontal lobes. The impulsivity is the main characteristic of the criminal behavior of the accused in especially serious crimes with the defeat of the prefrontal frontal lobe (prefrontal syndrome). Subjects with the defeat of the kinetic (dynamic) factor differed greater rigidity of criminal behavior. The behavior of those accused of committing particularly serious crimes was passive (energy-saving) in violation of the energy factor in the case of damage to the medial parts of the frontal lobes. The obtained results can be used to solve the issues of drawing a portrait of an unknown criminal, as well as in the course of correctional work with persons prone to repeat illegal behavior.&lt;/p&gt;

A Case Study on Cardiovascular Embolism and Its Impact on Facial Recognition

This case study presents an 84-year-old man patient with cardio-genic cerebral embolism in the right middle artery territory, who showed difficulty in recognizing faces and often mistook unfamiliar people for someone he knew. He was fully conscious, with normal visual acuity, and no hemianopia, neglect, and deafness. Results from a neuropsychological examination indicated visual agnosia for prosopagnosia. An MRI showed hyperintense signals from the frontal to temporal lobes on the right side. Initially suspected to be delusional misidentification syndrome, the patient’s case differed from Fregoli syndrome as he identified unfamiliar people as persons close to him. This case highlights the importance of careful diagnosis and assessment in patients with visual agnosia for prosopagnosia, which can have significant impact on daily life and functioning.

P187: A patient with early-onset Alzheimer’s disease presenting with a unique form of Capgras syndrome

Background:Capgras syndrome is a delusion in which the patient believes that a particular individual has been replaced by an imposter. It is observed in patients with psychiatric disorders such as schizophrenia but also occurs in patients with a neurodegenerative disease including Lewy body disease and Alzheimer’s disease. Here we report a patient with early-onset Alzheimer’s disease who presented with a unique form of Capgras syndrome.Case presentation:An early 60’s right-handed woman with 12 years of education, visited our outpatient clinic for evaluation of her memory impairment. Neurological examination was not remarkable. A MMSE score was 25/30 and a neuropsychological examination indicated mild impairment of attention and episodic memory, and relatively preserved visuospatial function. Six months after the initial visit of our clinic, she started to claim that she met several imposters of her husband. She called each imposter in different name, described each as a slightly different appearance, and expressed different level of sense of familiarity. An additional examination of face recognition using photographs of her husband revealed that there was a difficult to recognize her husband especially viewed from the side of his face. In addition, she showed a difficulty in discriminating between two different unknown faces and in judging approximate age of face in photographs. Brain MRI showed no significant atrophy and IMP-SPECT showed an extensive hypoperfusion in the bilateral, right-side dominant temporal, parietal, and occipital lobes. Both FP-CIT SPECT and MIBG scintigraphy were negative. Florbetapir PET was positive. Thus, a diagnosis of early-onset Alzheimer's disease was made. Acetylcholinesterase inhibitors and antipsychotics were used to treat her Capgras syndrome, but the symptom lasted for more than a year.Discussion:There are several possible factors that may induced patient’s unique Capgras syndrome: (1) psychodynamic background- the patient and her husband had been in a long-term common-law relationship; (2) mild impairment in face recognition; (3) dysfunction of right hemisphere, which is known to be strongly related to Capgras syndrome. The combination of these factors may result in the occurrence of multiple imposters of her husband with different degrees of familiarity.

P152: Early detection and evolution of Mild Behavioral Impairment in a sample of people with subjective cognitive complaints

Objective:Mild behavioral impairment (MBI) is a validated diagnostic entity, that describes the emergence of later life neuropsychiatric symptoms (NPS) in pre-dementia states. The aim of this study was to estimate the prevalence of MBI in people with subjective cognitive complains (SCCs) in primary care centers and observe the evolution in a longitudinal study.Methods:Three hundred twenty-three participants belonging to the CompAS longitudinal study who attended primary care centers with SCCs and without previous diagnosis of dementia and other neurological or psychiatric disturbances underwent clinical, neurological, and neuropsychological examinations at baseline and at two follow-up times (around 24 and 60 moths). At each evaluation point participants were diagnosed as Cognitively Unimpaired (UC), Mild Cognitive Impairment (MCI) and SDC; at the follow-up assessments dementia was diagnosed as well. Diagnosis of MBI was made via a series of semistructured independent interviews with patients and relatives in accordance with the ISTAART-AA criteria and using the Spanish MBI-C cut-off point (Mallo et al, 2019). Frequencies of participants diagnosed in each category were obtained and evolution of the MBI along the follow-up evaluations was studied.Results:MBI diagnosis prevalence was 22.9% at baseline corresponding to 74 individuals of which at 24 months follow-up were MBI stable 31.1%, 14.9% evolved to MCI, 1.3% to dementia and 40% to CU, (attrition 12.2%). At 60 months follow-up, from the 23 individuals with MBI, 6 remained stable (26.1%), 6 (21.1%) evolved to MCI, 2 (8.7%) to dementia, 3 (13%) to CU, (attrition 26.1%) (Figure 1).Conclusions:Results indicated that almost a quarter of individuals attending primary care centers with SCCs without previous diagnosis of dementia or psychiatric disorders are MBI. An important part of them evolve to UC or MCI, and only a minority progress to dementia. More studies are needed to analyze the cognitive, personal, and biological factors that determine this evolution.

Vascular dysfunction in behavior‐variant frontotemporal dementia

AbstractBackgroundThe vascular disturbance was recently found in a postmortem study of frontotemporal dementia (FTD), but whether vascular dysfunction exists in the early stage of FTD remains elusive. The study aimed to explore whether there was evidence of vascular dysfunction in FTD and its relationship with central neurodegeneration and the clinical outcome.MethodTwenty patients with behavior frontotemporal dementia (bvFTD) were enrolled and underwent assessment of peripheral plasma vascular markers, positron emission tomography/magnetic resonance imaging, and neuropsychological examinations. Group difference was tested using the student’s t‐test and Mann‐Whitney U test. Partial correlation analysis was implemented using age and sex as covariates to explore the association between peripheral vascular markers, neuroimaging, and clinical measures.ResultAll four factors including matrix metalloproteinases‐1(MMP‐1), matrix metalloproteinases‐3 (MMP‐3), Osteopontin, and pentraxin‐3 are increased in the FTD group. The plasma level of MMP‐1 was negatively correlated with the gray matter metabolism of the prefrontal cortex (r = ‐0.5119, p = 0.0210) and the anterior cingulate cortex (r = ‐0.4685, p = 0.0269). MMP‐3 was negatively correlated with the gray matter metabolism of the anterior temporal cortex (r = ‐0.4650, p = 0.0388). Pentraxin‐3 was negatively correlated with age at sampling (r = ‐0.5024, p = 0.0240) and age at onset (r = ‐0.5693, p = 0.0088). No other significant associations were found in other vascular cytokines and clinical measures.ConclusionThe vascular disturbance was found in patients with bvFTD and associated with the disease‐specific neurodegeneration pattern, indicating vascular dysfunction and perturbance of the BBB participation in the pathogenesis of FTD. The vascular pathway might be a promising target for future potential therapy.

Plasma melatonin night‐time peak levels and 24‐hour area under the curve profile seem higher in AD patients with epileptiform activity than in those without

AbstractBackgroundPlasma melatonin levels drop in elderly, which might become more pronounced in Alzheimer’s disease (AD) as compared to controls.(1) Melatonin can serve as a potential biomarker for AD, given the inverse correlation between cerebrospinal fluid (CSF) melatonin levels and severity of neuropathology (Braak stages).(2) Due to suggested antiepileptic effects(6), melatonin can potentially slow down disease progression as epileptiform activity may contribute to AD disease progression.(3‐5). We here present a preliminary interim analysis of an ongoing study.Aims1. To evaluate melatonin’s potential as biomarker for AD by comparing blood melatonin levels between patients with mild cognitive impairment (MCI) and dementia due to AD and preclinical AD subjects.2. To study the link between melatonin levels and epileptiform activity in AD.MethodsAll subjects underwent a neuropsychological examination, and lumbar puncture for analysis of core AD CSF biomarkers or amyloid brain PET. Subjects belonging to the AD continuum (dementia [n = 7]; MCI [n = 4]; preclinical AD [n = 1]) were diagnosed according to the NIA‐AA research criteria. A subset of subjects (n = 6) underwent 50‐minute magnetoencephalography to detect epileptiform activity. Blood samples were taken multiple times during a 24‐hour period, in in‐hospital controlled circumstances, and were analysed by use of liquid chromatography‐mass spectrometry.ResultsAD patients with epileptiform activity (n = 2) tended to have a higher melatonin 24‐hour area under the curve (AUC) and peak concentration (AUC 517.9pg/ml.h [+/‐140.1pg/ml.h] versus 204.5pg/ml.h [+/‐115.5pg/ml.h]; peak 65.4pg/ml [+/‐14.6pg/ml] versus 25.8pg/ml [+/‐17.5pg/ml]) than AD patients without (n = 4) (p = 0.064 for both; MWU test). There was no statistical difference regarding the melatonin 24‐hour plasma AUC or peak levels between patients with dementia, MCI, preclinical AD subjects (p = 0.760 for both; Kruskall‐Wallis test). We have to interpret these data with caution since sample sizes are still small and more patients are being recruited.ConclusionOn the basis of very preliminary data, 24‐hour plasma melatonin profile and peak plasma melatonin concentration tended to be higher in AD patients with epileptiform activity than in those without. Whether this could be a potential compensatory mechanism against epileptiform activity in AD or whether melatonin could rather have pro‐epileptic effects, remains to be elucidated in future research.

Functional connectivity in Alzheimer’s disease: A resting‐state EEG study

AbstractBackgroundAlzheimer’s disease (AD) is mainly associated with amnestic deficits. Imaging studies revealed a disruption of functional networks in AD, which plays a crucial role for the cognitive deficits. There is also evidence from resting‐state Electroencephalography (rsEEG) studies, which found altered functional connectivity measuring EEG coherence in AD (Babiloni et al., 2021; Wang et al., 2015). This was especially seen for the Alpha frequency band, which is known for its diagnostic potential in the disease. Furthermore, studies suggest that Alpha band marker correlate with cognitive decline in AD (Babiloni et al., 2010). The main aim of the current work is to gain a better understanding of the functional connectivity in Alzheimer’s disease based on EEG given a very high temporal resolution.MethodThe sample consisted of 15 patients (AD, 72.3 ± 8.28 years, 66.7% male) with mild cognitive impairment to mild dementia with a typical cerebrospinal fluid profile of Alzheimer’s disease or pathological Amyloid‐PET and 15 age‐matched healthy controls (HC, 72.93 ± 7.17 years, 53.3% male). All participants underwent a neuropsychological examination and rsEEG. The rsEEG was recorded with the Neurowerk Amplifier using an elastic cap with 19 electrodes (10‐20 system). Raw data were preprocessed and further analyzed with regard to functional connectivity focusing on the Alpha frequency band (Brainstorm, SPSS, EEGlab). Functional connectivity was calculated by the magnitude squared coherence. Coherence was further clustered in global coherence and coherence per electrode. Finally, coherence scores were evaluated in relation to neuropsychological scores.ResultsCenters of functional connectivity were found in frontal‐frontal and frontal‐parietal/occipital electrode pairs. Alpha frequency band (8 – 13 Hz), particularly Alpha1 frequency band (8 – 11 Hz), yielded the highest coherence scores. When comparing AD and HC, patients showed reduced coherence in Alpha2 (11 – 13 Hz) and Beta (13 – 20 Hz). Additionally, moderate correlations of global coherence and behavioral measures were found mainly for the Alpha1 frequency band.ConclusionAlzheimer’s disease can be associated with poorer functional connections of certain brain areas and rsEEG coherence might be a potential biomarker for AD.

Comparison between self‐ and informant‐rated versions of the Mild behavioral impairment checklist in patients with mild cognitive impairment

AbstractBackgroundMild behavioral impairment (MBI) describes de novo emergent and persistent neuropsychiatric symptoms in older individuals. MBI is common in individuals with mild cognitive impairment (MCI), but self‐endorsed symptoms may not align with reports from informants. In this study, we explore the consistency between self‐ and informant‐rated versions of the Mild behavioral impairment checklist (MBI‐C), which is used to assess MBI.MethodWe included 68 individuals with MCI (MMSE 26.59±2.55) who underwent neurological, extensive neuropsychological examination and brain MRI within the Czech Brain Aging Study and had no history of prior psychiatric disorder. Both participants and their close informants completed The Czech version of the MBI‐C (MBI‐C self and MBI‐C informant, respectively). The consistency and differences between the MBI‐C self and informant total and domain scores (i.e. motivation, affect, impulse dyscontrol, social inappropriateness and psychotic symptoms), and the presence of MBI based on a cut‐off of ≥7, were examined using Wilcoxon signed‐rank test, the binomial test and Spearman´s rank correlation. Further, we explored the association between the informant‐self score difference with the MMSE as a measure of global cognition.ResultThere was no difference between MBI‐C self and informant total score (both median ratings were 5.0). Among the domain scores, we observed a difference between self and informant ratings in the impulse dyscontrol (Z = ‐2.97, p = 0.003), but not in any other score. Disagreements on the presence of MBI were observed in 19 participants (28%), but both patients and informants were equally likely to disagree on the MBI presence vs. absence. We observed weak to modest correlations between MBI‐C self and informant total and domain scores (rS = 0.34‐0.53, ps&lt;0.01). The informant‐self score difference in MBI‐C impulse dyscontrol was negatively associated with the MMSE (rS = ‐0.39, p = 0.001).ConclusionPatients with MCI and their informants were not consistent regarding the presence of MBI, but among those who disagreed, neither informants nor patients were more likely to report MBI. The informants reported more severe impulse dyscontrol symptoms compared to the patients with MCI themselves and this difference was negatively associated with lower MMSE. The observed inconsistencies provide implications for clinical and research settings.

Characteristics of cerebrospinal fluid biomarkers/imaging findings in ptaients with amyloid PET‐negative dementia

AbstractBackgroundIn daily clinical practice, we often encounter cases with atypical clinical symptoms and imaging findings, even amoung those diagnosed with Alzheimer’s disease.MethodForty‐nine cases of undiagnosed patients with atypical clinical symptoms or imaging findings underwent both amyloid PET and cerebrospinal fluid(CSF) examinations.They were divided into amyloid‐positive group(n = 25) and amyloid‐negative group(n = 24).The cerebrospinal fluid findings,neuropsychological examination findings,MRI findings,and SPECT findings were compared between the two groups.ResultCSF findings showed significant differences in amyloid‐β42,amyloid‐β42/40, and P‐tau between the two groups.There was no significant difference in MRI findings.SPECT findings showed a significant difference in decreased blood flow in the right parietal lobe and bilateral precuneus.ConclusionIn dementia patients with atypical clinical symptoms and imaging findings, CSF findings and decreased blood flow in the right parietal lobe and bilateral precuneus are suggested to be useful indicators to distinguish whether amyloid is involved in the back ground pathology.

Clinical Manifestations.

Subjective cognitive complaints (SCC) in the elderly may represent an early cognitive marker of Alzheimer's disease (AD). Currently, there is no recommended gold standard for evaluating SCC. In addition, available questionnaires were originally developed to identify individuals at later stages of AD. Based on previous research, we constructed the Subjective Cognitive Changes Questionnaire (SCC-Q), which includes items potentially sensitive to early cognitive decline. The study aimed to analyse reliability of the individual items and construct and convergent validity of the SCC-Q. A total of 211 non-demented participants over the age of 55 from the Czech Brain Aging Study (CBAS) underwent a comprehensive neuropsychological examination, based on which they were classified into two groups: patients with amnestic mild cognitive impairment (n = 88) and those with subjective cognitive decline (SCD) (n = 88). Further, we included cognitively healthy volunteers without SCC (n = 35). All participants completed the novel 26-item SCC-Q in which they evaluated change in specific cognitive abilities during the last 5 years on a 5-point Likert scale. The structure of the SCC-Q was explored using the principal component analysis (PCA) with varimax rotation. To analyse associations between the components and cognitive performance (convergent validity), non-parametric partial rank correlations controlled for sex, age and education were performed. Cognitive performance was expressed as composite z-scores representing memory, attention and working memory, language, executive, and visuospatial function. Item analysis showed that all included items were highly reliable (McDonald's Ω > 0.9, Cronbach's α > 0.9). Using the PCA, four components explaining 57.6% of the variance were identified. Two of them were significantly associated with memory, attention and working memory, and executive or visuospatial function, respectively (all ps ≤ 0.048). The component more closely associated with cognitive domains includes items related to spatial orientation changes. The SCC-Q has the potential to become a valuable method for clinical practice in identifying individuals at risk of developing cognitive deficits. Further analyses are needed to confirm its validity.