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MCI
Kinds of MCI Terms modified by MCI Selected AbstractsRisk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010T. Luck Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H for the AgeCoDe Study Group. Risk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Objectives:, To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. Method:, Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the ,person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. Results:, During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7,62.7) per 1000 PY. Older age, vascular diseases, the apoE ,4 allele and subjective memory complaints were identified as significant risk factors for future MCI. Conclusion:, Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches. [source] Rate of progression of mild cognitive impairment to dementia , meta-analysis of 41 robust inception cohort studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2009A. J. Mitchell Objective:, To quantify the risk of developing dementia in those with mild cognitive impairment (MCI). Method:, Meta-analysis of inception cohort studies. Results:, Forty-one robust cohort studies were identified. To avoid heterogeneity clinical studies, population studies and clinical trials were analysed separately. Using Mayo defined MCI at baseline and adjusting for sample size, the cumulative proportion who progressed to dementia, to Alzheimer's disease (AD) and to vascular dementia (VaD) was 39.2%, 33.6% and 6.2%, respectively in specialist settings and 21.9%, 28.9% and 5.2%, respectively in population studies. The adjusted annual conversion rate (ACR) from Mayo defined MCI to dementia, AD and VaD was 9.6%, 8.1% and 1.9%, respectively in specialist clinical settings and 4.9%, 6.8% and 1.6% in community studies. Figures from non-Mayo defined MCI and clinical trials are also reported. Conclusion:, The ACR is approximately 5,10% and most people with MCI will not progress to dementia even after 10 years of follow-up. [source] In vitro and in vivo characterization of TC-1827, a novel brain ,4,2 nicotinic receptor agonist with pro-cognitive activityDRUG DEVELOPMENT RESEARCH, Issue 1 2004Georg Andrees Bohme Abstract Nicotine activates specific receptors that are cation-permeable ionic channels located in the central and autonomous nervous systems, as well as at the neuromuscular junction. Administration of nicotine to animals and humans has been shown to enhance cognitive processes. However, side effects linked to the activation of peripheral nicotinic receptors limit the usefulness of nicotine for the treatment of cognitive disorders such as Alzheimer's disease (AD) or mild cognitive impairments (MCI). The synthesis and properties of TC-1827, a novel metanicotine derivative that activates brain ,4,2 nicotinic receptors is described. TC-1827 has high affinity for nicotine-labeled receptors in the cortex (Ki=34 nM), full-agonist intrinsic activity in ,4,2 -mediated neurotransmitter release studies in synaptosomes, and has no functional activity at nicotinic receptors in ganglionic or muscular cell lines. The compound enhances long-term potentiation in hippocampal slices, a form of synaptic plasticity thought to be involved in information storage at the cellular level. In vivo studies demonstrate that TC-1827 dose-dependently occupies thalamic nicotinic receptors labeled with [3H]-cytisine, increases cortical extracellular acetylcholine levels following oral administration, and enhances cognitive performance in rat and mice behavioral procedures of learning and memory. Pharmacokinetic studies in mice, rats, and monkeys indicated that TC-1827 has good oral absorption with a first pass effect resulting in bioavailabilities of 13,65% across dose/species. Cardiovascular safety studies indicate good cardiovascular tolerability for this compound. The present data demonstrate that TC-1827 is a selective and potent activator of brain ,4,2 nicotinic receptors and is a prototypical member of a new class of compounds with potential utility in the symptomatic treatment of cognitive disorders including AD and MCI. Drug Dev. Res. 62:26,40, 2004. © 2004 Wiley-Liss, Inc. [source] Emergency medicine in India: Why are we unable to ,walk the talk'?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Suresh S David Abstract The largest democracy on earth, the second most populous country and one of the most progressive countries in the globe, India, has advanced tremendously in most conventional fields of Medicine. However, emergency medicine (EM) is a nascent specialty and is yet to receive an identity. Today, it is mostly practised by inadequately trained clinicians in poorly equipped emergency departments (EDs), with no networking. Multiple factors such as the size of the population, variation in standards of medical education, lack of pre-hospital medical systems and non-availability of health insurance schemes are some of the salient causes for this tardy response. The Indian medical system is governed by a central, regulatory body which is responsible for the introduction and monitoring of all specialties , the Medical Council of India (MCI). This organisation has not recognized EM as a distinct specialty, despite a decade of dogged attempts. Bright young clinicians who once demonstrated a keen interest in EM have eventually migrated to other conventional branches of medicine, due to the lack of MCI recognition and the lack of specialty status. The Government of India has launched a nationwide network of transport vehicles and first aid stations along the national highways to expedite the transfer of patients from a crash site. However, this system cannot be expected to decrease morbidity and mortality, unless there is a concurrent development of EDs. The present article intends to highlight factors that continue to challenge the handful of dedicated, full time emergency physicians who have tenaciously pursued the cause for the past decade. A three-pronged synchronous development strategy is recommended: (i) recognise the specialty of EM as a distinct and independent basic specialty; (ii) initiate postgraduate training in EM, thus enabling EDs in all hospitals to be staffed by trained Emergency physicians; and (iii) ensure that EMs are staffed by trained ambulance officers. The time is ripe for a paradigm shift, since the country is aware that emergency care is the felt need of the hour and it is the right of the citizen. [source] Differences in grey and white matter atrophy in amnestic mild cognitive impairment and mild Alzheimer's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2009M. L. F. Balthazar Background:, Grey matter (GM) atrophy has been demonstrated in amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD), but the role of white matter (WM) atrophy has not been well characterized. Despite these findings, the validity of aMCI concept as prodromal AD has been questioned. Methods:, We performed brain MRI with voxel-based morphometry analysis in 48 subjects, aiming to evaluate the patterns of GM and WM atrophy amongst mild AD, aMCI and age-matched normal controls. Results:, Amnestic mild cognitive impairment GM atrophy was similarly distributed but less intense than that of mild AD group, mainly in thalami and parahippocampal gyri. There were no difference between aMCI and controls concerning WM atrophy. In the mild AD group, we found WM atrophy in periventricular areas, corpus callosum and WM adjacent to associative cortices. Discussion:, We demonstrated that aMCI might be considered a valid concept to detect very early AD pathology, since we found a close proximity in the pattern of atrophy. Also, we showed the involvement of WM in mild AD, but not in aMCI, suggesting a combination of Wallerian degeneration and microvascular ischaemic disease as a plausible additional pathological mechanism for the discrimination between MCI and AD. [source] Dissociation between top-down attentional control and the time course of visual attention as measured by attentional dwell time in patients with mild cognitive impairmentEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2003Richard J. Perry Abstract Studies of the time course of visual attention have identified a temporary functional blindness to the second of sequentially presented stimuli in that the attentional cost of attending to one visual stimulus may lead to impairments in identifying a second stimulus presented within 500 ms of the first. This phenomenon is known as the attentional blink or attentional dwell time. The neural correlates of the attentional blink and its relationship to mechanisms that control attention are unknown. To examine this relationship we tested healthy controls and subjects in the preclinical stage of Alzheimer's disease, known as mild cognitive impairment (MCI), on a paradigm which affords quantification of both the attentional blink and the top-down control of attention. When subjects were asked to identify both a number and a letter that were rapidly and sequentially presented on a visual display, the detrimental effect that identifying the first stimulus had on the ability to identify the second served as a measure of the attentional blink. When asked to identify only one of the two stimuli, the ability to ignore the first stimulus was a function of their top-down attentional control. The MCI subjects demonstrated a normal attentional dwell time but in contrast they showed impaired top-down attentional control within the same paradigm. This dissociation suggests that these two aspects of visual attention are subserved by different neural systems. The possible neural correlates of these two attentional functions are discussed. [source] Dimensions of Ambiguous Loss in Couples Coping With Mild Cognitive Impairment,FAMILY RELATIONS, Issue 2 2007Rosemary Blieszner Abstract: We applied the theory of ambiguous loss to couples with mild cognitive impairment (MCI), an age-related decline in memory and other cognitive processes assumed not to interfere with daily activities or the maintenance of personal relationships. Face-to-face interviews with 67 older married couples revealed that lack of understanding about the behavioral manifestations of MCI resulted in much ambiguity in their lives. Fluctuations in the elders' functioning required spouses to alter their daily activities and responsibilities. As a result, couples often experienced distress that affected their emotional involvement with one another. Findings advance theoretical implications of ambiguous loss and provide educators and practitioners with suggestions for working with couples experiencing mild memory loss. [source] Is structure or function a better measure of the effects of water abstraction on ecosystem integrity?FRESHWATER BIOLOGY, Issue 10 2009RUSSELL G. DEATH Summary 1. Assessments of flow abstractions in streams often focus on changes to biological communities and in-stream physical characteristics, with little consideration for changes in ecosystem functioning. It is unclear whether functional indicators of ecosystem health may be useful for assessing the impacts of reduced discharge on small streams. 2. We used weirs and diversions to reduce stream discharge by over 89% in three small New Zealand streams (11,84 L s,1), ranging in water quality from pristine to moderately impaired. 3. We used both structural (benthic invertebrates) and functional (drifting invertebrates, leaf breakdown, coarse particulate organic matter (CPOM) retention and primary productivity) measures of ecosystem integrity to compare responses to water abstraction in before-after, control-impact designed experiments during summer 2005. 4. At the pristine site, the density of invertebrates, taxon richness, Macroinvertebrate Community Index (MCI), Quantitative MCI, percentage of Ephemeroptera, Plecoptera and Trichoptera individuals and percentage of filter-feeders decreased in response to reduced flows. Only taxon richness decreased at the mildly impaired stream, and reduced discharge had no effect on the invertebrate community at the stream with the lowest water quality. 5. We found that reduced discharge had little influence on the breakdown rate of willow leaves in mesh bags over 1 month. Primary productivity was also relatively insensitive to water abstraction. However, CPOM retention increased with decreased flows. Drift propensity of invertebrates increased at two sites but only within the first few days after flow reduction. 6. Structural measures of ecosystem integrity suggested that the impacts of water abstraction differed among streams of varying water quality, probably because of differences in the sensitivity of invertebrate assemblages in the three streams. In contrast, the three functional measures tested were generally less sensitive to water abstraction impacts, although understanding how stream ecosystems respond to water abstraction clearly requires that both are considered. [source] Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive AssessmentGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2010Yoshinori Fujiwara Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test,retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = ,0.79, P < 0.001) scores. The areas under receiver,operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90,1.00) and 0.99 (95% CI = 0.00,1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75,0.95) and 0.97 (95% CI = 0.00,1.00), and 0.86 (95% CI = 0.76,0.95) and 0.97 (95% CI = 0.00,1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. Conclusion: The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community. Geriatr Gerontol Int 2010; 10: 225,232. [source] Hippocampal volume and asymmetry in mild cognitive impairment and Alzheimer's disease: Meta-analyses of MRI studiesHIPPOCAMPUS, Issue 11 2009Feng Shi Abstract Numerous studies have reported a smaller hippocampal volume in Alzheimer's disease (AD) patients than in aging controls. However, in mild cognitive impairment (MCI), the results are inconsistent. Moreover, the left-right asymmetry of the hippocampus receives less research attention. In this article, meta-analyses are designed to determine the extent of hippocampal atrophy in MCI and AD, and to evaluate the asymmetry pattern of the hippocampal volume in control, MCI, and AD groups. From 14 studies including 365 MCI patients and 382 controls, significant atrophy is found in both the left [Effect size (ES), 0.92; 95% confidence interval (CI), 0.72,1.11] and right (ES, 0.78; 95% CI, 0.57,0.98) hippocampus, which is lower than that in AD (ES, 1.60, 95% CI, 1.37,1.84, in left; ES, 1.52, 95% CI, 1.31,1.72, in right). Comparing with aging controls, the average volume reduction weighted by sample size is 12.9% and 11.1% in left and right hippocampus in MCI, and 24.2% and 23.1% in left and right hippocampus in AD, respectively. The findings show a bilateral hippocampal volume loss in MCI and the extent of atrophy is less than that in AD. By comparing the left and right hippocampal volume, a consistent left-less-than-right asymmetry pattern is found, but with different extents in control (ES, 0.39), MCI (ES, 0.56), and AD (ES, 0.30) group. © 2009 Wiley-Liss, Inc. [source] Structural MRI biomarkers for preclinical and mild Alzheimer's disease,HUMAN BRAIN MAPPING, Issue 10 2009Christine Fennema-Notestine Abstract Noninvasive MRI biomarkers for Alzheimer's disease (AD) may enable earlier clinical diagnosis and the monitoring of therapeutic effectiveness. To assess potential neuroimaging biomarkers, the Alzheimer's Disease Neuroimaging Initiative is following normal controls (NC) and individuals with mild cognitive impairment (MCI) or AD. We applied high-throughput image analyses procedures to these data to demonstrate the feasibility of detecting subtle structural changes in prodromal AD. Raw DICOM scans (139 NC, 175 MCI, and 84 AD) were downloaded for analysis. Volumetric segmentation and cortical surface reconstruction produced continuous cortical surface maps and region-of-interest (ROI) measures. The MCI cohort was subdivided into single- (SMCI) and multiple-domain MCI (MMCI) based on neuropsychological performance. Repeated measures analyses of covariance were used to examine group and hemispheric effects while controlling for age, sex, and, for volumetric measures, intracranial vault. ROI analyses showed group differences for ventricular, temporal, posterior and rostral anterior cingulate, posterior parietal, and frontal regions. SMCI and NC differed within temporal, rostral posterior cingulate, inferior parietal, precuneus, and caudal midfrontal regions. With MMCI and AD, greater differences were evident in these regions and additional frontal and retrosplenial cortices; evidence for non-AD pathology in MMCI also was suggested. Mesial temporal right-dominant asymmetries were evident and did not interact with diagnosis. Our findings demonstrate that high-throughput methods provide numerous measures to detect subtle effects of prodromal AD, suggesting early and later stages of the preclinical state in this cross-sectional sample. These methods will enable a more complete longitudinal characterization and allow us to identify changes that are predictive of conversion to AD. Hum Brain Mapp 2009. © 2009 Wiley-Liss, Inc. [source] White matter vascular lesions are related to parietal-to-frontal coupling of EEG rhythms in mild cognitive impairmentHUMAN BRAIN MAPPING, Issue 12 2008Claudio Babiloni Abstract Do cerebrovascular and Alzheimer's disease (AD) lesions represent additive factors in the development of mild cognitive impairment (MCI) as a putative preclinical stage of AD? Here we tested the hypothesis that directionality of fronto-parietal functional coupling of electroencephalographic (EEG) rhythms is relatively preserved in amnesic MCI subjects in whom the cognitive decline is mainly explained by white-matter vascular load. Resting EEG was recorded in 40 healthy elderly (Nold) and 78 amnesic MCI. In the MCI subjects, white-matter vascular load was quantified based on magnetic resonance images (0,30 visual rating scale). EEG rhythms of interest were , (2,4 Hz), , (4,8 Hz), ,1 (8,10.5 Hz), ,2 (10.5,13 Hz), ,1 (13,20 Hz), and ,2 (20,30 Hz). Directionality of fronto-parietal functional coupling of EEG rhythms was estimated by directed transfer function software. As main results, (i) fronto-parietal functional coupling of EEG rhythms was higher in magnitude in the Nold than in the MCI subjects; (ii) more interestingly, that coupling was higher at ,, ,1, ,2, and ,1 in MCI V+ (high vascular load; N = 42; MMSE = 26) than in MCI V, group (low vascular load; N = 36; MMSE= 26.7). These results are interpreted as supporting the additive model according to which MCI state would result from the combination of cerebrovascular and neurodegenerative lesions. Hum Brain Mapp 2008. © 2007 Wiley-Liss, Inc. [source] Functional cognitive assessment scale (FUCAS): a new scale to assess executive cognitive function in daily life activities in patients with dementia and mild cognitive impairmentHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 5 2006Fotini Kounti Abstract Background Several tests have been developed to examine performance of demented patients in daily life activities. However, most of them are based either on the subjective evaluation of performance by the patient him/herself, or on the reports of relatives. Functional Cognitive Assessment Scale (FUCAS) is a new reliable (,,>,0.89,,,0.92) cognitive-behavioral scale that assesses executive function in daily life activities directly in patients with dementia. Aims This study aimed at testing FUCAS' internal consistency of items, criterion-related validity, interrater reliability, discriminative ability, and effect of age, sex, and education on FUCAS scores. Results Criterion-related validity was supported by significant correlations between FUCAS, CAMCOG, MMSE, and FRSSD. The interrater reliability of FUCAS' total score for two raters was r 0.997 and we found no significant effect of age, sex, or education on FUCAS' total performance. Discriminant analysis has identified that FUCAS was able to sufficiently discriminate the patients with MCI from those with moderate-severe dementia. Conclusion FUCAS is a useful and reliable diagnostic tool for MCI. Cognitive-behavioral assessment such as that provided by FUCAS can provide objective information that can serve to enhance the quality of clinical decision-making. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of a novel technology for presenting screening measures to detect mild cognitive impairment in elderly patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2010D. W. Wright Summary Background:, Available screening tools for mild cognitive impairment (MCI), often a precursor to Alzheimer's disease, are insensitive or not feasible for administration in a busy primary care setting. Display Enhanced TEsting for Cognitive impairment and Traumatic brain injury (DETECTÔ) addresses these issues by creating an immersive environment for the brief administration of neuropsychological (NP) measures. Objective:, The aim of this study was to determine if the DETECTÔ cognitive subtests can identify MCI patients as accurately as standard pen and paper NP tests. Methods:, Twenty patients with MCI recruited from a memory disorders clinic and 20 age-matched controls were given both a full battery of NP tests (standard NP) and the DETECTÔ screen. Logistic regression models were used to determine whether individual tests were predictive of group membership (MCI or control). Demographic variables including age, race, education and gender were adjusted as covariates. Selection methods were used to identify subset models that exhibited maximum discrimination between MCI patients and controls for both testing methods. Results:, Both the standard NP model (C-index = 0.836) and the DETECTÔ model (C-index = 0.865) showed very good discrimination and were not significantly different (p = 0.7323). Conclusion:, The DETECTÔ system shows good agreement with standard NP tests and is capable of identifying elderly patients with cognitive impairment. [source] Application of computerized image analysis in pigmentary skin diseasesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2001Eun-So Lee MD Background Melanocyte number and the amount of melanin pigment are related to diagnosis and treatment of pigmentary skin diseases. Various histologic methods are used, such as Fontana-Masson stain for melanin pigment or immunohistochemical stain for melanocytes. Recently, computerized image analysis has been applied to many fields to avoid interobserver bias. In this study, we applied a computerized image analysis to assess the melanin content and melanocyte density of human epidermis. Methods We evaluated the skin biopsy specimens (paraffin blocks) from normal human skin (33 ± 6.6, n = 11) and diseased skins; vitiligo (32 ± 10.0, n = 8), melasma (35 ± 8.6, n = 11), and lentigo senilis (40 ± 7.2, n = 11) (mean age ± SD). Each specimen was stained with Fontana,Masson for melanin pigments and immunohistochemical method for melanocytes. Quantitative analysis of melanin pigment and melanocyte number (density) were investigated through two methods: (1) two dermatologists measured the visual scales; and (2) computerized image analysis was used to measure melanin content indices (MCI). The data were evaluated using one-way anova. Results The visual scale of the Fontana,Masson stain was the highest for lentigo senilis (3.8 ± 0.40), followed by melasma (2.6 ± 0.67), normal skin (1.8 ± 0.60) and vitiligo (0) (P < 0.05). These findings were consistent with objective measurements made by computerized image analysis. MCI values were 120.3 ± 20.74 for lentigo senilis, 81.1 ± 19.27 for melasma, 45.5 ± 16.92 for normal skin, and 0.3 ± 0.30 for vitiligo in decreasing order (P < 0.05). MC/1E (melanocyte number per 1 mm epidermis) was about two fold larger in lentigo senilis (18.1 ± 8.92) than melasma (9.7 ± 2.40) or normal skin (9.3 ± 2.67) (P < 0.05). MC/1B (melanocyte number per 1 mm basal layer) was about 1.5 fold higher in lentigo senilis (13.5 ± 4.17), compared to normal skin (9.0 ± 3.55) (P < 0.05). Melasma showed increased melanocyte numbers compared to normal skin, but it was not statistically significant (P > 0.05). Conclusion We believe this computerized image analysis could be useful tool for diagnosis and comparison of interval changes in pigmentary diseases like melasma or lentigo senilis by quantifying melanin pigments or melanocytes in skin biopsy specimens. [source] Assessing mild cognitive impairment among older African AmericansINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2010Alyssa A. Gamaldo Abstract Objectives To examine the frequency of Mild Cognitive Impairment (MCI) in African American older adults. The study also plans to explore the specific cognitive domains of impairment as well as whether there are differences in demographics, health, and cognitive performance between MCI and normal participants. Design Cross-sectional. Setting Independent-living sample of urban dwelling elders in Baltimore, Maryland. Participants The sample consisted of 554 subjects ranging in age from 50 to 95 (Mean,=,68.79,±,9.60). Measurements Socio-demographics and health were assessed. Several cognitive measures were administered to assess inductive reasoning, declarative memory, perceptual speed, working memory, executive functioning, language and global cognitive functioning. Results Approximately 22% of participants were considered MCI (i.e. 18% non-amnestic vs. 4% amnestic). A majority of the non-amnestic MCI participants had impairment in one cognitive domain, particularly language and executive function. Individuals classified as non-amnestic MCI were significantly older and had more years of education than normal individuals. The MCI groups were not significantly different than cognitively normal individuals on health factors. Individuals classified as MCI performed significantly worse on global cognitive measures as well as across specific cognitive domains than cognitively normal individuals. Conclusion This study demonstrates that impairment in a non-memory domain may be an early indicator of cognitive impairment, particularly among African Americans. Copyright © 2010 John Wiley & Sons, Ltd. [source] Identifying functional impairment with scores from the repeatable battery for the assessment of neuropsychological status (RBANS)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2010Valerie L. Hobson Abstract Objective To examine the link between RBANS scores and functional impairment. Functional status was evaluated through informant report using the clinical dementia rating (CDR) scale. Methods Archival data were reviewed from records of 99 patients in a memory disorder clinic (MDC) research database. Consensus-based diagnoses were Alzheimer's disease (AD; n,=,48), mild cognitive impairment (MCI; n,=,48), AD with vascular components; (n,=,2) and dementia due to psychiatric conditions (n,=,1). Results The RBANS language index score was significantly related to CDR domain scores of community affairs (p,<,.01), home and hobbies (p,<,.01), personal care (p,<,.05), memory (p,<,0.01), and judgment (p,<,0.01). RBANS immediate memory index scores were significantly related to (p,<,0.05) the CDR Memory and judgment and problem solving domains. Based on these findings, follow-up regressions were conducted. Semantic fluency was significantly related to CDR memory (p,<,0.01), judgment (p,<,0.05), community affairs (p,<,0.05), home/hobbies (p,<,0.05), and personal care (p,<,0.05) functional domains. Picture naming was significantly related to the CDR personal care domain (p,<,0.05). List learning was significantly related to CDR memory functional domain (p,<,0.01) and judgment (p,<,0.05). Lastly, story memory was significantly related to the CDR judgment domain (p,<,0.05). Conclusions The RBANS may be an indicator of functional impairment as well as a neuropsychological testing tool. The use of the RBANS could reduce the amount of testing that is administered to the patient, or can provide a way to compare other measurements of functional impairment to assess accuracy of findings. Copyright © 2009 John Wiley & Sons, Ltd. [source] Everyday functioning in mild cognitive impairment and its relationship with executive cognitionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2010Eleni Aretouli Abstract Objective Elderly persons with mild cognitive impairment (MCI) are at increased risk of dementia and functional impairments. The present study investigated the contribution of three domains of executive cognition to everyday functioning among persons with MCI. Methods 124 MCI patients and 68 cognitively normal elderly participants were administered a cognitive screening battery. These tests were used to divide patients into four subgroups (amnestic single domain, amnestic multiple domain, non-amnestic single domain, and non-amnestic multiple domain). Subjects were then administered 18 executive function tests that assess planning/problem-solving, working memory, and judgment. Performance of everyday activities and everyday cognition was rated with two informant-reported measures. Results All MCI subtypes had more difficulties in everyday activities than cognitively normal elderly participants. Multiple domain MCI patients had more functional impairments than single domain MCI patients. Contrary to our expectations, only one executive function component, working memory, contributed significantly to functional status after controlling for demographic, health-related and other cognitive factors. Conclusions Functional abilities are compromised in all MCI subtypes. Working memory may be associated with functional impairments, but general cognitive measures account for more unique variance. Copyright © 2009 John Wiley & Sons, Ltd. [source] The impact of anxiety on conversion from mild cognitive impairment to Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009Deidre J. Devier Abstract Objective To compare state and trait anxiety in mild cognitive impairment (MCI) patients and matched control subjects, and to assess the impact of these variables in predicting conversion to Alzheimer's disease. Methods One hundred and forty-eight patients with MCI, broadly defined, were assessed and followed systematically. Baseline predictors for follow-up conversion to AD (entire sample: 39/148 converted to Alzheimer's disease (AD)) included the Spielberger State-Trait Anxiety Inventory (STAI). Results At baseline evaluation, MCI patients had higher levels of state and trait anxiety than controls, with no differences between future AD converters (n,=,39) and non-converters. In age-stratified Cox proportional hazards model analyses, STAI State was not a significant predictor of conversion to AD (STAI State ,30 vs.,>,30 risk ratio, 1.68; 95% CI, 0.75, 3.77; p,=,0.21), but higher Trait scores indicated a lower risk of conversion when STAI State, education, the Folstein Mini-Mental State Examination and HAM-D (depression score) were also included in the model (STAI Trait ,30 vs.,>,30 risk ratio, 0.36; 95% CI, 0.16, 0.82; p,=,0.015). Conclusions In contrast to two other recent studies that showed anxiety predicted cognitive decline or conversion to AD, in this clinic-based sample, state anxiety was not a significant predictor. However, higher Trait anxiety predicted a lower risk of future conversion to AD. Further research with systematic long-term follow-up in larger samples is needed to clarify the role of state and trait anxiety in predicting MCI conversion to AD. Copyright © 2009 John Wiley & Sons, Ltd. [source] Screening for mild cognitive impairment: a systematic reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2009Jane A. Lonie Abstract Objective Patients with mild cognitive impairment account for a significant number of referrals to old age psychiatry services and specialist memory clinics. The cognitive evaluation of such patients is commonly restricted to brief dementia screens, with no consideration to their suitability for assessing MCI. Here, we review the utility of such cognitive screens for MCI and provide an overview of validated instruments. Methods We identified papers published after Petersen and colleagues 1999 MCI criteria (Petersen et al., 1999) and examining face-to-face cognitive screening for MCI from publication databases using combinations of the search terms ,mild cognitive impairment' and ,cognitive screening'. We also combined the former search with the names of 39 screening tests recently identified in a relevant review (Cullen et al., 2007). Results Fifteen cognitive screening instruments were identified, 11 cover a restricted range of cognitive domains. High sensitivity and specificity for MCI relative to healthy controls were reported for two comprehensive and two noncomprehensive screening instruments, adequate test-retest and inter-rater reliability for only one of these. With the exception of three studies, sample sizes were universally small (i.e. n,,,100), and prognostic values were reported for only two of the identified 15 screening measures. Sensitivities of the full domain measures were universally high, but information about their specificity against psychiatric and non-progressive neurological conditions and predictive validity is lacking. Conclusion Several cognitive screening instruments afford the clinician the ability to detect MCI, early AD, and in some cases non-AD dementia, but they cannot currently be used to make reliable inferences about the course and eventual outcome of MCI. Copyright © 2009 John Wiley & Sons, Ltd. [source] Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2009Hans Debruyne Abstract Objective To determine the reliability of the 30-item Geriatric Depression Scale (GDS-30) for the screening of depressive symptoms in dementia and mild cognitive impairment (MCI) using the Cornell Scale for Depression in Dementia (CSDD) as the ,gold standard'. Methods Diagnosed according to strictly applied clinical diagnostic criteria, patients with MCI (n,=,156) and probable Alzheimer's disease (AD) (n,=,247) were included. GDS-30, CSDD, Mini Mental State Examination (MMSE) and Global Deterioration Scale were assessed in all patients at inclusion. The AD group was divided in three subgroups: mild AD (MMSE,18) (n,=,117), moderate AD (MMSE<,18 and ,10) (n,=,89) and severe AD (MMSE<10) (n,=,38). Results In MCI patients, moderate but highly significant correlations were found between GDS-30 and CSDD scores (Pearson: r,=,0.565; p,<,0.001). In mildly (r,=,0.294; p,=,0.001), moderately (r,=,0.273; p,=,0.010) and severely (r,=,0.348; p,=,0.032) affected AD patients, only weak correlations between GDS-30 and CSDD scores were calculated. ROC curve analysis showed that sensitivity and specificity values of respectively 95% and 67% were achieved when a GDS-30 cut-off score of 8 was applied in MCI patients. In AD patients, too low sensitivity and specificity values did not allow selecting an optimal cut-off score by means of ROC curve analysis. Conclusion Using the CSDD as ,gold standard', we demonstrated that the GDS-30 is a reliable screening tool for depressive symptoms in MCI but not in AD patients. Copyright © 2009 John Wiley & Sons, Ltd. [source] Effects of Alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving testINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2009Cristina Frittelli Abstract Objective To assess the effects of Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) on simulated car driving ability. Methods Twenty patients with a probable AD of mild severity (Clinical Dementia Rating, CDR,=,1) were compared with 20 subjects with MCI (CD,=,0.5), and a group of age-matched neurologically normal controls on a driving simulation task. Measures of driving competence included the length of run, the number of infractions (omission of stop at pedestrian crossings, speed limits violation), the number of stops at traffic lights, the mean time to collision, and the number of off-road events. Results in the driving competence measures were correlated with scores obtained from simple visual reaction times and mini-mental state examination (MMSE). Results The patients with mild AD performed significantly worse than MCI subjects and controls on three simulated driving measures, length of run and mean time to collision (p,<,0.001), and number of off-road events (p,<,0.01). MCI subjects had only a significantly shorter time-to-collision than healthy controls (p,<,0.001). Simple visual reaction times were significantly longer (p,<,0.001) in patients with AD, compared to MCI and healthy controls, and showed a borderline significant relation (p,=,0.05) with simulated driving scores. Driving performance in the three groups did not significantly correlate with MMSE score as measure of overall cognitive function. Conclusions Mild AD significantly impaired simulated driving fitness, while MCI limitedly affected driving performance. Unsafe driving behaviour in AD patients was not predicted by MMSE scores. Copyright © 2008 John Wiley & Sons, Ltd. [source] Neural correlates of verbal episodic memory in patients with MCI and Alzheimer's disease,,a VBM studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2008Dirk T. Leube Abstract Objective The hippocampus is a key area for episodic memory processes. Hippocampal atrophy is a hallmark feature of Alzheimer's disease (AD). We used a new and automatized morphometric technique to better characterize brain atrophy in subjects with different levels of cognitive deficit. Methods In this study 21 participants with Mild Cognitive Impairment (MCI), 12 patients with early AD and 29 elderly control subjects were subjected to high resolution MRI and a neuropsychological test battery. Brain volume across participants, measured by voxel-based morphometry (VBM), was correlated with verbal memory capacity, measured with a verbal memory test (VLMT). Results Atrophy in the anterior hippocampus, the ento- and perirhinal cortex as well as the parahippocampal gyrus, middle temporal gyrus and anterior cingulate cortex correlated closely with episodic memory performance. Conclusions These brain areas are known to subserve episodic encoding of verbal material. The data contribute to a better understanding of atrophic brain processes in subjects at risk for AD. A combination of neuropsychological testing and voxel-based morphometry may serve as a diagnostic tool in the future. Copyright © 2008 John Wiley & Sons, Ltd. [source] The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2008Alex J. Mitchell Abstract Background Subjective memory complaints (SMC) are frequently reported by individuals with objective evidence of cognitive decline although the exact rate of complaints and their diagnostic value is uncertain. Method A meta-analysis was conducted for all studies examining SMC and either concurrent dementia or mild cognitive impairment (MCI). Results Eight studies reported the rate of SMC in dementia, seven studies reported the rate of SMC in MCI and of these four compared the rate of SMC in dementia and MCI head-to-head. SMC were present in 42.8% of those with dementia and 38.2% of those with MCI. Across all levels of cognitive impairments 39.8% of people had SMC compared with 17.4% in healthy elderly controls (Relative Risk 2.3). In head-to-head studies there was a significantly higher rate of SMC in dementia vs MCI (48.4% vs 35.1%). Examining the diagnostic value of SMC in dementia, the meta-analytic pooled sensitivity was 43.0% and specificity was 85.8%. For MCI, meta-analytic pooled sensitivity was 37.4% and specificity was 86.9%. In community studies with a low prevalence the positive and negative predictive values were 18.5% and 93.7% for dementia and 31.4% and 86.9% for MCI. The clinical utility index which calculates the value of a diagnostic method suggested ,poor' value for ruling in a diagnosis of dementia but ,good' value for ruling out a diagnosis. Conclusions When assessed by simple questions, SMC appear to be present in the minority of those with mild cognitive impairment and dementia. In cross-sectional community settings, even when people agree that they have SMC there is only a 20% or 30% chance that dementia or MCI are present, respectively. Despite this, the absence of SMC may be a reasonable method of excluding dementia and MCI and could be incorporated into short screening programs for dementia and MCI but replication is required in clinical settings. Copyright © 2008 John Wiley & Sons, Ltd. [source] Mild cognitive impairment in the older population: Who is missed and does it matter?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2008Blossom C. M. Stephan Abstract Objectives Classifications of mild cognitive impairment (MCI) vary in the precision of the defining criteria. Their value in clinical settings is different from population settings. This difference depending on setting is to be expected, but must be well understood if population screening for dementia and pre-dementia states is to be considered. Of importance is the impact of missed diagnosis. The magnitude of missed ,at-risk' cases in the application of different MCI criteria in the population is unknown. Methods Data were from the Medical Research Council Cognitive Function and Ageing Study, a large population based study of older aged individuals in the UK. Prevalence and two-year progression to dementia in individuals whose impairment failed to fulfil published criteria for MCI was evaluated. Results Prevalence estimates of individuals not classified from current MCI definitions were extremely variable (range 2.5,41.0%). Rates of progression to dementia in these non-classified groups were also very variable (3.7,30.0%), reflecting heterogeneity in MCI classification requirements. Conclusions Narrow definitions of MCI developed for clinical settings when applied in the population result in a large proportion of individuals who progress to dementia being excluded from MCI classifications. More broadly defined criteria would be better for selection of individuals at risk of dementia in population settings, but at the possibility of high false positive rates. While exclusion may be a good thing in the population since most people are presumably ,normal', over-inclusion is more likely to be harmful. Further work needs to investigate the best classification system for application in the population. Copyright © 2008 John Wiley & Sons, Ltd. [source] Subjective cognitive complaints, neuropsychological performance, affective and behavioural symptoms in non-demented patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2008Roberto Gallassi Abstract Objective Subjective cognitive complaints (SCC) have been previously investigated to establish whether they are risk factors for dementia, but no clear-cut conclusions have emerged. In this study non-demented patients with SCC were studied and the neuropsychological findings, affective and behavioural aspects and parameters with the highest correct classifications in discriminating patients who had only SCC but no objective clinical and neuropsychological impairment, i.e. no cognitive impairment (NCI) patients and those with objective neuropsychological deficits, namely patients with mild cognitive (MCI) were analyzed. Methods Consecutive non-demented outpatients with SCC were enrolled of over 9 months and examined using neuropsychological tests and scales for depression, anxiety and behaviour. Clinical criteria and neuropsychological test results were used to classify patients into groups of NCI, MCI and subtypes of MCI. Results Ninety-two patients with SCC were included; 49 of them had objective deficits (MCI patients), whereas 43 were without any clinical and cognitive impairment (NCI patients). These patients had lower age, higher education and better general cognitive indices than MCI patients who had higher caregiver distress, depression and irritability. The combination of a battery for mental deterioration and for behavioural memory assessment were the most discriminative in differentiating the two groups. Conclusions An objective cognitive impairment, reaching the criteria for a MCI diagnosis, was present in almost half of patients having SCC. MCI patients have more behavioural disturbances than NCI subjects. SCC should not be underestimated and appropriate neuropsychological assessment is required to reassure subjects with normal results and to identify patients with MCI. Copyright © 2007 John Wiley & Sons, Ltd. [source] Do the ABCS 135 short cognitive screen and its subtests discriminate between normal cognition, mild cognitive impairment and dementia?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2007Timothy I. M. Standish Abstract Background Cognitive screening instruments are either too long for routine clinical use or not sensitive to distinguish mild cognitive impairment (MCI) from normal cognition (NC) or dementia. Objective To evaluate the sensitivity and specificity of the AB Cognitive Screen (ABCS) and its subtests with a view to improving its ability to differentiate between dementia, MCI and NC. The influence of age and education on sensitivity and specificity is also examined. Design Cross-sectional study. Methods Participants with dementia and MCI were recruited from those presenting to four specialty geriatric clinics in southern Ontario. Participants with NC were recruited from the family and friends of patients. A comprehensive geriatric assessment was done including ABCS, SMMSE and 15 point Geriatric Depression Scale. Analysis of variance and receiver operating characteristic (ROC) curves compared test scores. SMMSE scores were also analysed for comparison purposes. Results Three hundred and two participants had dementia, 166 had MCI and 174 had NC. ABCS total scores were significantly different between NC and MCI (mean difference 7.1, 1.8,12.5 CI, p,=,0.000) while SMMSE scores were not (mean difference 0.5, ,0.7,1.7, p,<,0.628). Of individual ABCS subtests, verbal fluency and delayed recall were most sensitive to differences between NC and MCI. ROC curve analysis, which presents sensitivity and specificity, showed verbal fluency was better than delayed recall in distinguishing between NC and MCI, among participants 75 years of age or older. Conclusion The AB Cognitive Screen (ABCS) can be administered in 3,5,min. The SMMSE and ABCS total and subtests significantly distinguished between dementia and MCI or NC. Verbal fluency and delayed recall were best at distinguishing between MCI and NC. The analysis illustrates how each subtest contributes to the sensitivity of the ABCS and suggests ways that sensitivity might be improved. Copyright © 2006 John Wiley & Sons, Ltd. [source] Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy eldersINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2005Sarah Tomaszewski Farias Abstract Background Previous studies show individuals with dementia overestimate their cognitive and functional abilities compared to reports from caregivers. Few studies have examined whether individuals with Mild Cognitive Impairment (MCI) also tend to underestimate their deficits. In this study we examined whether degree of discrepancy between patient and informant-reported everyday functioning was associated with cognitive status. Methods The sample consisted of 111 ethnically diverse community-dwelling older adults (46 Caucasians and 65 Hispanic individuals), which was divided into four diagnostic categories: cognitively normal, MCI-memory impaired, MCI-nonmemory impaired, and demented. Everyday functional abilities were measured using both a self-report and informant-report version of the Daily Function Questionnaire (DFQ). A Difference Score was calculated by subtracting patients' DFQ score from their informants' score. Results DFQ Difference Scores were significantly higher in the demented group compared to normals and both of the MCI groups. However, the Difference Scores for the MCI groups were not significantly different than the normals. Further, while patient reported everyday functioning did not differ among the four diagnostic groups, informant reported functional status was significantly different across all diagnostic groups except MCI-nonmemory impaired vs normals. Performance on objective memory testing was associated with informant-rated but not patient-rated functional status. Demographic characteristics of the patients and informants, including ethnicity, had no association with the degree of discrepancy between raters. Conclusions Although there may be some mild functional changes associated particularly with the MCI-memory impaired subtype, individuals with MCI do not appear to under-report their functional status as can often been seen in persons with dementia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairmentINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2005Linda Garand Abstract Background While the deleterious psychosocial and mental health effects of dementia caregiving are firmly established, very little is known about the burdens or psychiatric outcomes of providing care to a spouse with less severe cognitive impairment, such as mild cognitive impairment (MCI). We characterized the nature and level of caregiver burden and psychiatric morbidity in spouses of persons diagnosed with MCI. Methods Interview assessments were completed on a cohort of 27 spouses of persons with a recent diagnosis of MCI. Patient medical records were reviewed to collect information regarding the MCI patient's medical history. Results Respondents endorsed elevated levels of both task-related responsibilities and subjective caregiver burden. Depression and anxiety symptom levels also showed some elevations. Measures of caregiver burden were significantly associated with depression and anxiety levels. In particular, even after controlling for demographic risk factors for distress, nursing task burden was correlated with elevated depressive symptoms, and greater lifestyle constraints were correlated with higher anxiety levels. Conclusions Although caregiver burden and psychiatric morbidity levels were lower than those typically observed in family dementia caregiving samples, our findings suggest that MCI caregivers have already begun to experience distress in association with elevated caregiving burden. These individuals may be ideal targets for selective preventive interventions to maximize their psychological well-being as caregiving burdens related to their spouses' cognitive impairment increase. Copyright © 2005 John Wiley & Sons, Ltd. [source] Conceptualization of mild cognitive impairment: a reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2004Heather S. Davis Abstract Background Several factors have prompted renewed interest in the concept of declines in cognitive function that occur in association with aging, in particular the area between normal cognition and dementia. We review the changing conceptualization of what has come to be known as mild cognitive impairment (MCI) in an effort to identify recent developments and highlight areas of controversy. Methods Standard MEDLINE search for relevant English-language publications on mild cognitive impairment and its associated terms, supplemented by hand searches of pertinent reference lists. Results Many conditions cause cognitive impairment which does not meet current criteria for dementia. Within this heterogenous group, termed ,Cognitive Impairment, No Dementia' (CIND), there are disorders associated with an increased risk of progression to dementia. Still, the conceptualization of these latter disorders remains in flux, with variability around assumptions about aging, the relationship between impairment and disease, and how concomitant functional impairment is classified. Amongst patients with MCI, especially its amnestic form, many will progress to Alzheimer's disease (AD). In contrast with clinic-based studies, where progression is more uniform, population-based studies suggest that the MCI classification is unstable in that context. In addition to Amnestic Mild Cognitive Impairment (AMCI), other syndromes exist and can progress to dementia. For example, an identifiable group with vascular cognitive impairment without dementia shows a higher risk of progression to vascular dementia, Alzheimer's disease and mixed dementia. Conclusions Recent attempts to profile patients at an increased risk of dementia suggest that this can be done in skilled hands, especially in people whose symptoms prompt them to seek medical attention. Whether these people actually have early AD remains to be determined. The more narrowly defined MCI profiles need to be understood in a population context of CIND. Copyright © 2004 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||