The Extension of the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 to the Children’s Court: Opportunities and Shortfalls

In 2014, the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 in Victoria was extended to the Children’s Court of Victoria. This article describes the processes that preceded this change and the changes that occurred. The potential opportunities consequent to the changes are described, with their corresponding ethical implications. The decision not to resource some of the changes as recommended by the Victorian Law Reform Commission is described, with reference to the lack of establishment of an adolescent forensic mental health facility. The shortfalls currently occurring and their ethical implications are also discussed. We note the need for data regarding the number of children whose matters are being heard under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997, and the resourcing implications that flow from this.     

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

BackgroundRecent systematic review and meta-analysis showed that the prevalence of cognitive impairment was significantly increased in patients with heart failure (HF) when compared to the general population. However, the effect of cognitive impairment on cardiovascular outcome in this population is still unclear. We performed a systematic review and meta-analysis to assess whether cognitive impairment associated with worse outcome in patients with HF.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort (prospective or retrospective) or randomized control trials that evaluate the effect of cognitive impairment mortality in HF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).ResultsEight studies were included in the analysis involving 3318 participants (951 participants had cognitive impairment). In a random-effects model, our analysis demonstrated that cognitive impairment significantly increased the risk of mortality in HF patients (pooled HR = 1.64, 95% CI = 1.42–1.88, I² = 0.0%, p < 0.001).ConclusionOur systematic review and meta-analysis showed that the presence of cognitive impairment is strongly associated with an increased mortality risk in the HF population. Further research is needed to explore the pathophysiology of this association.     

线性法测量皮质下缺血性血管病患者脑萎缩及其与认知损害的相关性分析

目的通过线性法测量皮质下缺血性血管病(SIVD)患者脑萎缩,分析其与认知功能损害的相关性。方法共纳入SIVD组50例,健康对照组50例。所有入组对象均完成一般情况评定、Mo CA量表评估认知功能、头颅MRI检查,线性法进行脑萎缩测量。结果 SIVD组代表脑室系统横径的测量值及脑沟测量值,除桥池宽度外,均较对照组显著增大(P 0. 05)。SIVD组的脑萎缩测量相对值除脑干指数外,均显著高于对照组(P 0. 05)。SIVD组双侧侧脑室两额角间最宽距离、双侧侧脑室额角两侧尾状核头间最小距离、第三脑室宽度、双侧侧脑室腰部外侧壁最小距离与Mo CA评分呈显著负相关(P 0. 05)。SIVD组脑萎缩测量相对值中的额角指数、尾状核指数、哈氏值、第三脑室宽度与视空间能力、计算力、延迟记忆和定向力均呈负相关(P 0. 05)。结论 SIVD患者存在明显的皮质和皮质下萎缩,并与认知功能损害相关。哈氏值、额角指数、尾状核指数、第三脑室宽度可作为SIVD患者脑萎缩的预测指标,提示执行功能/视空间及计算力、记忆力的损害。     

Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

Sundown Syndrome in Older Persons: A Scoping Review

ObjectivesTo map comprehensive investigations of the sundown syndrome (SS), highlighting its key definition and associated characteristics.DesignScoping review of published articles on SS in PubMed, OVID, EMBASE, Scopus, CINAHL, and Science Direct.SettingPost-acute and long-term health care settings.ParticipantsOlder adults aged ≥60 years.MeasuresArticles must present primary data on specific SS behavior, with explicit psychopathological and quantitative outcomes; and/or evening disruptive behavior.ResultsFrom a total number of 460 articles focusing on psychopathology and standardized outcomes of SS, 23 were retained for the final analysis (n = 1210 subjects). The mean age of participants was 63.2 years, and slightly more participants were women. The samples were recruited by convenience from long-term care facilities and tertiary outpatient clinics. The frequency of SS varied from 2% to 82%, without evident difference between genders and race/ethnicity. Generally, the sundown episode occurred during later daytime, when psychomotor alterations and cognitive disturbance manifested repeatedly. The symptomatic manifestations of SS were heterogeneous across the studies. Demographic risk factors were inconsistent. Although some authors have viewed cognitive impairment as a substantive predisposing factor to SS, others supported SS as a predictor of looming cognitive decline. The disrupted circadian rhythm was the most accepted pathophysiology. To date, clinical trials to guide the management of SS with specific pharmacologic and nonpharmacologic approaches are scant.Conclusions and ImplicationsSS can be viewed as a cyclic delirium-like condition affecting the older population around the sunset hour that may last for a few hours. The scarcity of comprehensive studies makes it difficult to determine whether and to what extent it can represent a distinct disease, a prodromal stage of dementia, or an epiphenomenon of incipient or worsening dementia. Extensive gathering of clinical data from multiple health care settings, using uniform measurement tools, is much needed.     

For the Sciences They Are A‐Changin’: A Response to Commentaries on Núñez et al.’s (2019) “What Happened to Cognitive Science?”

A recent issue of Topics in Cognitive Science featured 11 thoughtful commentaries responding to our article “What happened to cognitive science?” (Núñez et al., 2019). Here, we identify several themes that arose in those commentaries and respond to each. Crucial to understanding our original article is the fundamental distinction between multidisciplinary and interdisciplinary endeavors: Cognitive science began (and has stayed) as multidisciplinary but has failed to move on to form a cohesive interdisciplinary field. We clarify and elaborate our original argument and reiterate the importance of a data‐driven evaluation of the current status of the field, which exhibits a marked disciplinary imbalance, a lack of a coherent conceptual core, and a striking absence of a consistent curriculum in the institutions that grant degrees in this domain. Half a century after the creation of cognitive science, it may now be a good time to revisit goals and visions for how to best approach the ever‐fascinating scientific study of the mind(s).     

Proteomics as a reliable approach for discovery of blood-based Alzheimer’s disease biomarkers: A systematic review and meta-analysis

In order to gauge the impact of proteomics in discovery of Alzheimer’s disease (AD) blood-based biomarkers, this study had systematically reviewed articles published between 1984−2019. Articles that fulfilled the inclusion criteria were assessed for risk of bias. A meta-analysis was performed for replicable candidate biomarkers (CB). Of the 1651 articles that were identified, 17 case-control and two cohort studies, as well as three combined case-control and longitudinal designs were shortlisted. A total of 207 AD and mild cognitive impairment (MCI) CB were discovered, with 48 reported in >2 studies. This review highlights six CB, namely alpha-2-macroglobulin (α2M)_ps, pancreatic polypeptide (PP)_ps, apolipoprotein A-1 (ApoA-1)_ps, afamin_p, insulin growth factor binding protein-2 (IGFBP-2)_ps and fibrinogen-γ-chain_p, all of which exhibited consistent pattern of regulation in >three independent cohorts. They are involved in AD pathogenesis via amyloid-beta (Aβ), neurofibrillary tangles, diabetes and cardiovascular diseases (CVD). Meta-analysis indicated that ApoA-1_ps was significantly downregulated in AD (SMD = −1.52, 95% CI: −1.89, −1.16, p < 0.00001), with low inter-study heterogeneity (I² = 0%, p = 0.59). α2M_ps was significantly upregulated in AD (SMD = 0.83, 95% CI: 0.05, 1.62, p = 0.04), with moderate inter-study heterogeneity (I² = 41%, p = 0.19). Both CB are involved in Aβ formation. These findings provide important insights into blood-based AD biomarkers discovery via proteomics.     

Fast-food for thought: Retail food environments as resources for cognitive health and wellbeing among aging Americans?

In this exploratory sequential mixed-methods study, interviews with 125 adults aged 55–92 (mean age 71) living in the Minneapolis (Minnesota) metropolitan area suggested that eateries, including coffee shops and fast-food restaurants, represent popular neighborhood destinations for older adults and sources of wellbeing. Thematic analysis of how older adults perceived and utilized local eateries included sites of familiarity and comfort; physical and economic accessibility; sociability with friends, family, staff, and customers; and entertainment (e.g., destinations for outings and walks, free newspapers to read). To test the hypothesis that these sites, and the benefits they confer, are associated with cognitive welfare, we analyzed data from urban and suburban community-dwelling participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national racially diverse sample of older Americans followed since 2003 (n = 16,404, average age at assessment 72 years). Results from multilevel linear regression models of these data demonstrated a positive association between kernel density of local eateries and cognitive functioning, which corroborated qualitative findings. Taken together, these results complicate our understanding of casual eatery settings as possible sites of wellbeing through social interaction and leisure activities. Results prompt further research investigating whether and how retail food environments can serve as community spaces for older adults that may help buffer against cognitive decline.     

Calidad del sueño y déficit de memoria en el envejecimiento sano

ObjectiveTo study the relationship between sleep quality and memory in healthy ageing.MethodsThe study included 99 people older than 50 years (69 women and 30 men; mean age, 68.74 ± 7.18 years) with no associated diseases. Patients completed digital versions of the Word Learning and Visual Paired Associates tests and the Pittsburgh Sleep Quality Index questionnaire to assess the quality of sleep.ResultsPittsburgh Sleep Quality Index score was negatively correlated with Visual Paired Associates and Word Learning test performance. Performance in these 2 memory tests decreased in line with sleep quality. In addition, performance in Visual Paired Associates test was negatively correlated with subjective sleep quality, duration, and sleep disturbances. Performance on the Word Learning test was negatively correlated with subjective sleep quality and efficiency. Participants’ sex showed a weak effect on Visual Paired Associates performance and sleep latency.ConclusionsMedical professionals working with elderly patients should take into consideration the effect of poor sleep quality on memory. Cognitive impairment in these patients may be a manifestation of a neuroendocrine imbalance due to a disrupted circadian rhythm. More research is needed to prove this hypothesis.