Normal Elderly People Research Articles

Mapping High‐Frequency Conductivity Using MRI in the Brains of Alzheimer’s Disease Patients

AbstractBackgroundPrevious studies reported increased concentrations of metallic ions and imbalanced Na+ and K+ ions in patients with Alzheimer’s disease (AD) and the increased mobility of protons by microstructural disruptions in AD. The purposes of this study were: 1)to apply a high‐frequency conductivity (HFC) mapping technique using a clinical 3T MRI system and 2)to compare HFC values among participant groups.MethodThis prospective study included 74 participants (23 AD patients, 27 amnestic mild cognitive impairment (MCI) patients, and 24 cognitively normal (CN) elderly people) to explore the clinical application of HFC mapping in the brain. For the brain MREPT images, a multi‐echo turbo spin‐echo pulse sequence was used. A homemade software was used to map the HFC at the Larmor frequency of 128 MHz at 3T. We performed statistical analyses to 1) compare HFC maps between the three participant groups and 2) to evaluate the association of HFC maps with Mini‐Mental State Examination (MMSE) scores.ResultThe HFC value was higher in the AD group than in the CN and MCI groups. MMSE scores were negatively associated with HFC values, but age was positively associated with HFC values. The HFC value in the insula has a high area under the ROC curve (AUC) value to differentiate AD patients from the CN participants (Sensitivity (SE) = 82, Specificity (SP) = 97, AUC = 0.902, p < 0.0001), better than GMV in hippocampus (SE = 79, SP = 83, AUC = 0.880, p < 0.0001).ConclusionHFC values were significantly increased in the AD group compared to the CN group and increased with age and disease severity. HFC values of the insula along with the GMV of the hippocampus can be used as an imaging biomarker to improve the differentiation of AD from CN.

Ribosomal protein SA is a common component of neuronal intranuclear inclusions in polyglutamine diseases and Marinesco bodies.

Neuronal intranuclear inclusions (NIIs) are common key structures in polyglutamine (polyQ) diseases such as Huntington disease (HD), spinocerebellar ataxia type 1 (SCA1), and SCA3. Marinesco bodies (MBs) of dopaminergic neurons in the substantia nigra are also intranuclear structures and arefrequently seen in normal elderly people. Ribosomal dysfunction is closely related to two differential processes; therefore, we aimed to identify the pathological characteristics of ribosomal protein SA (RPSA), a ribosomal protein, in both states. To this end, we evaluated the autopsy findings in four patients with HD, two SCA3, and five normal elderly cases (NCs). Immunohistochemical studies demonstrated that both NIIs and MBs contain RPSA. In polyQ diseases, RPSA was co-localized with polyQ aggregations, and 3D-reconstructed images revealed their mosaic-like distribution. Assessments of the organization of RPSA and p62 in NIIs showed that RPSA was more localized toward the center than p62 and that this unique organization was more evident in the MBs. Immunoblotting of the temporal cortices revealed that the nuclear fraction of HD patients contained more RPSA than that of NCs. In conclusion, our study revealed that RPSA is a common component of both NIIs and MBs, indicating that a similar mechanism contributes to the formation of polyQ NIIs and MBs.

The Purdue Pegboard Test: Normative Data From 1,355 Healthy People From Austria

Abstract Importance: The Purdue Pegboard Test (PPT) is widely used as a measure of manual dexterity. Declining manual dexterity may predict cognitive decline among elderly people, but normative data for this population are scarce. Objective: To identify demographic and clinical predictors of PPT results in normal middle-aged and elderly Austrian people and to provide norms stratified by significant determinants. Design: A prospective, community-based cohort study using baseline data of participants from two study panels (1991–1994 and 1999–2003). Setting: Monocentric study Participants: 1,355 healthy, randomly selected, community-dwelling people ages 40 to 79 yr. Method: Extensive clinical examination, including completion of the PPT. Outcomes and Measures: The number of pegs placed within a 30-s time limit on four subtests: using the right hand, left hand, both hands, and assembly (within 60 s), respectively. Demographic outcomes were the highest grade achieved. Results: For all four subtests, increasing age (βs = −0.400 to −0.118, SEs = 0.006 to 0.019, p < .001) and male sex (βs = −1.440 to −0.807, SEs = 0.107 to 0.325, p < .001) was related to worse test results. Among vascular risk factors, diabetes (βs = −1.577 to −0.419, SEs = 0.165 to 0.503, p < .001) was related to worse test results but explained only a small portion (0.7%–1.1%) of the variability in PPT performance. Conclusions and Relevance: We provide age- and sex-specific norms of the PPT for a middle-aged and elderly population. The data represent useful reference values when assessing manual dexterity in older age groups. What This Article Adds: Advancing age and male sex relate to worse performance on the PPT in a community-dwelling cohort without signs and symptoms of neurological disease. Vascular risk factors explain only very little of the variance of test results in our population. Our study adds to the limited age- and sex-specific norms of the PPT among middle-aged and older people.

A study of auxiliary screening for Alzheimer's disease based on handwriting characteristics.

Alzheimer's disease (AD) has an insidious onset, the early stages are easily overlooked, and there are no reliable, rapid, and inexpensive ancillary detection methods. This study analyzes the differences in handwriting kinematic characteristics between AD patients and normal elderly people to model handwriting characteristics. The aim is to investigate whether handwriting analysis has a promising future in AD auxiliary screening or even auxiliary diagnosis and to provide a basis for developing a handwriting-based diagnostic tool. Thirty-four AD patients (15 males, 77.15 ± 1.796 years) and 45 healthy controls (20 males, 74.78 ± 2.193 years) were recruited. Participants performed four writing tasks with digital dot-matrix pens which simultaneously captured their handwriting as they wrote. The writing tasks consisted of two graphics tasks and two textual tasks. The two graphics tasks are connecting fixed dots (task 1) and copying intersecting pentagons (task 2), and the two textual tasks are dictating three words (task 3) and copying a sentence (task 4). The data were analyzed by using Student's t-test and Mann-Whitney U test to obtain statistically significant handwriting characteristics. Moreover, seven classification algorithms, such as eXtreme Gradient Boosting (XGB) and Logistic Regression (LR) were used to build classification models. Finally, the Receiver Operating Characteristic (ROC) curve, accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Area Under Curve (AUC) were used to assess whether writing scores and kinematics parameters are diagnostic. Kinematic analysis showed statistically significant differences between the AD and controlled groups for most parameters (p < 0.05, p < 0.01). The results found that patients with AD showed slower writing speed, tremendous writing pressure, and poorer writing stability. We built statistically significant features into a classification model, among which the model built by XGB was the most effective with a maximum accuracy of 96.55%. The handwriting characteristics also achieved good diagnostic value in the ROC analysis. Task 2 had a better classification effect than task 1. ROC curve analysis showed that the best threshold value was 0.084, accuracy = 96.30%, sensitivity = 100%, specificity = 93.41%, PPV = 92.21%, NPV = 100%, and AUC = 0.991. Task 4 had a better classification effect than task 3. ROC curve analysis showed that the best threshold value was 0.597, accuracy = 96.55%, sensitivity = 94.20%, specificity = 98.37%, PPV = 97.81%, NPV = 95.63%, and AUC = 0.994. This study's results prove that handwriting characteristic analysis is promising in auxiliary AD screening or AD diagnosis.

Neuroimaging modalities in the detection of Alzheimer's disease-associated biomarkers.

Alzheimer's disease (AD) is the most common cause of dementia. Neuropathological changes in AD patients occur up to 10-20 years before the emergence of clinical symptoms. Specific diagnosis and appropriate intervention strategies are crucial during the phase of mild cognitive impairment (MCI) and AD. The detection of biomarkers has emerged as a promising tool for tracking the efficacy of potential therapies, making an early disease diagnosis, and prejudging treatment prognosis. Specifically, multiple neuroimaging modalities, including magnetic resonance imaging (MRI), positron emission tomography, optical imaging, and single photon emission-computed tomography, have provided a few potential biomarkers for clinical application. The MRI modalities described in this review include structural MRI, functional MRI, diffusion tensor imaging, magnetic resonance spectroscopy, and arterial spin labelling. These techniques allow the detection of presymptomatic diagnostic biomarkers in the brains of cognitively normal elderly people and might also be used to monitor AD disease progression after the onset of clinical symptoms. This review highlights potential biomarkers, merits, and demerits of different neuroimaging modalities and their clinical value in MCI and AD patients. Further studies are necessary to explore more biomarkers and overcome the limitations of multiple neuroimaging modalities for inclusion in diagnostic criteria forAD.

Low Magnesium in Conjunction with High Homocysteine and Less Sleep Accelerates Telomere Attrition in Healthy Elderly Australian.

The relationship between sleep and micronutrients, including magnesium, is implicated in its regulation. The effects of low magnesium and other micronutrients on sleep disruption and telomere loss are not well understood. The present study was carried out in 172 healthy elderly subjects from South Australia. Plasma micronutrients including magnesium were measured. Each participant provided information about their sleep hours (&lt;7 h or ≥7 h). Lymphocyte telomere length (TL) was measured by real-time qPCR assay. Plasma magnesium level was significantly low in subjects who sleep less than 7 h (p = 0.0002). TL was significantly shorter in people who are low in magnesium and sleep less than 7 h (p = 0.01). Plasma homocysteine (Hcy) is negatively associated with magnesium (r = -0.299; p &lt; 0.0001). There is a significant interaction effect of magnesium and Hcy on sleep duration (p = 0.04) and TL (p = 0.003). Our results suggest that inadequate magnesium levels have an adverse impact on sleep and telomere attrition rate in cognitively normal elderly people, and this may be exacerbated by low levels of vitamin B12 and folate that elevate Hcy concentration.

The difference of paraspinal muscle between patients with lumbar spinal stenosis and normal middle-aged and elderly people, studying by propensity score matching.

The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis. The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis. The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people. The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people.

The Bender Gestalt Test is useful for clinically diagnosing dementia with Lewy bodies: Analysis of its sensitivity, specificity, and clinical characteristics of the figure copy

A previous study that evaluated the ability of the Bender Gestalt Test (BGT) to discriminate between dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) suggested that a total score of 98 is the optimal cutoff value for discriminating between these two diseases and that DLB tends to exhibit unique errors; i.e., “element deformation” and “gestalt destruction.” The objectives of the present study were: (1) to examine the sensitivity and specificity of a total BGT score of 98 as a cutoff value in greater numbers of DLB patients than in the previous study, (2) to set a new cutoff value if a cutoff value of 98 is not optimal, and (3) to clarify the frequency of element deformation and gestalt destruction in DLB patients. The participants were 133 DLB patients, 65 AD patients, and 30 cognitively normal elderly people. All of the participants underwent the Mini-Mental State Examination, BGT, and brain magnetic resonance imaging. As a result, the total BGT score cutoff value of 98 showed low sensitivity (0.58), and a cutoff value of 84 was indicated to be the optimal cutoff value for discriminating between DLB and AD. In addition, 32 out of 133 DLB patients and one out of 65 AD patients exhibited element deformation or gestalt destruction. This study suggested that the BGT is a useful neuropsychological test for differentiating DLB from AD. In addition, the need to evaluate the spatial and perceptual difficulties of DLB patients with various types of visual stimulation is also discussed.

Glucose metabolism patterns: A potential index to characterize brain ageing and predict high conversion risk into cognitive impairment.

Exploring individual hallmarks of brain ageing is important. Here, we propose the age-related glucose metabolism pattern (ARGMP) as a potential index to characterize brain ageing in cognitively normal (CN) elderly people. We collected 18F-fluorodeoxyglucose (18F-FDG) PET brain images from two independent cohorts: the Alzheimer's Disease Neuroimaging Initiative (ADNI, N = 127) and the Xuanwu Hospital of Capital Medical University, Beijing, China (N = 84). During follow-up (mean 80.60months), 23 participants in the ADNI cohort converted to cognitive impairment. ARGMPs were identified using the scaled subprofile model/principal component analysis method, and cross-validations were conducted in both independent cohorts. A survival analysis was further conducted to calculate the predictive effect of conversion risk by using ARGMPs. The results showed that ARGMPs were characterized by hypometabolism with increasing age primarily in the bilateral medial superior frontal gyrus, anterior cingulate and paracingulate gyri, caudate nucleus, and left supplementary motor area and hypermetabolism in part of the left inferior cerebellum. The expression network scores of ARGMPs were significantly associated with chronological age (R = 0.808, p < 0.001), which was validated in both the ADNI and Xuanwu cohorts. Individuals with higher network scores exhibited a better predictive effect (HR: 0.30, 95% CI: 0.1340 ~ 0.6904, p = 0.0068). These findings indicate that ARGMPs derived from CN participants may represent a novel index for characterizing brain ageing and predicting high conversion risk into cognitive impairment.

Application of High-Frequency Conductivity Map Using MRI to Evaluate It in the Brain of Alzheimer's Disease Patients.

BackgroundThe previous studies reported increased concentrations of metallic ions, imbalanced Na+ and K+ ions, and the increased mobility of protons by microstructural disruptions in Alzheimer's disease (AD).Purpose(1) to apply a high-frequency conductivity (HFC) mapping technique using a clinical 3T MRI system, (2) compare HFC values in the brains of participants with AD, amnestic mild cognitive impairment (MCI), and cognitively normal (CN) elderly people, (3) evaluate the relationship between HFC values and cognitive decline, and (4) explore usefulness of HFC values as an imaging biomarker to evaluate the differentiation of AD from CN.Materials and MethodsThis prospective study included 74 participants (23 AD patients, 27 amnestic MCI patients, and 24 CN elderly people) to explore the clinical application of HFC mapping in the brain from March 2019 to August 2021. We performed statistical analyses to compare HFC maps between the three participant groups, evaluate the association of HFC maps with Mini-Mental State Examination (MMSE) scores, and to evaluate the differentiation between the participant groups for HFC values for some brain areas.ResultsWe obtained a good HFC map non-invasively. The HFC value was higher in the AD group than in the CN and MCI groups. MMSE scores were negatively associated with HFC values. Age was positively associated with HFC values. The HFC value in the insula has a high area under the receiver operating characteristic (ROC) curve (AUC) value to differentiate AD patients from the CN participants (Sensitivity [SE] = 82, Specificity [SP] =97, AUC = 0.902, p < 0.0001), better than gray matter volume (GMV) in hippocampus (SE = 79, SP = 83, AUC = 0.880, p < 0.0001). The classification for differentiating AD from CN was highest by adding the hippocampal GMV to the insular HFC value (SE = 87, SP = 87, AUC = 0.928, p < 0.0001).ConclusionHigh-frequency conductivity values were significantly increased in the AD group compared to the CN group and increased with age and disease severity. HFC values of the insula along with the GMV of the hippocampus can be used as an imaging biomarker to improve the differentiation of AD from CN.

The Effect of Training Sample Size on the Prediction of White Matter Hyperintensity Volume in a Healthy Population Using BIANCA.

Introduction: White matter hyperintensities of presumed vascular origin (WMH) are an important magnetic resonance imaging marker of cerebral small vessel disease and are associated with cognitive decline, stroke, and mortality. Their relevance in healthy individuals, however, is less clear. This is partly due to the methodological challenge of accurately measuring rare and small WMH with automated segmentation programs. In this study, we tested whether WMH volumetry with FMRIB software library v6.0 (FSL; https://fsl.fmrib.ox.ac.uk/fsl/fslwiki) Brain Intensity AbNormality Classification Algorithm (BIANCA), a customizable and trainable algorithm that quantifies WMH volume based on individual data training sets, can be optimized for a normal aging population.Methods: We evaluated the effect of varying training sample sizes on the accuracy and the robustness of the predicted white matter hyperintensity volume in a population (n = 201) with a low prevalence of confluent WMH and a substantial proportion of participants without WMH. BIANCA was trained with seven different sample sizes between 10 and 40 with increments of 5. For each sample size, 100 random samples of T1w and FLAIR images were drawn and trained with manually delineated masks. For validation, we defined an internal and external validation set and compared the mean absolute error, resulting from the difference between manually delineated and predicted WMH volumes for each set. For spatial overlap, we calculated the Dice similarity index (SI) for the external validation cohort.Results: The study population had a median WMH volume of 0.34 ml (IQR of 1.6 ml) and included n = 28 (18%) participants without any WMH. The mean absolute error of the difference between BIANCA prediction and manually delineated masks was minimized and became more robust with an increasing number of training participants. The lowest mean absolute error of 0.05 ml (SD of 0.24 ml) was identified in the external validation set with a training sample size of 35. Compared to the volumetric overlap, the spatial overlap was poor with an average Dice similarity index of 0.14 (SD 0.16) in the external cohort, driven by subjects with very low lesion volumes.Discussion: We found that the performance of BIANCA, particularly the robustness of predictions, could be optimized for use in populations with a low WMH load by enlargement of the training sample size. Further work is needed to evaluate and potentially improve the prediction accuracy for low lesion volumes. These findings are important for current and future population-based studies with the majority of participants being normal aging people.

Characteristics of Cortical Atrophy and White Matter Lesions Between Dementia With Lewy Bodies and Alzheimer's Disease: A Case-Control Study.

Introduction: Currently, there is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. For better diagnosis and prognosis, further exploration of local cortical atrophy patterns and white matter lesions is needed.Methods: We reviewed the outpatient medical records of 97 DLB patients and 173 AD patients from January 2018 to September 2020 along with 30 matched outpatient clinic normal elderly people. MRI visual rating scales, including medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale (GCA-F), posterior atrophy (PA), Fazekas scale, Evans Index and cerebral microbleeds were evaluated and analyzed in DLB and AD patients with different severities and normal controls.Results: Overall, patients with DLB had higher scores on all visual rating scales than the normal controls. Meanwhile, compared with AD, DLB had lower MTA scores in the mild to moderate groups (both p ≤ 0.001), but the GCA-F and PA scores were similar (all p > 0.05). The Fazekas scores in the moderate to severe DLB group were lower than those in the AD group (p = 0.024 and p = 0.027, respectively). In addition, the diagnostic performance and sensitivity of multiple imaging indicators for DLB were better than that of MTA alone (the combination of MTA, GCA-F, PA, Fazekas visual rating scales, AUC = 0.756, 95%CI: 0.700–0.813, sensitivity = 0.647, specificity = 0.804 and MTA visual rating scale, AUC = 0.726, 95%CI: 0.667–0.785, sensitivity = 0.497, specificity = 0.876, respectively).Conclusion: The medial temporal lobe of DLB patients was relatively preserved, the frontal and parietal lobes were similarly atrophied to AD patients, and the white matter hyperintensity was lighter than that in AD patients. Combined multiple visual rating scales may provide a novel idea for the diagnosis of early DLB.

The normative data of cortical volumes in normal aging from Neuro I, a brain image quantitative analysis system

AbstractBackgroundThe aging of brain is a topic has been constantly studied. Particularly, the norms for the elderly are important in diagnosing degenerative brain diseases, but the aging brain of East Asians has not been fully studied yet. “Neuro I” is a brain image quantitative analysis system with a built‐in large‐scale normative database for East Asians to provide quantified clinical information on how different an individual patient is from normal people. The study aimed to investigate ethnic differences of cortical brain volumes in normal elderly people, and to determine whether the norms considering racial disparities could improve the accuracy of diagnosis.MethodUsing Neuro I, cortical volumes were measured from brain magnetic resonance (MR) images of 1,686 cognitively normal elderly Koreans aged 59 to 89. For Caucasians, the brain images of 855 Caucasian‐Non‐Hispanic subjects were selected from the ADNI and OASIS datasets. The regression model predicting brain volumes were built using ethnicity, age, sex, intracranial volume (ICV), magnetic field strength (MFS), and scanner manufacturers as predictors. Based on the prediction model, the z‐scores of each individual were calculated. To validate the z‐score for diagnosis, 420 Alzheimer’s disease (AD) subjects of Koreans and Caucasians, and the same number of normal subjects were selected. The four validation groups divided by race and diagnosis were age‐ and sex‐matched using a propensity score matching method.ResultThe models predicting cortical volumes had a considerate amount of explained variance (mean R2: 55.8%, range: 42.7%–77.5%). Ethnicity explained substantial variances for temporal and parietal lobes (mean R2: 5.6%, range: 4.2%–7.5%), comparable to age (mean R2: 3.3%, range: 2.0%–4.3%). Furthermore, the z score of each region based on the model with ethnicity as a predictor (AUCs = .75, .72, .67, and .67 for left and right temporal and left and right parietal lobes, respectively) improved the accuracy of AD diagnosis compared to the z score based on the model without ethnicity (AUCs = .62, .59, .55, and .57).ConclusionRace or ethnicity should be considered for establishing the normative data in normal aging and AD diagnosis.

Elevated Fasting Plasma Glucose Is Associated With an Increased Risk of MCI: A Community-Based Cross-Sectional Study.

BackgroundMild cognitive impairment (MCI) is a transitional state between normal elderly people and dementia, with a higher risk of dementia transition. The primary purpose of the current study was to investigate whether routine blood and blood biochemical markers could be used to predict the onset of MCI.MethodsData was obtained from the cohort study on brain health of the elderly in Shanghai. A total of 1015 community elders were included in the current study. Based on clinical evaluation and the scores of Montreal Cognitive Assessment (MoCA), these participants were divided into the MCI (n=444) and cognitively normal groups (n=571). Then we tested their fasting blood routine and blood biochemical indexes, and collected their general demographic data by using a standard questionnaire.ResultsBy using binary logistic regression analysis and the ROC curve, we found that elevated fasting plasma glucose (p=0.025, OR=1.118, OR=1.014-1.233) was a risk factor for MCI.ConclusionsElevated fasting blood glucose may be a risk factor for mild cognitive impairment, but the above conclusions need to be verified by longitudinal studies.

Alternation in Effective Connectivity With Cognitive Aging: A Longitudinal Study of Elderly Populations.

In this research, we investigated the alterations in the directionality and strength of regional interactions within functionally changed brain networks and their relationship to cognitive decline during the aging process in normal elderly individuals. Thirty-seven cognitively normal elderly people received resting-state fMRI scans and cognitive assessments at baseline (age = 78.65 ± 3.56 years) and at 4-year follow-up. Functional connectivity analyses were used to identify networks containing brain regions whose functions changed with age as regions of interest. The spectral dynamic causal modeling (spDCM) method was used to estimate the causal interactions within networks in subjects at different time points and in subjects with different cognitive levels to explore the alterations with cognitive aging. The results showed that, at both time points, all the networks, except the frontal-parietal network (FPN) at baseline, had mutual interactions between each pair of nodes. Furthermore, when the subjects were divided with global cognition level, lost connections were only found in the subgroup with better performance. These indicated that elderly people appeared to need more interaction pathways between brain areas with cognitive decline. We also observed that the strength of the flow of information from the left angular gyrus to the precuneus, which is associated with activation of memory retrieval and the functional hub involved in various cognitive domains, was predictive of declines in executive function with the aging process, making it a potential predictor of such situation.

Analysis of Heart Rate Variability in Response to Serious Games in Elderly People.

As the proportion of elderly people continues to grow, so does the concern about age-related cognitive decline. Serious games have been developed for cognitive training or treatment, but measuring the activity of the autonomic nervous system (ANS) has not been taken to account. However, cognitive functioning has been known to be heavily influenced by the autonomic nervous system (ANS), and ANS activity can be quantified using heart rate variability (HRV). This paper aims to analyze the physiological response in normal elderly people as they play two types of serious games using HRV features from electrocardiography (ECG). A wearable device designed in-house was used to measure ECG, and the data from this device was pre-processed using digital signal processing techniques. Ten HRV features were extracted, including time-domain, nonlinear, and frequency-domain features. The experiment proceeds as follows: rest for three minutes, play a cognitive aptitude game, rest for another three minutes, followed by two reaction time games. Data from thirty older adults (age: 65.9 ± 7.34; male: 15, female: 15) were analyzed. The statistical results show that there was a significant difference in the HRV between the two types of games. From this, it can be concluded that the type of game has a significant effect on the ANS response. This can be further used in designing games for the elderly, either for training or mood management.

11C-Pittsburgh compound B and 18F-THK 5351 positron emission tomography brain imaging in cognitively normal individuals.

Abnormal beta-amyloid plaques and tau protein accumulation are the core pathologic features of Alzheimer's disease. However, the accumulation of these proteins is also common in cognitively normal elderly people. Therefore, this study is aimed to evaluate the amyloid and tau accumulation in the cognitively normal population. A preliminary prospective study was conducted on 24 cognitively normal individuals who underwent Pittsburgh compound B (11C-PiB) and 18F-THK 5351 positron emission tomography (PET)/computed tomography scans. The standardized uptake value ratio (SUVR) was used for quantitative analysis of the two tracers and comparisons between two age groups: ≤60 years and >60 years. Co-registration was applied between the dynamic acquisition PET and T1-weighted magnetic resonance imaging to delineate various cortical regions. P-mod software with the automated anatomical labeling-merged atlas was employed to generate automatic volumes of interest for different brain regions. The posterior cingulate versus precuneus SUVRs of PiB uptake was 1.40 ± 0.07 and 1.38 ± 0.22 versus 1.17 ± 0.07 and 1.14 ± 0.18 in those aged ≤60 years and >60 years, respectively, whereas the SUVRs of THK5351 retention at brain stem versus inferior temporal SUVRs were 1.84 ± 0.06 and 1.91 ± 0.18 versus 1.37 ± 0.04 and 1.48 ± 0.21 in the age groups of ≤ 60 years and >60 years, respectively (P = 0.20). Our findings allow the determination of the preliminary optimal cutoff points for SUVRs in amyloid and tau PET studies. Ultimately, these values can be applied to normal databases in clinical use to improve quantitative analysis.

An Exploration of the Own-Age Effect on Facial Emotion Recognition in Normal Elderly People and Individuals with the Preclinical and Demented Alzheimer’s Disease

The issue of whether there exists an own-effect on facial recognition in the elderly remains equivocal. Moreover, currently the literature of this issue in pathological aging is little. Our study was thus to explore the issue in both of healthy older people and patients with ADMethods:In study 1, 27 older and 31 younger healthy adults were recruited; in study 2, 27 healthy older adults and 80 patients (including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD) groups) were recruited. Participants received the Taiwan Facial Emotion Recognition Task (FER Task), and a clinical neuropsychological assessment. No significant differences on the FER test were found among our groups, except for sadness recognition in which our MCI and AD patients' scores were remarkably lower than their healthy counterparts. The own-age effect was not significantly evident in healthy younger and older adults, except for recognizing neutral photos. Our patients with MCI and AD tended to have the effect, particularly for the sad recognition in which the effect was significantly evident in terms of error features (mislabeling it as anger in younger-face and neutral in older-face photos). Our results displayed no remarkable own-age effect on facial emotional recognition in the healthy elderly (including SCD). However, it did not appear the case for MCI and AD patients, especially their recognizing those sadness items, suggesting that an inclusion of the FER task particularly involving those items of low-intensity emotion in clinical neuropsychological assessment might be contributory to the early detection of AD-related pathological individuals.

Systematic and Comprehensive Automated Ventricle Segmentation on Ventricle Images of the Elderly Patients: A Retrospective Study.

Background and Objective: Ventricle volume is closely related to hydrocephalus, brain atrophy, Alzheimer's, Parkinson's syndrome, and other diseases. To accurately measure the volume of the ventricles for elderly patients, we use deep learning to establish a systematic and comprehensive automated ventricle segmentation framework.Methods: The study participation included 20 normal elderly people, 20 patients with cerebral atrophy, 64 patients with normal pressure hydrocephalus, and 51 patients with acquired hydrocephalus. Second, get their imaging data through the picture archiving and communication systems (PACS) system. Then use ITK software to manually label participants' ventricular structures. Finally, extract imaging features through machine learning.Results: This automated ventricle segmentation method can be applied not only to CT and MRI images but also to images with different scan slice thicknesses. More importantly, it produces excellent segmentation results (Dice > 0.9).Conclusion: This automated ventricle segmentation method has wide applicability and clinical practicability. It can help clinicians find early disease, diagnose disease, understand the patient's disease progression, and evaluate the patient's treatment effect.

Characteristics of Sleep Structure Assessed by Objective Measurements in Patients With Amnestic Mild Cognitive Impairment: A Meta-Analysis

Objectives: This study aims to explore the differences of sleep structure between patients with amnestic mild cognitive impairment (aMCI) and elderly people with normal cognition, which will help to provide evidence for the relationship between sleep disturbances and cognitive impairment.Methods: A systematic review and meta-analysis were conducted on the literature on sleep parameters obtained by polysomnography or actigraphy in patients with aMCI. The PubMed and EMBASE databases were searched up to April 2020. Inclusion and exclusion criteria were established according to evidence-based medicine methods, and data of all eligible studies were meta-analyzed using the Review Manager 5.3 software.Results: Among the 1,171 literature articles on sleep structure of patients with MCI, eight case-control studies met the inclusion criteria and were included in this meta-analysis. A total of 278 subjects were included, of which 103 were patients with aMCI and 175 were elderly people with normal cognition. The results showed that sleep efficiency (SE) and slow wave sleep (SWS) of patients with aMCI were significantly lower than those of healthy elderly people. Compared with the control group, the percentage of stage 1 of non-rapid eye movement (N1%) in the aMCI patients group increased, and the percentage of stage 2 of non-rapid eye movement (N2%) decreased.Conclusions: Patients with aMCI may experience more severe sleep disturbances than normal cognitive elderly people. There were specific changes, especially in SE and SWS, in the sleep structure of patients with aMCI when compared to those with normal cognition.