Petersen Criteria Research Articles

Association between sleep structure and amnesic mild cognitive impairment in patients with insomnia disorder: a case-control study.

To examine the association between sleep structure and amnesic mild cognitive impairment (aMCI) in patients with insomnia disorder. A total of 256 patients with insomnia disorder were diagnosed by neurologists, 45 of whom were diagnosed with aMCI according to the Petersen criteria, and 45 participants with intact cognition were chosen as controls matched for age and education. A case-control study was conducted to compare sleep structure between aMCI and control patients with insomnia disorder. We evaluated self-reported sleep problems by the Insomnia Severity Index and objective sleep features by polysomnography. Logistic regression models were used to estimate the associations between sleep parameters and aMCI in patients with insomnia disorder. There was no significant difference in Insomnia Severity Index scores between the aMCI and control groups. In the logistic regression after adjustment for covariates, people with a longer sleep duration (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI]: 0.36-0.89), greater sleep efficiency (aOR = 0.50, 95% CI: 0.32-0.77), and a higher percentage of total sleep time in stage 3 of non-rapid eye movement sleep (N3%) (aOR = 0.02, 95% CI: 0.01-0.15) have a lower relative probability of having aMCI. By contrast, higher N1% (aOR = 2.28, 95% CI: 1.36-3.82) and wake after sleep onset (aOR = 1.31, 95% CI: 1.11-1.55) may be risk factors for aMCI in patients with insomnia. In patients with insomnia disorder, sleep duration, sleep fragmentation, sleep efficiency, N1% and N3% were independently associated with the presence of aMCI. In the clinical setting, if patients with insomnia show much more serious abnormalities in these sleep indices, clinicians should pay attention to their cognitive function. In-depth research would also be worthwhile to elaborate the causality between sleep and cognitive decline.

The role of depressive symptoms within the association of long-term exposure to indoor and outdoor traffic noise and cognitive function - Results from the Heinz Nixdorf Recall study.

Traffic noise is negatively associated with cognitive function, and its perception can differ between depressed and non-depressed people. We studied the role of depressive symptoms in the association between traffic noise and cognitive function. We studied the role of depressive symptoms in the association between traffic noise and cognitive function. During the first follow-up examination (2006-2008) of the German Heinz Nixdorf Recall study, cognitive function (five subtests and an additive global summary score, GCS) and depressive symptoms (CES-D score) were assessed in 2745 participants (aged 50-80, 49.8% women). Mild cognitive impairment (MCI) was diagnosed according to the Petersen criteria in 380 participants. Long-term exposure to traffic noise was modeled as weighted 24-h mean (LDEN) and night-time mean (LNIGHT) at the façade of the baseline addresses, and was corrected for indoors (LDEN_IN and LNIGHT_IN). We developed multiple linear and logistic regression models adjusted for individual-level characteristics to investigate cross-sectionally the role of depressive symptoms in the association of traffic noise with cognitive function. Overall, 8.6% participants had depressive symptoms. The median noise values were LDEN 52.1dB(A) and LDEN_IN 34.7dB(A). Associations were slightly stronger for cognitive subtests in those with severe depression (CES-D>21), i.e., per 10dB(A) LDEN and verbal fluency: β=-0.04 [-0.11; 0.03] for CES-D≤21 and β=-0.09 [-0.24; -0.06] for CES-D>21. Additional adjustment of the main model for CES-D did not change the association between noise and cognitive outcomes. Estimates using indoor noise exposure were generally stronger and more precise. Depressed people may be more susceptible to adverse effects of noise than non-depressed. Modeled estimates of indoor noise exposure is possibly a more appropriate measure of exposure.

Diagnostic Cardiovascular Magnetic Resonance Imaging Criteria in Noncompaction Cardiomyopathy and the Yield of Genetic Testing

BackgroundNoncompaction cardiomyopathy (NCCM) is characterized by a thickened myocardial wall with excessive trabeculations of the left ventricle, and ∼30% is explained by a (likely) pathogenic variant [(L)PV] in a cardiomyopathy gene. Diagnosing an (L)PV is important because it allows accurate identification of which relatives are at risk and helps predicting prognosis. The goal of this study was to assess which specific clinical and morphologic characteristics of the myocardium may predict an (L)PV and which of the cardiovascular magnetic resonance (CMR) diagnostic criteria for NCCM can best be used for that purpose. MethodsSixty-two patients with NCCM, diagnosed by means of echocardiographic Jenni criteria, underwent CMR imaging that was evaluated according the Petersen, Stacey, Jacquier, Captur, and Choi diagnostic CMR criteria for NCCM. Patients also underwent DNA testing and were stratified according to having an (L)PV. ResultsThirty-three patients (53%) with NCCM had an (L)PV. The apical and mid-lateral segments were the dominant locations for meeting Petersen and/or Stacey criteria. Correlation between different CMR criteria varied from moderate to very strong. In multivariate binary logistic regression analysis with CMR and non-CMR parameters, independent positive predictors for an (L)PV were familial cardiomyopathy, trabecular mass, and meeting Petersen criteria in ≥ 2 out of 3 long-axis views, whereas left bundle branch block and hypertension were negative predictors. The receiver operating characteristic curve of this multivariate model had an area under the curve of 0.89 (95% confidence interval 0.82-0.97). ConclusionsCMR criteria together with family history help to distinguish those patients in whom an (L)PV can be identified, consequently leading to referral for genetic diagnostics and cascade screening.

Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study.

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

Which factors can we control the transition from mild cognitive impairment to dementia?

Mild cognitive impairment (MCI) is a clinical condition in the transitional stage between healthy aging and dementia. In this study, we investigated the risk factors and the development of dementia in MCI patients.Seventy six patients who diagnosed MCI, according to the Petersen criteria, over sixty-years old, and risk factors in transition to dementia were investigated. Neurological examinations, laboratory tests, systemic comorbidities, mini-mental state examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scale of the patients every 3–6 months were investigated. Dementia developed in 44.7% of MCI patients. Vascular risk factors were the most prominent risk factors in the transition from MCI to dementia (p = 0.000).Increased vascular risk factors and advancing age in MCI patients accelerate the transition to dementia. Therefore, modifiable vascular risk factors, which are significant factors in the transition to dementia, should be controlled and these patients should be closely monitored.

Prevalence of Mild Cognitive Impairment in the Elderly Population in Greece: Results From the HELIAD Study.

Timely recognition of mild cognitive impairment (MCI) is essential in optimizing prevention and treatment for Alzheimer disease. Because of the paucity of data on MCI epidemiology in Greece and the variability of worldwide published results, we investigated the prevalence and determinants of MCI in the elderly population in Greece. As part of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD), we randomly selected 1960 individuals 65 years and older to undergo full neurological and neuropsychological assessment by a multidisciplinary team. MCI was diagnosed according to the Petersen criteria. The age-standardized and gender-standardized prevalence of MCI in people aged 65 years and older in Greece is 13.11%. The amnestic and multidomain MCI subtypes are more common than their nonamnestic and single-domain counterparts, respectively. Almost two thirds of cases are because of suspected Alzheimer disease. Every additional year of age increases the odds of prevalent MCI by 7.4%, every additional year of education decreases the odds of MCI by 6.3%, and apolipoprotein E (APOE-ε4) carriage increases the odds of MCI by 57.9%. MCI prevalence in the elderly population in Greece is on par with previously reported rates. Prospective studies with robust methodology will enhance our understanding of the dementia continuum.

Levels of Vitamins and Homocysteine in Older Adults with Alzheimer Disease or Mild Cognitive Impairment in Cuba.

INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen's criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented signifi cantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were signifi cantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not signifi cantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were signifi cantly higher for hyperhomocysteinemia (PR = 3.26; 1.84-5.80) and defi - ciency of all B vitamins: thiamine (PR = 1.89; 1.04-3.43), B-2 (PR = 2.85; 1.54-5.26), folate (PR = 3.02; 1.53-5.95), B-12 (PR = 2.21; 1.17-4.19), vitamin C (PR = 3.88; 2.12-7.10) and A (PR = 5.47; 3.26-9.17). In mild cognitive impairment, prevalence rates were signifi cantly higher for hyperhomocysteinemia (PR = 1.42; 1.08-1.87), vitamin B-2 defi ciency (PR = 1.70; 1.24-2.32) and vitamin A defi - ciency (PR =1.88; 1.05-3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin defi ciencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies. KEYWORDS Vitamins, homocysteine, geriatrics, Alzheimer disease, cognitive impairment, Cuba.

136 Long Term Clinical Outcomes in CMR Quantified Left Ventricular Noncompaction

There is currently no diagnostic gold standard for Left Ventricular Noncompaction cardiomyopathy (LVNC) and no definitive method to accurately delineate noncompacted myocardium. We developed a novel tool based on signal intensity to quantify noncompacted myocardial mass in 97 patients with isolated Petersen criteria LVNC and assess the association with major adverse cardiovascular and cerebrovascular events (MACCE) including cardiac death, cardiac transplantation, cardiac re-synchronization device, ventricular tachycardia and ischemic stroke. 81(83.5%) patients had preserved and 16 (16.5%) had reduced LV systolic function. In addition, five (5.2%) patients had late gadolinium enhancement (LGE); all patients had reduced LV function. Patients with reduced function had more end-systolic noncompacted mass (61.9g+/-22.4 vs 38.1g+/-15.8, p<0.001) and larger end-systolic noncompacted to total myocardial mass (44%+/-9 vs 36%+/-12, p=0.003). MACCE occurred in 12(12.3%) patients; 10(10.3%) with impaired LV function and 2(2.5%) with preserved LV function; p<0.001. Cardiac death only occurred in patients with reduced function (3/16; 18.8% and LGE (2/5; 40%); p=0.038 and 0.063. Signal intensity can accurately define noncompacted myocardium and quantify myocardial mass. In patients with isolated Petersen criteria LVNC, reduced LV function and LGE were predictors of MACCE (p<0.001) but the amount of noncompaction was not. Moving forward, future diagnostic criteria cannot be limited to the presence of noncompaction and must include LV parameters.

Racial Disparity in Cerebrospinal Fluid Amyloid and Tau Biomarkers and Associated Cutoffs for Mild Cognitive Impairment

Prior evidence suggests that racial differences exist in tau biomarkers in mild cognitive impairment (MCI) and Alzheimer disease (AD). Whether this reported disparity is associated with a differential level of neurodegeneration and disease stage or with underlying mechanisms separate from amyloid or tau is unclear. To compare cerebrospinal fluid (CSF) biomarkers in African American and white individuals with normal cognition and MCI, to estimate race-based cutoffs for these biomarkers that maximize diagnostic discrimination between normal cognition and MCI, and to study the association of demographic characteristics, cognitive performance, and common vascular risk factors with these differences. This case-control study conducted from March 1, 2016, through January 31, 2019, included participants in the Brain Stress Hypertension and Aging Research Program cohort undergoing baseline assessment. Participants were 50 years or older and recruited from the Atlanta, Georgia, area. Self-reported race and cognitive status categorized using modified Petersen criteria and clinical consensus diagnosis. Levels of β-amyloid 1-42 (Aβ1-42), tau, and phosphorylated tau 181 (pTau181), the ratio of tau or pTau181 to Aβ1-42, and hippocampal volume on magnetic resonance imaging of the brain. Data from 362 study participants were analyzed (mean [SD] age, 65.6 [7.9] years), of whom 152 (42.0%) were African American, 230 (63.5%) were women, and 189 (52.2%) had MCI. After adjustment for demographic characteristics and cognitive performance, lower mean (SE) levels were observed in African American vs white individuals with MCI for tau (52.40 [5.90] vs 78.98 [5.02] pg/mL; P = .001) and pTau181 (15.42 [2.06] vs 25.24 [1.75] pg/mL; P = .001) and a lower pTau181 to Aβ1-42 ratio (0.07 [0.02] vs 0.14 [0.01]; P = .003). There were no racial differences in the normal cognition group or in hippocampal volumes in the MCI group. Cutoffs for CSF biomarkers were higher for Aβ1-42 in African American relative to white individuals (208 [95% CI, 126-321] vs 197 [95% CI, 183-245] pg/mL) and lower for tau (51 [95% CI, 31-59] vs 59 [95% CI, 56-92] pg/mL) and pTau181 (12 [95% CI, 12-19] vs 20 [95% CI, 12-27] pg/mL) levels. Cutoffs for the pTau181 to Aβ1-42 ratio were 0.05 (95% CI, 0.03-0.12) for African American participants and 0.05 (95% CI, 0.05-0.13) for white participants. This study found that African American individuals had lower levels of tau-based biomarkers that were not likely explained by the degree of disease stage or neurodegeneration reflected by hippocampal volumes. This study suggests that race is an important factor when interpreting CSF biomarkers, especially in the clinical diagnosis of prodromal AD. It appears that using the pTau181 to Aβ1-42 ratio may ameliorate these differences.

REAL-WORLD REPRESENTATIVENESS OF CANADIAN RESEARCH SUBJECTS WITH MILD COGNITIVE IMPAIRMENT

Studies of mild cognitive impairment (MCI) utilize stringent inclusion/exclusion criteria which may impact the generalizability of findings to the broader clinical population. We compared characteristics of MCI patients in a Canadian memory clinic in Calgary to MCI research participants in published Canadian studies to assess the representativeness of research samples. Clinic participants included 555 MCI patients from the Prospective Study for Persons with Memory Symptoms registry. Research participants included 4,981 individuals with MCI retained from a systematic literature review of 112 peer-reviewed empirical Canadian studies. Clinic patients and research participants were diagnosed with MCI using similar diagnostic criteria (i.e., from the NIA-AA, or Petersen criteria). Both samples were compared on baseline demographic variables, medical and psychiatric comorbidities, and global cognitive performance using chi-square tests and t-tests with weighted means. Diverse presumed causes were noted among clinic patients. Clinic patients were younger, more likely to be male, and more educated than research participants (ds: 0.22-0.98). Psychiatric disorders, traumatic brain injury, and sensory impairments were common in clinic patients (up to 83%), but participants with these conditions were excluded from approximately 80% of studies in the systematic review. Clinic patients performed significantly worse on two global cognitive assessments (ds: 0.53 – 1.27). Stringent eligibility criteria such as used in Canadian MCI research studies would exclude a considerable subset of MCI patients seen in our referral clinic. This may have contributed to the disparities between the clinical and research cohorts in the cognitive measures examined. The implications of these findings will be discussed.

Screening for Fabry disease in patients with left ventricular noncompaction

Introduction and AimIt is unclear whether left ventricular noncompaction (LVNC) is a distinct cardiomyopathy or a morphologic manifestation of different cardiomyopathies. We previously reported a case of LVNC in a Fabry disease (FD) patient, but it remains to be clarified whether LVNC is a cardiac manifestation of FD, a coincidental finding or an overdiagnosis, which has major therapeutic implications. This study aims to determine the prevalence of FD among patients with LVNC. MethodsWe performed a retrospective study including all patients diagnosed with LVNC in eight hospital centers. Diagnosis of LVNC was based on at least one echocardiographic or cardiac magnetic resonance criterion. FD screening was performed by combined enzyme and genetic testing. ResultsThe study included 78 patients diagnosed with LVNC based on the Jenni (84.6%), Stöllberger (46.2%), Chin (21.8%), Petersen (83.8%) and Jacquier (16.2%) criteria. Left ventricular systolic dysfunction was present in 48.7%. Heart failure was found in 60.3%, ventricular dysrhythmias in 21.6% and embolic events in 11.5%. FD screening found no additional cases among patients with LVNC, besides the previously described case. ConclusionNo additional FD cases were found among patients with LVNC, which argues against the hypothesis that LVNC is a cardiac manifestation of FD.

Altered Cingulate Cortex Functional Connectivity in Normal Aging and Mild Cognitive Impairment

PurposeResting-state functional Magnetic Resonance Imaging studies revealed that the brain is organized into specialized networks constituted by regions that show a coherent fluctuation of spontaneous activity. Among these networks, the cingulate cortex appears to play a crucial role, particularly in the default mode network, the dorsal attention network and the salience network. In the present study, we mapped the functional connectivity (FC) pattern of different regions of the cingulate cortex: the anterior cingulate cortex, midcingulate cortex and posterior cingulate cortex/retro splenial cortex, which have been in turn divided into a total of 9 subregions. We compared FC patterns of the cingulate subregions in a sample of mild cognitive impairment patients and healthy elderly subjects.MethodsWe enrolled 19 healthy elders (age range: 61–72 y.o.) and 16 Mild cognitive impairment patients (age range 64–87 y.o.). All participants had comparable levels of education (8–10 years) and were neurologically examined to exclude visual and motor impairments, major medical conditions, psychiatric or neurological disorders and consumption of psychotropic drugs. The diagnosis of mild cognitive impairment was performed according to Petersen criteria. Subjects were evaluated with Mini-Mental State Examination, Frontal Assessment Battery, and prose memory (Babcock story) tests. In addition, with functional Magnetic Resonance Imaging, we investigated resting-state network activities.ResultsHealthy elderly, compared to mild cognitive impairment, showed significant increased level of FC for the ventral part of the anterior cingulate cortex in correspondence to the bilateral caudate and ventromedial prefrontal cortex. Moreover, for the midcingulate cortex the healthy elderly group showed increased levels of FC in the somatomotor region, prefrontal cortex, and superior parietal lobule. Meanwhile, the mild cognitive impairment group showed an increased level of FC for the superior frontal gyrus, frontal eye field and orbitofrontal cortex compared to the healthy elderly group.ConclusionOur findings indicate that cognitive decline observed in mild cognitive impairment patients damages the global FC of the cingulate cortex, supporting the idea that abnormalities in resting-state activities of the cingulate cortex could be a useful additional tool in order to better understand the brain mechanisms of MCI.

BIRTH COHORT ANALYSIS OF TRENDS IN AMNESTIC MILD COGNITIVE IMPAIRMENT (MCI)

Prior work suggests that dementia incidence rates may be declining in western nations. However, data regarding temporal trends in amnestic mild cognitive impairment (aMCI) incidence are limited. The Einstein Aging Study (EAS) provided the opportunity to examine whether age specific aMCI incidence rates have declined over sequential birth cohorts from 1915 to 1935, and whether trends in aMCI rates have differed for white and black older adults. Age specific incidence of aMCI was examined by birth year for 1,233 individuals age ≥70 who were enrolled in EAS population based cohort between November 1, 1993 and February 22, 2016, did not have cognitive impairment at the time of enrollment and who had at least one annual follow-up clinic visit. aMCI was defined using the updated Petersen criteria as presence of objective memory impairment, subjective memory impairment, and absence of functional decline or clinical dementia. Poisson regression was used to model aMCI incidence as a function of age, sex, race, education and birth year. Profile likelihood was used to identify the timing of noticeable increases or drops in incidence rates, with a change point allowed to fall any time between 1915 and 1935. Additional models were adjusted for trends in self-reported history of diabetes, myocardial infarction and stroke. Analyses included 5,320.9 person years of follow-up. Poisson regression analyses did not yield any significant change point in aMCI incidence rates in the overall cohort (p-value for Likelihood ratio test controlling for age, sex, race/ethnicity and education = 0.76). This result was similar for Blacks and Whites, and among men or women born between 1915 and 1935. Although stroke history was an independent predictor of incident aMCI, inclusion of stroke, MI and diabetes in the models did not change the results

Low estradiol levels escalate menopausal symptoms leading to mild cognitive impairment in postmenopausal women

BACKGROUND Women in menopause experience dramatic alterations in gonadal hormone concentrations, including diminished estradiol levels. It has been hypothesized that these hormonal changes may be responsible for the occurrences of menopausal symptoms, such as hot flushes, sleep disruption, night sweats, and irritability, as well as mild cognitive impairment (MCI) in postmenopausal women. Therefore, this study was aimed to determine if there is any association between hormonal changes and menopausal symptoms, including MCI in postmenopausal women.METHODS A total of 245 postmenopausal women were recruited for this cross-sectional study and classified into 2 groups; MCI and non-MCI groups. Diagnosis of MCI was made using the modified Petersen criteria. Variables such as subjects’ age, duration of menopause, menopausal symptoms, anthropometric status, hormone levels, and cognitive status were assessed and statistically analyzed.RESULTS Of the 245 subjects enrolled in this study, 53.9% had MCI. Multivariate analysis found that sleep disruption and estradiol levels were independent risk factors of MCI in postmenopausal women. No significant correlation was found between menopausal symptoms and estradiol concentration.CONCLUSIONS Low estradiol levels were associated with higher risks of experiencing menopausal symptoms and MCI. Sleep disruption and estradiol levels were the most influential factors in the development of MCI in postmenopausal women.

Mild Cognitive Impairment with a High Risk of Progression to Alzheimer's Disease Dementia (MCI-HR-AD): Effect of Souvenaid® Treatment on Cognition and 18F-FDG PET Scans.

Background:Previous studies have shown that Souvenaid (medical food) can have benefits on memory, cognition, and function in early Alzheimer’s disease (AD) and mild cognitive impairment (MCI).Objective:Demonstrate that Souvenaid could improve or maintain cognition and has an effect on neurodegeneration biomarkers.Methods:This cohort study was carried out from June 2015 through December 2016 in the Neurology Department, Infanta Cristina Hospital, Madrid, Spain. MCI-HR-AD were recruited using Petersen criteria, neuropsychology (NPS), and 18F-FDG PET scans to confirm the high risk of progression to dementia with one year of follow-up. Age, sex, vascular risk factors (VRF), and NPS values (Barcelona brief version) were analyzed. 18F-FDG PET scans were analyzed as a visual procedure. The study was approved by the Research Committee of ICH. Statistical analysis was made with SPSS 22.0 version.Results:Subjects included 43 MCI patients (58.5% women; mean age 69.78±7.89): 17 receiving Souvenaid® treatment (ST), 24 receiving no treatment (WT) and 2 who withdrew. No differences were seen in VRF, only hypercholesterolemia, and were less prevalent in the ST group (p = 0.002). The rate of progression to dementia was 48.8% (no differences between groups, p = 0.654). A second round of 18F-FDG PET scans showed a significance worsening of glucose metabolism in WT (p = 0.001) versus ST, in which it was low (p = 0.050). For NPS testing, there was a significant worsening in memory performance in the WT group (p = 0.011) and a stabilization in ST (p = 0.083), as well as in executive functions and attention (worsening in WT, p = 0.014). For the Subjective Changing Scale (SCS), caregivers indicated a stabilization/improvement in ST (p = 0.017).Conclusion:Souvenaid had a significant effect on several cognitive domains, and on SCS in patients with MCI-HR-AD. Its intervention had an impact on preservation on 18F-FDG PET scans.

Decreased CSF Levels of ß-Amyloid in Patients With Cortical Superficial Siderosis.

Background: Cortical superficial siderosis (cSS) represents a key neuroimaging marker of cerebral amyloid angiopathy (CAA) that is associated with intracranial hemorrhages and cognitive impairment. Nevertheless, the association between cSS and core cerebrospinal fluid (CSF) biomarkers for dementia remain unclear.Methods: One hundred and one patients with probable (79%, 80/101) or possible (21%, 21/101) CAA according to the modified Boston criteria and mild cognitive impairment according to Petersen criteria were prospectively included between 2011 and 2016. CSF analyses of ß-amyloid 42, ß-amyloid 40, total tau and phosphorylated tau were performed using sandwich-type enzyme-linked immunosorbent-assay. All patients received MRI and Mini-Mental-State Examination (MMSE). Logistic regression analysis was used to adjust for possible confounders.Results: cSS was present in 61% (62/101). Of those, 53% (33/62) had disseminated cSS and 47% (29/62) focal cSS. ß-amyloid 42 was lower in patients with cSS than in patients without cSS (OR 0.2; 95% CI 0.08–0.6; p = 0.0052) and lower in patients with disseminated cSS than in those with focal cSS (OR 0.02; 95% CI 0.003–0.2; p = 0.00057). Presence of cSS had no association with regard to ß-amyloid 40, total tau and phosphorylated tau.Conclusions: Our results demonstrate that the presence and extent of cSS are associated with reduced CSF ß-amyloid 42 levels. Further studies are needed to investigate the underlying mechanisms of this association.

Machine learning approaches to studying the role of cognitive reserve in conversion from mild cognitive impairment to dementia.

The overall aim of the present study was to explore the role of cognitive reserve (CR) in the conversion from mild cognitive impairment (MCI) to dementia. We used traditional and machine learning (ML) techniques to compare converter and nonconverter participants. We also discuss the predictive value of CR proxies in relation to the ML model performance. In total, 169 participants completed the longitudinal study. Participants were divided into a control group and three MCI subgroups, according to the Petersen criteria for diagnosis. Information about the participants was compared using nine ML classification techniques. Seven relevant performance metrics were computed in order to evaluate the accuracy of prediction regarding converter and nonconverter participants. ML algorithms applied to socio-demographic, basic health, and CR proxy data enabled prediction of conversion to dementia. The best performing models were the gradient boosting classifier (accuracy (ACC)=0.93; F1=0.86, and Cohen κ=0.82) and random forest classifier (ACC=0.92; F1=0.79, and Cohen κ=0.71). Use of ML techniques corroborated the protective role of CR as a mediator of conversion to dementia, whereby participants with more years of education and higher vocabulary scores survived longer without developing dementia. We used ML approaches to explore the role of CR in conversion from MCI to dementia. The findings indicate the potential value of ML algorithms for detecting risk of conversion to dementia in cognitive aging and CR studies. Further research is required to develop an ML-based procedure that can be used to make robust predictions.

NON-COMPACTION LEFT VENTRICLE: NOVEL RESULTS OF SUBTLE MRI SUB-ANALYSIS

Prevalence of abnormal structure of left ventricle (LV) named Non-compaction left ventricle (NCLV) has been discovered to be un-expectedly frequent in adolescents studied by screening MRI (about 19% by Petersen's criteria; LVEF = 61.8%, mean) Out of 959 cases of NCLV, we carried out exact

Frequency and associated factors of amnestic mild cognitive impairment at four senior citizen clubs in Lima, Peru.

ABSTRACTAmnestic mild cognitive impairment (aMCI) is a subtle alteration in cognitive function that does not affect day-to-day activities and can precede Alzheimer's dementia. An increase in the prevalence of both these conditions is expected given the growing elderly population and recognizing risk factors can help reduce the burden.Objective:the aim of this study was to determine the frequency and associated factors of aMCI in senior citizen clubs (SCC) at four districts with different socioeconomic status in Lima, Peru.Methods:we applied Petersen's criteria to determine the presence of the condition in an interview which included the use of the Memory Alteration Test (M@T) and the Pfeffer Functional Activity Questionnaire (PFAQ).Results:sixty-three out of 352 (17.9%) participants had aMCI. Factors associated with this condition were older age, fewer years of education at marriage whereas being from the SCC La Molina (district with highest socioeconomic status and resources for activities for the elderly) were associated with not having aMCI. There was no difference for sex, body mass index or history of hypertension.Conclusion:this predementia stage is frequent and usually undetected in urban Lima. Tools such as the M@T could help general practitioners detect this condition before its progression to dementia.

Frequent involvement of the amyloid pathway in prodromal dementia with Lewy bodies

Lewy body dementia (LBD) is the most frequent of the degenerative dementias, after Alzheimer's disease. To analyse the core biomarkers of Alzheimer's disease in the cerebrospinal fluid of exclusively Hispanic patients with prodromal LBD, in order to determine whether there is involvement of the amyloid pathway or the tau pathway. Between 2008 and 2017 we included 430 patients with mild cognitive impairment according to Petersen criteria, from three hospitals in the province of Alicante. They underwent clinical check-ups every 6-12 months to evaluate their clinical stability or their progression to dementia using current clinical criteria. Among other complementary tests, biomarkers for Alzheimer's disease in the cerebrospinal fluid were analysed. Of all the patients included, 26 developed LBD and 29 remained stable for at least five years, and were thus considered as a reference. In this group only five (17%) had Abeta(1-42) protein values below normal, whereas 16 (55%) of the patients with LBD had altered levels. No differences were found in the levels of tau protein. On comparing the LBD groups with and without amyloidosis, differences were only found in the levels of Abeta(1-42) protein. We highlight the frequent presence of amyloid pathology in prodromal LBD in our population, and the probable involvement of different metabolic pathways in the same clinically defined dementia.