Petersen Criteria Research Articles

Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis.

This systematic review evaluates the accuracy of the Montreal Cognitive Assessment (MoCA) for detecting mild cognitive impairment (MCI). We searched MEDLINE, PSYCInfo, EMBASE, and Cochrane CENTRAL (1995-2021) for studies comparing the MoCA with validated diagnostic criteria to identify MCI in general practice. Screening, data extraction, and risk of bias assessment were performed independently, in duplicate. Pooled sensitivity and specificity for MoCA cutoffs were estimated using bivariate meta-analysis. Thirteen studies [2158 participants, 948(44%) with MCI] were included; 10 used Petersen criteria as the reference standard. Risk of bias of studies were high or unclear for all domains except reference standard. Sensitivity and specificity were 73.5%(95% confidence interval: 56.7-85.5) and 91.3%(84.6-95.3) at cutoff <23; 79.5%(67.1-88.0) and 83.7%(75.4-89.6) at cutoff <24; and 83.8%(75.6-89.6) and 70.8(62.1-78.3) at cutoff <25. MoCA cutoffs <23 to <25 maximized the sum of sensitivity and specificity for detecting MCI. The risk of bias of included studies limits confidence in these findings.

Lifelong Cognitive Reserve, Imaging Markers of Brain Aging, and Cognitive Function in Dementia-Free Rural Older Adults: A Population-Based Study.

Cognitive reserve (CR) partly explains cognitive variability in the presence of pathological brain aging. We investigated the interplay of lifelong CR with age, sex, and brain aging markers in cognitive phenotypes among older adults with very limited education. This population-based cross-sectional study included 179 dementia-free participants (age ≥65 years; 39.7% women; 67.0% had no or elementary education) examined in 2014-2016. We assessed lacunes and volumes of hippocampus, ventricles, grey matter, white matter (WM), and white matter hyperintensities. Lifelong CR score was generated from six lifespan intellectual factors (e.g., education and social support). We used Mini-Mental State Examination (MMSE) score to assess cognition and Petersen's criteria to define mild cognitive impairment (MCI). Data were analyzed using general linear and logistic models. The association of higher lifelong CR score (range: -4.0-5.0) with higher MMSE score was stronger in women (multivariable-adjusted β-coefficient and 95% CI: 1.75;0.99-2.51) than in men (0.68;0.33-1.03) (pinteraction = 0.006). The association of higher CR with MCI (multivariable-adjusted odds ratio and 95% CI: 0.77;0.60-0.99) did not vary by age or sex. Among participants with low CR (<1.4[median]), greater hippocampal and WM volumes were related to higher MMSE scores with multivariable-adjusted β-coefficients being 1.77(0.41-3.13) and 0.44(0.15-0.74); the corresponding figures in those with high CR were 0.15(-0.76-1.07) and -0.17(-0.41-0.07) (pinteraction <0.01). There was no statistical interaction of CR with MRI markers on MCI. Greater lifelong CR capacity is associated with better late-life cognition among people with limited education, possibly by compensating for impact of neurodegeneration.

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

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

Effectiveness of cognitive rehabilitation on mild cognitive impairment using teleneuropsychology.

To measure the effects of cognitive telerehabilitation on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with mild cognitive impairment. A sample of 60 patients with mild cognitive impairment according to Petersen's criteria was randomly divided into two groups: 30 treatment cases and 30 controls (waiting list group). Subjects were matched by age, sex, and Montreal Cognitive Assessment. The treatment group received ten cognitive telerehabilitation sessions of 45 minutes duration once a week. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different linear mixed models were estimated to test treatment effect (cognitive telerehabilitation vs. controls) on each outcome of interest over time (pre/post-intervention). A significant group (control/treatment) x time (pre/post) interaction revealed that the treatment group at week 10 had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency (p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ satisfaction p=0.004) and use of memory strategies (MMQ strategy p=0.000), as well as, and a significant reduction of affective symptomatology: depression (GDS p=0.000), neuropsychiatric symptoms (NPI-Q p=0.045), forgetfulness (EDO-10 p=0.000), and stress (DAS stress p=0.000). Our study suggests that CTR is an effective intervention.

The relationship between mushroom consumption and cognitive performance among middle-aged and older adults: a cross-sectional study.

Objectives: Bioactive compounds in mushrooms may protect the brain from neurodegeneration by inhibiting the production of amyloid-β and playing an antioxidant role. This study aimed at examining the associations of mushroom consumption with cognitive function and mild cognitive impairment (MCI) among middle-aged and older adults in China. Design: A cross-sectional study. Setting and participants: This study was conducted in seven cities in China and included 2203 middle-aged and older adults. Methods: Data on mushroom consumption were collected using a semi-quantitative food frequency questionnaire. Cognitive function was evaluated by the Auditory Verbal Learning Test (AVLT), Verbal Fluency Test (VFT), Digit Symbol Substitution Test (DSST), and Trail Making Test-B (TMT-B). The composite z score was used to reflect global cognition. MCI was determined according to the Petersen criteria. Multiple linear regression and logistic regression were used to examine the relationship between mushroom consumption and cognitive performance. Results: This study included 2203 participants aged 55 years and above (mean age = 63.43 years). After controlling demographic characteristics, lifestyle factors, other dietary factors, and history of chronic disease, higher mushroom consumption was associated with better global cognition. Compared to the lowest quartile (Q1, 0-4.00 g day-1), the βs (95% confidence intervals, 95% CIs) were 0.10 (0.03, 0.18) for Q2 (4.01-10.42 g day-1), 0.13 (0.06, 0.20) for Q3 (10.43-20.84 g day-1), and 0.13 (0.06, 0.20) for Q4 (>20.84 g day-1). The higher mushroom consumption was positively related to better performance in DSST and TMT-B (P-values < 0.05). A 10 g day-1 increment in mushroom consumption was related to 12% lower odds of MCI (odds ratio = 0.88, 95% CI: 0.80-0.97). Conclusions: Higher mushroom consumption was positively related to better cognitive function and associated with lower odds of MCI. Further studies are needed to replicate our findings in other populations and determine the underlying mechanisms.

Relationship between cognitive reserve, brain volume, and neuropsychological performance in amnestic and nonamnestic MCI

ABSTRACT Cognitive Reserve (CR) is a theoretical construct that influences the onset and course of cognitive and structural changes that occur with aging and mild cognitive impairment (MCI). There is a paucity of research that examines the relationship of CR and brain volumes in amnestic (aMCI) and nonamnestic (naMCI) separately. This study is a retrospective chart review of MCI patients who underwent neuropsychological evaluation and brain MRI with NeuroReader™ (NR). NR is an FDA-cleared software that standardizes MRI volumes to a control sample. Classifications of aMCI and naMCI were based on Petersen criteria. CR was measured as education, occupation, and word reading. Data analysis included bivariate correlations between CR, neuropsychological test scores, and NR-brain volumes by MCI subtype. The Benjamini–Hochberg method corrected for multiple comparisons. The sample included 91 participants with aMCI and 41 with naMCI. Within naMCI, positive correlations were observed between CR and whole brain volume, total gray matter, bifrontal, left parietal, left occipital, and bilateral cerebellum. Within aMCI, no significant correlations were observed between CR and brain volumes. Positive correlations with CR were observed in language, attention, and visual learning in both aMCI and naMCI groups. The current study adds to the minimal literature on CR and naMCI. Results revealed that CR is associated with volumetrics in naMCI only, though cognitive findings were similar in both MCI groups. Possible explanations include heterogeneous disease pathologies, disease stage, or a differential influence of CR on volumetrics in MCI. Additional longitudinal and biomarker studies will better elucidate this relationship.

Evaluating the relationship between endostatin and cognition in mild cognitive impairment (MCI), coronary artery disease (CAD), and Alzheimer’s disease (AD)

AbstractBackgroundEndostatin is an endogenous angiogenesis inhibitor that can regulate pro‐and anti‐angiogenic factors, notably vascular endothelial growth factor. Research shows that endostatin levels in the brain are associated with amyloid plaque formation in Alzheimer’s disease (AD), and may contribute to AD pathogenesis. Hence, endostatin may be relevant to the broad range of cognitive impairments, namely people with mild cognitive impairment (MCI), AD, and/or coronary artery disease (CAD) who are at risk for cognitive impairment. We examine associations between serum endostatin and global cognition.MethodsParticipants with MCI, AD, or CAD (with or without MCI) were recruited. Serum endostatin concentrations were measured and analyzed using enzyme‐linked immunosorbent assays. MCI was diagnosed using either the Petersen criteria or the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) criteria. AD was diagnosed using DSM‐5 criteria. CAD was defined as at least 1 of previous hospitalization for acute myocardial infarction, coronary angiographic evidence of ≥ 50% blockage in ≥ 1 major coronary artery or a prior revascularization procedure. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA). Linear regression analyses were used to assess the association between endostatin levels and global cognition with and without covariates. Endostatin levels were log‐transformed prior to analyses due to significant departure from normality in Shapiro‐Wilk tests.ResultsIn 119 participants, 94 (79.0%) were male, 102 (85.7%) had CAD, and 23 (19.3%) had MCI or AD; the mean(SD) age was 65.6(7.5), years of education were 16.4(3.3), and endostatin levels were 156.3(38.6) ng/mL. Endostatin was associated with global cognition alone [F(1,117) = 11.39, p &lt;.001, R2 = .089] and also when considering covariates: age, sex, body mass index (BMI), education, MCI/AD diagnosis, and CAD diagnosis [F(7,111) = 11.27, p&lt; .001, R2 = .415]. All variables except age, sex, BMI, and CAD diagnosis added significantly to the association (p&lt; .05). Controlling for other variables, one log endostatin unit was associated with a total MoCA score 5.08 (SE= 2.52) points lower.ConclusionIn this sample, lower serum endostatin concentrations were associated with higher cognitive performance. This relationship may support the involvement of endostatin in cognitive functions and neurodegenerative diseases.

Abstract 11915: Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Left Ventricular Noncompaction

Introduction: Left ventricular noncompaction (LVNC) is a limited knowledge myocardial disease. Risk stratification in such patients remains a controversy. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable predictor for risk stratification in patients with heart failure. However, data on the effect of NT-proBNP on patients with LVNC is limited. This study aimed to evaluate the predicted effect of NT-proBNP on patients with LVNC. Hypothesis: NT-proBNP can be a predictor for adverse outcomes in patients with LVNC. Methods: This retrospective study enrolled 287 patients diagnosed with LVNC through imaging criteria (Jenni criteria or Petersen criteria). The primary endpoint was major adverse cardiovascular events (MACEs), which represented a composite event of all-cause death, heart transplantation, stroke/TIA, intracardiac thrombi, and venous thrombosis. Results: Patients were divided into 2 groups based on the median of NT-pro BNP: group 1(NT-pro BNP &lt;1008.1 fmol/L, n=143) and group 2(NT-pro BNP ≥1008.1 fmol/L, n=144). During a median of 2.8 years follow-up, 64 patients (22.3%) occurred MACEs. Patients in group 2 (36.8%) had a higher incidence of MACEs than group 1 (7.69%). The Kaplan-Meier curves showed that patients in group 2 were associated with a higher risk of MACEs (Log rank test, P &lt;0.001). Crude Cox regression model results revealed that log NT-proBNP levels were associated with increased risk of MACEs (Crude HR 4.49, 95% CI 2.84-7.09, P &lt;0.001). After adjusting for risk factors including BMI, systolic blood pressure, NYHA functional class, hypertension, prior thromboembolism, atrial fibrillation, left atrial diameter, and LVEF, log NT-proBNP level was an independent risk factor for MACEs (Adjusted HR 2.72, 95% CI 1.53-4.82, P &lt;0.001). The ROC curves showed that the AUC of NT-proBNP was 0.767. Conclusions: NT-proBNP was independently associated with MACEs and can be a robust predictor for the risk stratification in patients with LVNC.

The predictive value of left atrial diameter for thrombotic risk in patients with left ventricular noncompaction

Abstract Purpose Patients with left ventricular noncompaction (LVNC) are associated with increased risk of thromboembolism including system embolism (SE) and stroke. Moreover, left atrial (LA) diameter was proved to be a strong predictor for stroke and SE [1]. This study aimed to evaluate the predictive value of left atrial diameter on the risk of thromboembolism in patients with LVNC. Methods This retrospective longitudinal study enrolled 302 patients (median age 46 years, 65.9% male) diagnosed as LVNC through echocardiography or cardiac nuclear magnetic according to Jenni criteria [2] and Petersen criteria [3], respectively. The primary endpoint was thromboembolism events including SE and stroke. Results The 302 patients with LVNC were divided into 2 groups: large LA group (LA diameter ≥43mm, n=155) and small LA group (LA diameter&amp;lt;43mm, n=147), according to the median of LA diameter. After a median follow-up of 4.3 years, 19 cases (6.3%) patients occurred thromboembolism events. In the large LA group, 16 patients (10.3%) occurred thromboembolism events while there were 3 cases (2.0%) suffering from SE/stroke in the small LA group (p&amp;lt;0.05). The Kaplan-Meier curves (Figure 1) compared by the log-rank test showed that the large LA group was associated with a higher risk of thromboembolism events and the difference between the 2 groups was significant (p&amp;lt;0.05). Crude Cox regression model results revealed that LA diameter was an independent risk factor for thromboembolism events in patients with LVNC (Crude HR 1.07, 95% CI 1.02–1.12, p=0.004). After adjusting for prior heart failure, NYHA class, atrial fibrillation, prior stroke, coronary artery disease, pulmonary arterial hypertension, family history of cardiomyopathy, LA diameter was still associated with increased thrombotic risk (Adjusted HR 4.98, 95% CI 1.07–23.04, p=0.04). Moreover, the ROC curves (Figure 2) showed that the AUC of LA diameter was 0.692 and even better than the CHA2DS2-VASc score (AUC=0.576). Conclusion The current study indicated that LA diameter is an effective predictor of thrombotic risk in patients with LVNC. Moreover, extra attention is needed in LVNC patients with larger LA diameters for the risk of thromboembolism. Funding Acknowledgement Type of funding sources: None.

Characteristics and long-term survival of patients with left ventricular non-compaction cardiomyopathy.

Left ventricular non-compaction cardiomyopathy (LVNC) is a poorly understood entity resulting in heart failure. Whether it is a distinct form of cardiomyopathy or an anatomical phenotype is a subject of discussion. The current diagnosis is based on morphologic findings by comparing the compacted to non-compacted myocardium. The study aimed to compare demographic and prognostic variables of patients with dilated cardiomyopathy (DCM) and LVNC. Emphasis was given to cardiac magnetic resonance (CMR) imaging analysis. Data on survival were also assessed. We retrospectively evaluated the characteristics and outcomes of 262 non-ischaemic cardiomyopathy patients with LVNC and DCM phenotypes. Petersen's CMR criteria of non-compacted to the compacted myocardial ratio 2.3 were used to diagnose LVNC. The primary endpoint was a composite endpoint of major adverse cardiovascular events comprising cardiovascular-related death, left ventricular assisted device implantation, or heart transplantation. A total of 262 patients with CMR data were included in the study. One hundred fifty-five patients who fulfilled CMR criteria were diagnosed as LVNC. CMR findings revealed that LVNC patients had higher left ventricular end-diastolic (137.2±51.6, 116.8±44.6, P=0.002) and systolic volume index (98.4±49.5, 85.9±42.7, P=0.049). Cardiac haemodynamics, cardiac output (5.61±2.03, 4.96±1.83; P=0.010), stroke volume (73.9±28.8, 65.1±25.1; P=0.013), and cardiac index (2.85±1.0, 2.37±0.72; P<0.0001), were higher in LVNC patients. Of all the 249 patients, 102 (40.9%) patients demonstrated late gadolinium enhancement (LGE). According to Petersen's criteria, the Kaplan-Meier survival outcome did not reveal significant differences (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: [0.89-2.63], P=0.11). The presence or pattern of LGE did not show significant importance for endpoint-free survival. Most of the sub-epicardial LGE pattern was found in LVNC patients (94.4%). When receiver operator characteristics analysis was applied to NC/C ratio to discriminate the primary endpoint, a higher NC/C ratio of 2.57 was associated with adverse events (HR: 1.90, 95% CI: [1.12-3.24], P=0.016). Our study questions the criteria being used for the diagnosis of LVNC. Further evaluation of CMR variables and association of these findings with demographic variables and survival is mandatory.

The effect of dietary patterns on mild cognitive impairment and dementia incidence among community-dwelling older adults.

Multiple studies have shown that dietary patterns have beneficial health effects on cognitive function. However, information on this relationship is presently limited, particularly among older adults. Thus, this study aimed to determine the effects of dietary patterns on mild cognitive impairment (MCI) and dementia incidence among Malaysian community-dwelling older adults. In this prospective cohort study, a total of 280 participants aged 60 years and above were included in the 5-year follow-up analysis. Participants’ sociodemographic, medical history, anthropometry, blood pressure, body composition, biochemical indices, cognitive assessments, psychosocial functions, functional status, and dietary intake were obtained. MCI was classified based on Petersen criteria, whereas dementia status was assessed using clinical dementia rating (CDR). Univariate analysis was performed for all variables, followed by multinomial regression analysis to identify the ability of dietary patterns in predicting the incidence of MCI and dementia. After controlling for confounding factors, the findings indicated that “local snacks-fish and seafood-high salt foods” dietary pattern was associated with an increased risk of MCI incidence, where the T3 [adjusted OR = 3.943 (95% CI: 1.212–12.832), p = 0.032] had the highest OR compared to T2 [adjusted OR = 3.252 (95% CI: 1.108–9.546), p = 0.023]. Meanwhile, a negative association across the tertiles of tropical fruits-oats dietary pattern and dementia incidence was observed [T2: adjusted OR = 0.152 (95% CI: 0.026–0.871), p = 0.034; T3: Adjusted OR = 0.101 (95% CI: 0.011–0.967), p = 0.047]. In conclusion, specific dietary patterns, particularly “local snacks-fish and seafoods-high salt foods,” were shown to increase the risk of MCI, while increasing intakes of “tropical fruits-oats” dietary patterns would protect against the dementia incidence among Malaysian older adults.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country.

ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

The Incidence and Burden of Risk Factors for Mild Cognitive Impairment in Older Rural Chinese Persons.

Objective: The study investigated the prevalence of mild cognitive impairment (MCI), a common cognitive disorder in late life, among rural older residents in China. The associated risk factors were also analyzed. Methods: Two thousand one hundred forty-six older adults aged 60 or more in a rural town of Zhejiang Province, China, were recruited and analyzed. Demographic characteristics were collected by a self-designed questionnaire. Diagnosis of MCI was made by well-trained primary care physicians according to the Petersen criteria. Results: 23.16% of the analyzed sample were diagnosed with MCI, while the prevalence was significantly higher in women, those never married, not employed, and with older age, lower education, diabetes, coronary heart disease and stroke. Stepwise logistic regression indicated that age, education, diabetes, coronary heart disease, and stroke were significant predictive factors of MCI. Conclusion: The prevalence of MCI in rural older residents in China is high, and those with specific demographic characteristics like women, never married, not employed, and with older age, lower education and chronic physical conditions should be more concerned in primary care management. Integrated care approaches managing MCI and comorbid chronic conditions are recommended in future management practices.

Mild cognitive impairment among rural-dwelling older adults in China: A community-based study.

Epidemiological studies of mild cognitive impairment (MCI) and subtypes of MCI have rarely focused on rural residents in China. This population-based study included 5068 participants (age ≥60 years) who were living in rural communities. We defined MCI, amnestic MCI (aMCI), and non-amnestic MCI (naMCI) following the Petersen's criteria that integrated neuropsychological assessments with in-person clinical evaluations. The overall prevalence of MCI, aMCI, and naMCI was 26.48%, 22.30%, and 4.18%, respectively. The prevalence of MCI increased with age. The adjusted odds ratio (OR) of MCI was 0.71 (95% confidence interval [CI] 0.61 to 0.82) for primary school (vs. illiteracy), 0.30 (0.24 to 0.39) for middle school or above, 1.35 (1.09 to 1.67) for being farmers, 0.65 (0.54 to 0.78) for alcohol consumption, 1.43 (1.20 to 1.70) for stroke history, and 1.14 (0.95 to 1.36) for any apolipoprotein E (APOE) ε4 allele (vs ε3/ε3). MCI affects over one-fourth of rural older adults in China. Overall MCI was associated with demographic factors, non-alcohol consumption, and stroke, but not with APOE genotype and cardiometabolic factors.

Genetic Effects of NDUFAF6 rs6982393 and APOE on Alzheimer's Disease in Chinese Rural Elderly: A Cross-Sectional Population-Based Study.

PurposeTo investigate the associations of genotypes of NDUFAF6 rs6982393 and APOE and their combined genotypes with the risk of Alzheimer’s disease (AD) and mild cognitive impairment (MCI) in Chinese rural elderly.MethodsThis cross-sectional population-based study included 5096 older adults (age ≥60 years, 57.1% female). Genotypes of NDUFAF6 rs6982393 and APOE were detected using the multiple-polymerase chain reaction amplification. We diagnosed AD following the criteria of Diagnostic and Statistical Manual of Mental Disorders, the fourth edition and diagnosed MCI following the Petersen’s criteria MCI. Data were analyzed using the logistic regression model.ResultsThe overall prevalence of AD and MCI was 3.57% (95% confidence interval [CI]: 0.040, 0.053) and 22.65% (95% CI: 0.223, 0.247), separately. The TT versus CC/CT genotype of NDUFAF6 rs6982393 was related to a higher risk of AD with the multi-adjusted odds ratio (95% CI) being 1.61 (1.02, 2.54) in the total sample, 3.36 (1.48, 7.60) in those aged 60–69, and 1.24 (0.71, 2.17) in those aged 70 years and above. The interaction between genotype of NDUFAF6 rs6982393 with age groups (60–69 versus ≥70 years) was significant on the risk of AD. The presence of APOE ε4 was not significantly associated with the risk of AD. Carrying both NDUFAF6 TT and APOE ε4 was related to a higher risk of AD with the multi-adjusted odds ratio (95% CI) being 2.69 (1.10, 2.56). In addition, there was no significant association between the above genotypes and MCI.ConclusionIn Chinese rural elderly, the TT versus CT/CC genotype of NDUFAF6 rs6982393 was associated with an increased likelihood of AD; such an association only existed among young-old adults. Carrying both NDUFAF6 rs6982393-TT and APOE ε4 was related to a higher risk of AD. This finding highlights the importance of considering age and combined genotype in studying the genetic profiles of AD.

Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: A systematic review and meta-analysis.

IntroductionWith no treatment for dementia, there is a need to identify high risk cases to focus preventive strategies, particularly in low‐ and middle‐income countries (LMICs) where the burden of dementia is greatest. We evaluated the risk of conversion from mild cognitive ompairment (MCI) to dementia in LMICs.MethodsMedline, Embase, PsycINFO, and Scopus were searched from inception until June 30, 2020. The search was restricted to observational studies, conducted in population‐based samples, with at least 1 year follow‐up. There was no restriction on the definition of MCI used as long as it was clearly defined. PROSPERO registration: CRD42019130958.ResultsTen thousand six hundred forty‐seven articles were screened; n = 11 retained. Of the 11 studies, most were conducted in China (n = 7 studies), with only two studies from countries classified as low income. A qualitative analysis of n = 11 studies showed that similar to high‐income countries the conversion rate to dementia from MCI was variable (range 6.0%–44.8%; average follow‐up 3.7 years [standard deviation = 1.2]). A meta‐analysis of studies using Petersen criteria (n = 6 studies), found a pooled conversion rate to Alzheimer's disease (AD) of 23.8% (95% confidence interval = 15.4%–33.4%); approximately one in four people with MCI were at risk of AD in LMICs (over 3.0–5.8 years follow‐up). Risk factors for conversion from MCI to dementia included demographic (e.g., age) and health (e.g., cardio‐metabolic disease) variables.ConclusionsMCI is associated with high, but variable, conversion to dementia in LMICs and may be influenced by demographic and health factors. There is a notable absence of data from low‐income settings and countries outside of China. This highlights the urgent need for research investment into aging and dementia in LMIC settings. Being able to identify those individuals with cognitive impairment who are at highest risk of dementia in LMICs is necessary for the development of risk reduction strategies that are contextualized to these unique settings.

447 Left ventricular non-compaction with coronary artery anomaly: incidental diagnosis after ST-elevation myocardial infarction

Abstract Left ventricular noncompaction (LVNC) is a rare congenital cardiomyopathy thought to be caused by arrest of normal endomyocardial morphogenesis. A 33-year-old male, smoker, dyslipidemic not on medical therapy, with family history for sudden cardiac death (SCD) presented to the ER for chest pain radiated to the left arm, unrelated to exertion. The physical examination was within normal limits. Blood tests showed increased cardiac enzymes levels (Troponin I hs 49 308.7 ng/l). The EKG showed STE in the anterior leads and diffuse ventricular repolarization anomalies, suggestive of anterior STEMI. The patient underwent coronary catheterization, with evidence of anomalous origin of the Cx from the RCA and critical stenosis on the proximal LAD, treated with PPCI and implantation of a DES with good angiographic result. The patient was transferred to the Cardiac Intensive Care Unit. TTE showed moderate LV dilatation, severe LV dysfunction (EF 30%) with apical, septal and anterior wall akinesis, and lateral wall hypertrabecularization with multiple prominent trabeculations and deep intertrabecular recesses communicating with the cavity, suggestive for LVNC. Cardiac MRI documented dilated LV with EF 34%, anterior and antero-septal wall akinesis (associated with increased T1 mapping values and areas of LGE after contrast injection, compatible with ischaemic outcomes), infero-lateral wall hypokinesia and LV free wall marked hypertrabecularization with a ratio of not compacted(T)/compacted(M) myocardium of 5 (Petersen criteria for LVNC diagnosis: T/M &amp;gt; 2.3 in telediastolic long-axis view). The patient was discharged in stable clinical conditions in DAPT(Cardioaspirin and Ticagrelor). At two months cardiologic follow-up the patient was asymptomatic and TTE confirmed a dilated LV with severely depressed EF (30%). In consideration of the post-ischaemic dilated cardiomyopathy with severely depressed EF and of the family history of SCD (father deceased at 54-years-old), the patient was admitted in our Cardiology Unit and he underwent subcutaneous ICD (sICD) implantation. He was discharged in stable conditions with remote home monitoring transmitter. The association between LVNC and anomalous coronary artery origin is rare. LVNC is sometimes associated with coronary artery disease, but only rare cases of acute myocardial infarction have been described in literature, with exceptionally rare cases of LVNC incidental diagnosis after STEMI. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in literature. Some authors hypothesized that a single gene responsible for both myocardial development and coronary endothelium could be involved in the pathogenesis of LVNC and at the same time predispose to coronary atherosclerosis. Further studies are necessary in order to assess the possible pathophysiological mechanisms that correlate LVNC and coronary atherosclerosis. According to European guidelines, LVNC in the absence of additional risk factors is not an indication for primary ICD implantation, and for arrhythmic risk stratification it’s recommended to follow the criteria used for non-ischaemic dilated cardiomyopathy. The anomalous origin of the Cx from the RCA has an incidence of 0.37%, and it is generally not linked to an increased risk of SCD. Involvement of RV in LVNC cannot be excluded even when RV appears normal on CMR, and if involved there is higher risk of perforation by the lead. sICD overcomes disadvantages of transvenous ICD in patients without a need for pacing therapy. In literature use of sICD is reported only in 14 patients with LVNC, mainly children and young adults.

Racial differences in AD CSF biomarkers in persons with MCI: Implications and insights

AbstractBackgroundThe implications for potential racial differences in tau CSF biomarkers for Alzheimer's disease (AD) and mild cognitive impairment (MCI) are unclear for standard cutoffs used for determining enrollment criteria into novel clinical trials, and insight into interaction with markers of non‐biological determinants.MethodSetting &amp; Participants‐ Data presented were obtained from baseline assessment of a case control study conducted from March 1, 2016 through January 31, 2019. Participants were 50 years or older adult volunteers recruited from Atlanta, Georgia into the Brain Stress Hypertension and Aging Research Program (B‐SHARP, PI: Hajjar R01AG051633) at the Emory Goizueta Alzheimer’s Disease Research Center. Exposures‐ Self‐reported race and cognitive status per modified Petersen criteria. Outcome measures‐ CSF levels of Aβ1‐42, tau, P‐tau181, ratio of tau or P‐tau181 to Aβ1‐42, and hippocampal volume.Result362 study participants were analyzed (mean [SD] age, 65.6 [7.9] years of age), where 152 (42.0%) were African American, 230 (63.5%) were women, and 189 (52.2%) had MCI. After adjusting for multiple determinants, including age, sex, cognitive performance, body mass index (BMI), education, and family history of AD, results suggest Black Americans compared to white individuals with MCI had lower mean (SE) levels of CSF tau (52.4 [5.9] vs. 78.98 [5.02] pg/mL; P=.001) and P‐tau181 (15.42 [2.06] vs. 25.24 [1.75] pg/mL; P=.001). After adjusting for intracranial volume and other covariates in the total sample hippocampal volumes did not differ by race. However, using ROC analyses, AUC comparisons suggest that Aβ1‐42 (0.632 vs 0.779; P=.02) and P‐tau181 (0.638 vs 0.768;P=.03) had lower specificity and sensitivity in Black Americans to distinguish between MCI and normal cognition.ConclusionWe recommend caution in using current biomarker cutoffs to determine enrollment criteria for potential Black American study cohorts. While we hypothesized that these differences could be explained by increased vascular contributors, our supposition was not supported; after adjusting for hypertension and diabetes, racial differences yet remained. Further investigation should clarify the impact of biological factors like vascular disease, interaction with more explicit and well‐defined environmental determinants like education quality and quantity, and their life‐course occurrence.

Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults

BackgroundCognitive frailty, a combination of physical frailty and cognitive impairment, is associated with functional decline in older adults. However, there is limited information if cognitive frailty predicts the incidence of falls, injuries, and disability. In this study, we aimed to determine the ability of cognitive frailty in predicting the incidence of falls, injuries and disability among multi-ethnic older adults in Malaysia at 5 years follow-up.MethodsIn this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants’ socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p < 0.05.ResultsCognitive frailty was found to be associated with greater risk of adverse consequences after adjusting for covariates. Both cognitive frailty (Adjusted Odd ratio (Adj OR) = 2.98, 95% confidence interval (CI): 1.78–4.99, p < 0.05) and physical frailty (Adj OR = 2.88, 95% CI: 1.19–6.99, p < 0.05) were significant predictors of incidence of falls. Risk of injuries was also significantly increased with the presence of cognitive frailty (Adj OR = 3.06, 95% CI: 1.23–7.60, p < 0.05) and physical frailty (Adj OR = 3.04, 95% CI: 1.75–5.28, p < 0.05). In addition, cognitive frailty (Adj OR = 5.17, 95% CI: 1.11–24.21, p < 0.05) and physical frailty (Adj OR = 4.99, 95% CI: 1.11–22.57, p < 0.05) were shown to significantly predict the incidence of disability among older adults.ConclusionCognitive frailty is a robust predictor of falls, injuries, and disability in older adults. Possible early multi-domain preventive and management strategies of cognitive frailty that contribute to adverse consequences are required to decrease further functional decline and promote independence in older adults.

Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI).

Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment SEARCH METHODS: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.