Presence Of Mild Cognitive Impairment Research Articles

Cognitive Overload? An Exploration of the Potential Impact of Cognitive Functioning in Discrete Choice Experiments with Older People in Health Care

ObjectivesThis exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. MethodsA DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. ResultsBoth the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE. ConclusionsThis study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people.

A large, cross-sectional observational study of serum BDNF, cognitive function, and mild cognitive impairment in the elderly.

Objective: The clinical relationship between brain-derived neurotrophic factor (BDNF) and cognitive function or mild cognitive impairment (MCI) is not well-understood. The purpose of this study was to identify the relationship between serum BDNF and cognitive function and MCI, and determine whether serum BDNF level might be a useful biomarker for assessing risk for MCI in older people.Materials and Methods: A total of 4463 individuals aged 65 years or older (mean age 72 years) participating in the study. We measured performance in a battery of neuropsychological and cognitive function tests; serum BDNF concentration.Results: Eight hundred twenty-seven participants (18.8%) had MCI. After adjustment for sex, age, education level, diabetes, and current smoking, serum BDNF was associated with poorer performance in the story memory, and digit symbol substitution task scores. Serum BDNF was marginally associated with the presence of MCI (odds ratio, 95% confidence interval: 1.41, 1.00–1.99) when BDNF was 1.5 SD lower than the mean value standardized for sex and age, education level, diabetes, and current smoking.Conclusion: Low serum BDNF was associated with lower cognitive test scores and MCI. Future prospective studies should establish the discriminative value of serum BDNF for the risk of MCI.

Mild cognitive impairment is linked with faster rate of cortical thinning in patients with Parkinson’s disease longitudinally

Previous studies have shown greater atrophy in grey and white matter of various brain regions in patients with Parkinson's disease with mild cognitive impairment than in those without. These anatomical differences likely account for the distinct clinical profiles observed between those groups, but do not account for the evolution of regional brain degradation observed as the disease evolves. Although we have shown recently that cortical thinning correlates significantly more with disease duration in Parkinson's patients with mild cognitive impairment than in those without, to the best of our knowledge no study to date has explored this longitudinally. The present study investigated the longitudinal changes of the cortical and subcortical grey matter in patients with Parkinson's disease with and without mild cognitive impairment. Additionally, these two groups were compared with healthy controls. We found a higher rate of cortical thinning in the temporal, occipital, parietal and supplementary motor area, in patients with Parkinson's disease with mild cognitive impairment compared with both cognitively stable patients and healthy controls. On the other hand cognitively stable patients had only one lateral occipital and one fusiform cluster with increased rate of thinning compared with healthy individuals. Correlating the rate of change of cortical thickness with the results of Montreal Cognitive Assessment scores revealed significant thinning associated with cognitive decline in the group of all patients, in similar regions including temporal and medial occipital lobe. Finally, a significant decrease in the volume of the amygdala and nucleus accumbens was observed specifically in patients with Parkinson's disease with mild cognitive impairment. These results indicate that the early presence of mild cognitive impairment in patients with Parkinson's disease is associated with a faster rate of grey matter thinning in various cortical regions as well as a significant diminishment of limbic subcortical structures. This specific pattern of brain degradation associated with the early presence of mild cognitive impairment might serve as a marker of development toward dementia.

EPA-1295 - Dementia and depression in elderly patients - differential diagnosis and comorbidity

The combination of dementia and depression in elderly patients is challenging for the differential diagnosis of the clinical situation To examinethe comorbidity of dementia and depression in elderly patients 231 patients aged 70 years and older. MMSE and clock drawing test, HADS and Cornell Scalefor Depression in Dementia (SCDD). The study revealed the presence of mild cognitive impairment in 118 patients, unequivocally proven symptoms of dementia - in 113 patients. Depressive disorders were found in 88 patients. Depressive symptoms were found in 136 patients. In patients with mild cognitive disorders prevailed depressive disorders of mild to moderate severity. The relations of depression and dementia in Alzheimer's disease or vascular dementia are the following options: 1. Depressive disorders are often detected in the patients who later developed dementia. 2. The clinical picture of depression in Alzheimer's disease may occur with atypical symptoms, as well as a number of symptoms of dementia can be mistakenly classified as a manifestation of depressive disorder. 3. In some cases, patients with incipient dementia can be set psychogenic the nature of depression. The development of depression in elderly patients, especially without the presence of a ‘trigger’ social factor may be a predictor or risk factor for cognitive impairment in the future. This applies particularly to patients who have depressive disorder is an atypical clinical picture and the processes of the clinic ‘pseudodementia’ and to the patients, in addition to having a depressive disorder clinically significant neurologic deficit.

Mild cognitive impairment in obstructive sleep apnea

INTRODUCTION Obstructive sleep apnea (OSA) causes sleep disruption and intermittent nocturnal hypoxemia, which can lead to daytime sleepiness and cognitive deficits. Cognitive deficits reported in individuals suffering from OSA can be severe enough to warrant a diagnosis of mild cognitive impairment (MCI). However, the frequency of MCI in individuals with OSA is unknown and factors associated with co-morbid MCI and OSA need to be investigated. Objectives: Determine the frequency and subtypes of MCI in subjects with OSA and identify demographic and clinical variables associated with co-morbid MCI and OSA. Materials and methods Fifty-one subjects with OSA (apnea- hypopnea index 10; mean age: 60.13 9.48 yrs) and 51 healthy controls (mean age: 61.82 9.49 yrs), matched for sex and education, underwent an overnight polysomnography and a comprehensive neuropsychological assessment. MCI was defined as: 1) objective evidence of cognitive decline; and 2) no major impact of cognitive deficits in activities of daily living. MCI subtypes were categorized as nonamnestic single domain, amnestic single domain, nonamnestic multiple domains and amnestic multiple domains. Group difference in the proportion of MCI was assessed using a ÷ test. Subjects with co-morbid OSA and MCI were compared to subjects with OSA alone on respiratory, demographic, questionnaire, and polysomnographic variables using Student t-tests. Results MCI was found in 37% (19/51) of OSA subjects. In contrast, only 13% (7/51) of controls had MCI ( ÷ = 7.43, dl = 1, p 0.01). Eight (42%) of the 19 patients with comorbid OSA and MCI met the criteria for nonamnestic single domain (6 with impaired attention and executive functions and 2 with impaired visuospatial abilities), two (11%) for amnestic single domain, four (21%) for nonamnestic multiple domains and five (26%) for amnestic multiple domains. Subjects with co-morbid OSA and MCI showed a lower education level (t (52) = 5.17, p 0.01) and a higher score on the vascular burden index (t (23) = -2.07, p 0.05) compared to patients with OSA alone. No difference was found between these two groups for respiratory and polysomnographic variables. Conclusion Results showed that OSA subjects have higher risk of developing MCI compared to control subjects. Nonamnestic MCI subtypes with attention/executive dysfunctions were predominant in OSA. Low education level and high vascular burden were also associated with the presence of MCI among OSA subjects. Future studies are needed to assess the effects of co- morbid MCI and OSA on the risk of converting to dementia. Acknowledgements Supported by the Canadian Institutes of Health Research and the Fonds de recherche du Quebec e Sante

Are cognitive deficits observed in obstructive sleep apnea associated with cognitive complaints?

Introduction Obstructive sleep apnea (OSA) causes sleep disruption and intermittent nocturnal hypoxemia, which can lead to daytime sleepiness and cognitive deficits. Cognitive deficits reported by individuals suffering from OSA can be severe enough to warrant a diagnosis of mild cognitive impairment (MCI). However, no study has focused on the specific cognitive complaints reported by OSA patients. Objectives: To investigate the cognitive complaints reported by OSA patients compared to control subjects, and to explore whether the presence of MCI in OSA is associated with increased or different cognitive complaints. Materials and methods Thirty-four subjects with OSA (apnea–hypopnea index (AHI) mean: 32.5 ± 14.5; mean age: 63.4 ± 6.5 yrs) and 24 healthy controls (mean age: 64.3 ± 6.5 yrs), matched for sex and education, underwent an overnight polysomnography and a comprehensive neuropsychological assessment. All participants filled out the following questionnaires: Cognitive failure questionnaire (CFQ), a French adapted version of Cognitive Difficulties Scale (CDS), Beck depression inventory-II (BDI-II), Beck anxiety inventory (BAI) and Epworth Sleepiness Scale (ESS). MCI was defined as an objective evidence of cognitive decline and no major impact of cognitive deficits on activities of daily living. Groups were compared on respiratory variables, demographic characteristics and questionnaires using Student t -tests. Results Although OSA and control groups differ on body mass index ( t (48) = 2.29, p t (48) = 18.83, p n = 14) and non-MCI ( n = 20) sub-groups, no significant groups differences was observed for frequency or type of cognitive complaints: CFQ (OSA N-MCI: 30.9 ± 2.9, OSA MCI: 28.4 ± 1.8), CDS (OSA N-MIC: 35.3 ± 15.7, OSA MCI: 33.4 ± 15.7). No other group difference was found, except for a lower education in OSA patients with MCI compared with OSA without MCI and control subjects. Conclusion Patients with OSA do not have more or different self-reported cognitive impairments than healthy subjects. This absence of group difference was also found for OSA patients with a diagnosis of MCI. Further studies should investigate whether OSA patients with MCI are aware of their cognitive impairments and if the questionnaires used in this study are sensitive enough to detect self-reported cognitive difficulties among this population. Acknowledgements Supported by the Canadian Institutes of Health Research and the Fonds de recherche du Quebec – Sante

Cognitive Performances and Mild Cognitive Impairment in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: Results of a Longitudinal Follow-Up Study

To investigate the capacity of neuropsychological deficits in idiopathic rapid eye movement sleep behavior disorder (iRBD) to predict the development of dementia and/or parkinsonism. Prospective longitudinal follow-up study. Tertiary sleep center. Twenty patients with initial iRBD (19 males, mean age 66.1 ± 7.1) underwent a clinical and neuropsychological follow-up within a mean of 43 ± 19 months. Neuropsychological performances at baseline were compared with those of healthy controls matched for sex, age, and education. Discontinuation of clonazepam at least 7 days before the follow-up evaluation. At follow-up, the Wilcoxon test showed a significant worsening of scores on Raven Colored Matrices 47 (P = 0.01), Attentive matrices (P = 0.002), phonemic (P = 0.04) and sematic (P = 0.04) fluency. Thirteen patients (65%) showed cognitive deterioration involving multiple domains. Of these, four patients (20%) maintained a stable cognitive dysfunction and nine (45%) showed a progression of cognitive dysfunction: six (30%) in constructional abilities (P = 0.03), four (20%) in short-term memory (P = NS), three (15%) in executive functions and non-verbal logic (P = NS), one (5%) in verbal fluency (P = NS), and one (5%) in long-term memory (P = NS) (McNemar test). Seven patients (35%) retained a normal cognitive profile. Mild cognitive impairment (MCI) was diagnosed at baseline in seven patients (35%). At follow-up, three of these patients showed overt dementia that was accompanied by parkinsonism in all cases; one had worsened from non-amnesic single-domain to nonamnesic multiple-domain MCI, two were stable, and one patient no longer met the criteria for MCI. Four patients (20%) without MCI at baseline had MCI at follow-up. Patients who developed MCI/dementia had an older age at disease onset (65.8 ± 5.4 versus 56.8 ± 9.3; P = 0.01) compared with those who did not. Our findings corroborate evidence that visuospatial abilities constitute the area most affected in idiopathic rapid eye movement sleep behavior disorder (learning as a stable deficit and copying as an evolving deficit). Cognitive deterioration, involving mainly nonverbal logic, attention, and executive functions, can be observed in rapid eye movement sleep behavior disorder follow-up, suggesting an underlying evolving degenerative process. Our data confirm that mild cognitive impairment is frequent in idiopathic rapid eye movement sleep behavior disorder. The presence of mild cognitive impairment predicts the eventual risk of developing dementia, which seemed to be associated with parkinsonism.

Effect of mild cognitive impairment on the patterns of neural activity in early Parkinson's disease

We have previously observed decreased activation of corticostriatal loops involved in planning (cognitive loop) and execution (motor loop) of a set shift in patients with early Parkinson's disease (PD) compared with control subjects. Here, we aimed to assess whether cognitive impairment in PD could drive these differences. Nondemented patients underwent a comprehensive neuropsychological evaluation and participated in our Wisconsin Card Sorting task functional magnetic resonance imaging protocol. Patients were separated into 2 groups according to the presence of mild cognitive impairment (MCI). Patients with MCI displayed reduced activity in the cognitive corticostriatal loop, which includes the caudate nucleus and prefrontal cortex while planning a set shift, whereas non-MCI patients exhibited activation patterns similar to those of healthy participants from our previous studies. Furthermore, reduced activation was observed in the premotor cortex of the MCI patients. Finally, hippocampal activity, correlated with individual memory scores, suggesting a compensatory mechanism in patients with preserved memory. These results suggest that the presence of MCI in PD affects activity in the prefrontal cortex and caudate nucleus as well as motor-related regions.

Cognitive function and self-care management in older patients with heart failure

People with heart failure have difficulty with self-care management. We do not know if patients with heart failure have difficulty with self-care management due to underlying, mild cognitive impairment (MCI). The purpose of this study was to determine whether MCI, as identified on a simple screening tool, is significantly associated with self-care management in a sample of community dwelling older patients with heart failure. Using a cross-sectional design, heart failure patients (n=100, mean age 72 SD 10 years) attending an outpatient heart failure clinic completed the Montreal Cognitive Assessment tool (MoCA), Self-Care in Heart Failure Index (SCHFI) and Geriatric Depression Scale. The presence of MCI, as defined by a MoCA score <26, was present in 73% patients; 21% had an adequate self-care management SCHFI score; and 12% reported symptoms of depression. Participants with a MoCA score <26 vs. ≥ 26 scored significantly lower on the self-care management subscale of the SCHFI (48.1 SD 24 vs. 59.3 SD 22 respectively, p=0.035). Using backward regression, the final model was fitted to self-care management while controlling for age and sex and was significant, with (F= 7.04 df (3, 96), and p<0.001), accounting for 18% of the total variance in self-care management (R (2) = 18.03%). The MoCA score was the only variable which remained in the model significantly with p= 0.001. Findings from this study highlight the difficulty older heart failure patients have with self-care management and the need to include formal screening for MCI when exploring variables contributing to self-care management in heart failure patients.

Accurate Assessments of Healthcare Use Along the Course of Cognitive Decline

Accurate Assessments of Healthcare Use Along the Course of Cognitive Decline

P 4: Association of insulin sensitivity level and atherogenic lipid profile in mild cognitive impairment

As an early stage of cognitive decline (mild cognitive impairment (MCI)) has been linked to changes in cholesterol profiles, previous studies have suggested that decreased insulin sensitivity and dyslipidemia are consistently indicated as essential in the pathophysiology, and possibly the pathogenesis of Alzheimer disease (AD), most common form of age-related non vascular dementia. As diagnosis of MCI, the intermediate cognitive disorder between normal aging and AD, are becoming more reliable, the aim of this study was to analyze in patient with MCI the levels of (a) insulin sensitivity (IS), (b) plasma insulin (PI) and (c) lipid parameters comprising total cholesterol (Ch), low-density (LDL) and high density (HDL) Ch, triglycerides and apolipoproteins (apoAI, apoAII, apoB, Lp(a) and apoE) potentially involved the pathogenesis of the disease. We included 40 normoglycemic patients with MCI (group A; BMI: 24,43 +/−0.52 kg/m 2 , age: 69,36+/−7,31 years), and 30 matched controls (group B; BMI: 24,29+/−0,61 kg/m 2 , age: 65,38+/−6,69 years). IS was evaluated by using euglycemic hyperinsulinemic clamp method with insulin infusion rate of 1 mU/kgbw/min during 120 min and glucose infusion adjusted manually, at 5 min intervals, to maintain target euglycemia. Total glucose uptake (M value) was calculated on the basis of the amount of glucose infused during steady state period (80–120 min). PI levels were determined by radioimmunossay. Total cholesterol, HDL-Ch, and triglycerides levels were determined by using enzymatic method, and LDL-Ch was calculated using the formula of Friedewald. Apolipoproteins ApoAI, ApoAII, Lp(a), ApoB and ApoE were determined by using nephelometry method. We found that total glucose uptake was significantly lower in group A vs group B (M value; A: 7,51 +/−0,57; B:8,53 +/−0,45 mg/min/kg, p<0.01). In addition, basal PI levels were higher in group A vs group B (A: 11,37+/−1,35; B:7,39+/−0,70 mU/l, p<0.01). Moreover, the levels of total Ch and LDL-Ch were significantly higher in group A vs group B (total-Ch; A:6,34 +/−0,26; B:5,38 +/−0,35; LDL-Ch: A: 4,28 +/−0,33; B:3,19 +/−0,22 mmol/l, p<0.01). The HDL-Ch levels were significantly lower in group A vs B (A:1,34 +/−0,11; B: 1,54 +/−0,14 mmol/l, p<0.01). Simultaneously, the levels of ApoAI were significantly lower in group A vs B (A:1,69+/−0,12; B: 2,06+/−0,43 g/l, p<0.01). The levels of triglycerides and other apolipoproteins, ApoAII, ApoB, Lp(a) and ApoE, did not differ significantly between the groups. Our results have demonstrated that the presence of MCI in patients was associated with decreased IS and increases in peripheral insulin levels. Moreover, our results has been suggested overlap in patogenic influence of factors like insulin resistance and abnormal cholesterol metabolism, especially the increases in LDL-Ch, decreases in HDL-Ch and ApoAI levels in cognitive decline, which emphasise that appropriate changes to diets and lifestyles will likely reduce MCI risk, and also improve the prognosis for people already suffering from conditions like insulin resistance and dyslipidemia.

Neural correlates of true and false memory in mild cognitive impairment.

The goal of this research was to investigate the changes in neural processing in mild cognitive impairment. We measured phase synchrony, amplitudes, and event-related potentials in veridical and false memory to determine whether these differed in participants with mild cognitive impairment compared with typical, age-matched controls. Empirical mode decomposition phase locking analysis was used to assess synchrony, which is the first time this analysis technique has been applied in a complex cognitive task such as memory processing. The technique allowed assessment of changes in frontal and parietal cortex connectivity over time during a memory task, without a priori selection of frequency ranges, which has been shown previously to influence synchrony detection. Phase synchrony differed significantly in its timing and degree between participant groups in the theta and alpha frequency ranges. Timing differences suggested greater dependence on gist memory in the presence of mild cognitive impairment. The group with mild cognitive impairment had significantly more frontal theta phase locking than the controls in the absence of a significant behavioural difference in the task, providing new evidence for compensatory processing in the former group. Both groups showed greater frontal phase locking during false than true memory, suggesting increased searching when no actual memory trace was found. Significant inter-group differences in frontal alpha phase locking provided support for a role for lower and upper alpha oscillations in memory processing. Finally, fronto-parietal interaction was significantly reduced in the group with mild cognitive impairment, supporting the notion that mild cognitive impairment could represent an early stage in Alzheimer’s disease, which has been described as a ‘disconnection syndrome’.

Diabetes is associated with cognitive impairment no dementia in the aging, demographics, and memory study (ADAMS)

Individuals with diabetes mellitus have a 1.39 times increased risk of Alzheimer's disease, a 2.38 times increased risk of vascular dementia, and a faster rate of cognitive decline compared to individuals without diabetes (Lu et al., 2009). In a study, over a 9-year follow-up diabetes was associated with accelerated progression from mild cognitive impairment (MCI) to dementia, but was not associated with progression from no impairment to MCI (Xu et al., 2010). Many previous studies on cognitive impairment and diabetes are limited by the use of cognitive screens to diagnose and assess cognitive impairment. A few studies diagnosing cognitive impairment with comprehensive neuropsychological batteries provide mixed results. For instance, Luchinger et al. (2007) found that diabetes was correlated with the presence of MCI, whereas diabetes was not associated with the presence of dementia versus no dementia in the Aging, Demographics, and Memory Study ADAMS; (Llewellyn et al., 2010).

Cognitive assessment protocol design in the ISSYS (Investigating Silent Strokes in hYpertensives: A magnetic resonance imaging Study)

Hypertension and silent cerebrovascular lesions (SCL) detected by brain magnetic resonance imaging (MRI) are associated with an increased risk of cognitive decline. In a prospective observational study in 1000 hypertensive patients, aged 50–70years, with no prior history of stroke or dementia, we will study the presence of mild cognitive impairment (MCI) and the relationship between SCL and cognition. All participants will be assessed by means of the Dementia Rating Scale—2 (DRS-2) and will undergo a brain MRI. In order to better characterize MCI and future dementia risk in our cohort, those patients that are suspected to be cognitively impaired according to the DRS-2 results will have a further neurological evaluation and complete neuropsychological testing. Follow-up for the entire cohort is planned to last for at least 3years.

Abstract 188: Total And Frontal Lobe White Matter Hyperintensity Volume And Impaired Mobility Among Older Adults

Introduction: Gait speed is associated with multiple adverse outcomes of aging. White matter hyperintensities (WMH) on magnetic resonance imaging (MRI) have been associated with gait speed, though few studies have examined changes in gait speed over time, regional localization of WMH, or enrolled participants community-based studies and in ethnic/racial minorities. We examined the association between a decline in gait speed and total and regional WMH volumes in a community-based study of aging. Methods: Participants were enrolled in the Washington Heights Inwood Columbia Aging Project (WHICAP), a cohort of Medicare recipients residing in Northern Manhattan. At enrollment participants underwent a comprehensive medical evaluation, as well as neuropsychological testing and assessment of gait speed via a 4 meter walk test. An MRI sub-study was started in 2004, at which time participants underwent a second gait speed measurement (mean 4.7 [SD=0.5] years apart). Odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the associations of large (defined as one standard deviation above the age-expected mean) WMH volume and regional WMH volumes (as a continuous measure) with the primary outcome (transition from normal to abnormal gait speed, defined as &lt; 0.4 meters/second) using logistic regression. Analyses were adjusted for socio-demographic factors, clinical history of stroke, hypertension, diabetes, body mass index, the presence of mild cognitive impairment or dementia, the length of time between the two physical performance measures, and the initial gait speed measure. Results: A total of 758 participants in WHICAP underwent MRI and two measures of gait speed. At the time of MRI the mean age was 80.3 (SD=5.6) and 114 (14.4%) had a large WMH volume. Large WMH volume was associated with a transition to an abnormal gait speed between the two visits (adjusted OR 3.09, 95% CI=1.21-7.93). Total frontal WMH volume (adjusted OR 1.06, 95%CI=0.93-1.20), or other regional volumes, were not associated with a transition to an abnormal gait speed between the two gait speed measurements. Conclusion: Total, but not regional, WMH are associated with slowing of gait over time. Modification of the known risk factors associated withWMH presents a potential strategy for the prevention of gait speed decline.

Does mild cognitive impairment affect the occurrence of radiographic knee osteoarthritis? A 3-year follow-up in the ROAD study

ObjectiveTo determine whether mild cognitive impairment (MCI) increases the risk of occurrence or progression of radiographic knee osteoarthritis (KOA) in a general population.DesignPopulation-based cohort study.SettingResidents in mountain and seaside areas...

Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy

To assess the contribution of hyperammonemia and inflammation to induction of mild cognitive impairment (or MHE). We analyzed the presence of mild cognitive impairment (CI) by using the PHES battery of psychometric tests and measured the levels of ammonia and of the inflammatory cytokines IL-6 and IL-18 in blood of patients with different types of liver or dermatological diseases resulting in different grades of hyperammonemia and/or inflammation. The study included patients with 1) liver cirrhosis, showing hyperammonemia and inflammation; 2) non-alcoholic fatty liver disease (NAFLD) showing inflammation but not hyperammonemia; 3) non-alcoholic steatohepatitis (NASH) showing inflammation and very mild hyperammonemia; 4) psoriasis, showing inflammation but not hyperammonemia; 5) keloids, showing both inflammation and hyperammonemia and 6) controls without inflammation or hyperammonemia. The data reported show that in patients with liver diseases, cognitive impairment may appear before progression to cirrhosis if hyperammonemia and inflammation are high enough. Five out of 11 patients with NASH, without liver cirrhosis, showed cognitive impairment associated with hyperammonemia and inflammation. Patients with keloids showed cognitive impairment associated with hyperammonemia and inflammation, in the absence of liver disease. Hyperammonemia or inflammation alone did not induce CI but the combination of certain levels of hyperammonemia and inflammation is enough to induce CI, even without liver disease.

Does the Clock Drawing Test Predict Dementia? Results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

Background/Aims: Conversion rates to dementia are known to be high for patients with mild cognitive impairment (MCI), but the diagnosis of MCI is very time-consuming. Since the Clock Drawing Test (CDT) is quick to administer, it will be of interest to compare the predictive validity of the CDT and of an MCI diagnosis for the diagnosis of dementia. Methods: In a sample of 384 individuals, CDT scores and the presence of MCI were assessed at baseline and then compared between individuals with an incident dementia diagnosis at follow-up and those without. Multivariate analyses, receiver operating characteristic analyses and values of sensitivity and specificity of the CDT were performed. Results: Individuals with incident dementia had significantly higher CDT scores at baseline than those without dementia. CDT was a significant predictor of incident dementia after adjusting for other factors. CDT reached a sensitivity of 68% and specificity of 65%. The area under the receiver operating characteristic curve of CDT was 0.70 and therefore slightly lower than for MCI diagnosis (0.78). Conclusions: Because of the only slightly lower predictive value of the CDT, its quick application and scoring compared to the MCI concept applied, it will be worthwhile to improve the CDT scoring system in order to increase the predictive validity in dementia.

Validity of the Montreal Cognitive Assessment (MoCA) as a Screening Test for Mild Cognitive Impairment (MCI) in a Cardiovascular Population

While rates of mild cognitive impairment (MCI) are relatively high in populations with cardiovascular diseases and risk factors, screening tests for MCI have not been evaluated in this patient group. This study investigated the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA) tool for detecting MCI in 110 patients (mean age 67.9 + 11.7 years; 60% female) recruited from hospital cardiovascular outpatient clinics. Mean MoCA performance was relatively low (22.8 + 3.8) in this group, with 72.1% of participants scoring below the recommended cutoff for cognitive impairment (<26). The presence of MCI was determined using the Neuropsychological Assessment Battery Screening Module (NAB-SM). Both amnestic MCI and multiple-domain MCI were identified. The optimum MoCA cutoff for detecting MCI in this group was <24. At this cutoff, the MoCA's sensitivity for detecting amnestic MCI was 100% and for multiple-domain MCI it was 83.3%. Specificity rates for amnestic MCI and multiple-domain MCI were 50.0% and 52% respectively. The poor specificity of the MoCA suggests that it will have limited value as a screening test for MCI in settings where the overall prevalence of MCI is low.

Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson's disease

To investigate the frequency and subtypes of mild cognitive impairment (MCI) in idiopathic rapid eye movement sleep behavior disorder (RBD) and Parkinson's disease (PD) in association with RBD. One hundred and twelve subjects without dementia or major depression including 32 idiopathic RBD patients, 22 PD patients with polysomnography-confirmed RBD, 18 PD patients without RBD, and 40 healthy control subjects, underwent a comprehensive neuropsychological evaluation. We compared the proportion of patients with MCI between groups using standard diagnostic criteria. MCI was found in 50% of idiopathic RBD patients and 73% of PD patients with RBD. In contrast, only 11% of PD patients without RBD and 8% of control subjects had MCI. The presence of MCI was significantly greater in idiopathic RBD patients and PD patients with RBD than in PD patients without RBD and control subjects. PD patients with RBD also performed worse than idiopathic RBD patients on neuropsychological tests assessing visuoconstructional and visuoperceptual abilities. In both its association with PD and its idiopathic form, RBD is an important risk factor for MCI. Except for visuoconstructional and visuoperceptual problems, RBD may be an important determinant of cognitive impairment in PD. Ann Neurol 2009;66:39-47.