Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment

Objective

This study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls.

Methods

This study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning.

Results

The total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%).

Conclusion

The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.     

Thalamic Shape and Cognitive Performance in Amnestic Mild Cognitive Impairment

ObjectiveThis study aimed to investigate thalamic shape alterations and their relationships with various episodic memory impairments in subjects with amnestic mild cognitive impairment (aMCI).MethodsWe compared volumes and morphological alterations of the thalamus between aMCI subjects and healthy controls. In addition, we investigated the correlation between thalamic deformations and various memory impairments in aMCI subjects using a comprehensive neuropsychological battery.ResultsThe normalized left thalamic volumes of the aMCI group were significantly smaller than those of the healthy control group (p<0.0001). aMCI subjects exhibited significant thalamic deformations in the left thalamic dorso-medial and antero-medial areas compared with healthy individuals. CERAD-K Word List Memory scores were significantly correlated with the left dorso-medial areas in aMCI subjects. There were no significant correlations between verbal fluency, Boston naming test, constructional praxis, Word List Recognition, and Visuospatial Recall scores and thalamic shape in aMCI subjects. Verbal delayed recall scores were also significantly correlated with the left dorso-medial areas in the aMCI group.ConclusionStructural alterations in the thalamic deformations in the left dorso-medial and antero-medial areas might be core underlying neurobiological mechanisms of thalamic dysfunction related to Word List Memory and delayed verbal recall in individuals with aMCI.     

Everyday action planning in schizophrenia

Planning of everyday tasks was examined in 48 inpatients with schizophrenia and 26 healthy controls. Participants were administered the Naturalistic Action Test, which requires completion of three everyday tasks (e.g., make toast and coffee). Planning variables, including planning behaviours (e.g., gathering items before engaging in a subtask) and planning time (e.g., period between task instructions and first action) were coded to evaluate forward thinking in these tasks. Results showed that planning variables were reliably coded. Controls demonstrated more planning behaviours than participants with schizophrenia; however, this difference was accounted for by education. People with schizophrenia spent significantly less time planning when planning time was analysed as a proportion of the total time on tasks. Planning variables were related to the ability to accomplish everyday task steps and to perform everyday task steps accurately. Together these findings suggest that rehabilitation strategies that emphasise both planning time and planning behaviours may facilitate everyday functioning in people with schizophrenia.     

Cognitive Correlates of Functional Abilities in Individuals with Mild Cognitive Impairment: Comparison of Questionnaire,Direct Observation,and Performance-Based Measures

The relationship between, and the cognitive correlates of, several proxy measures of functional status were studied in a population with mild cognitive impairment (MCI). Participants were 51 individuals diagnosed with MCI and 51 cognitively healthy older adults (OA). Participants completed performance-based functional status tests and standardized neuropsychological tests, and performed eight activities of daily living (e.g., watered plants, filled medication dispenser) while under direct observation in a campus apartment. An informant interview about everyday functioning was also conducted. Compared to the OA control group, the MCI group performed more poorly on all proxy measures of everyday functioning. The informant report of instrumental activities of daily living (IADL) did not correlate with the two performance-based measures; however, both the informant-report IADL and the performance-based everyday problem-solving test correlated with the direct observation measure. After controlling for age and education, cognitive predictors did not explain a significant amount of variance in the performance-based measures; however, performance on a delayed memory task was a unique predictor for the informant-report IADL, and processing speed predicted unique variance for the direct observation score. These findings indicate that differing methods for evaluating functional status are not assessing completely overlapping aspects of everyday functioning in the MCI population.     

A comparison of screening tools for the assessment of Mild Cognitive Impairment: Preliminary findings

We report a pilot investigation into the utility of screening tools in Mild Cognitive Impairment (MCI). The Addenbrooke's Cognitive Examination-Revised (ACE-R), Montreal Cognitive Assessment (MoCA) and the novel Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) were administered to 20 elderly controls and 15 MCI cases. Non-parametric Mann–Whitney U-tests showed significant differences between groups (p?<?.0001) on the CANS-MCI and MoCA. The ACE-R and MoCA total scores showed high sensitivity (90%) to MCI. Area under the curve was consistently significant in discriminating controls and MCI for memory scores across all screening instruments. A useful profile of quantitative and qualitative information pertaining to cognitive functioning in MCI can be obtained with the MoCA, ACE-R, and CANS-MCI.     

轻度认知功能障碍的神经影像学最新研究进展

轻度认知功能障碍（mild cognitive impairment，MCI）是介于正常老化、痴呆之间的一种临 床状态，表现为轻度的记忆和智能损害，达不到痴呆诊断标准，但有进展为痴呆的高风险。因此，早 发现、早诊断、早治疗非常关键。在MCI的具体诊断上，神经影像诊断表现出显著的临床应用价值， 该诊断方式在早期诊断MCI及预防AD疾病的发生上具有显著作用。本文综述了当前国内外应用神经 影像学诊断MCI的方法与结果，为进一步诊断及治疗MCI提供依据。     

Utility of the drs for predicting problems in day-to-day functioning

Predicting the consequences of cognitive impairment relative to day-to-day functioning is challenging, especially when impairment is mild. This study examined the ability of the Dementia Rating Scale (DRS) to predict Record of Independent Living (ROIL) performances in 2469 individuals with varying levels of cognitive ability, and describes specific activities of daily life that are likely impacted given specific DRS scores. Lower DRS scores were associated with greater difficulty in activities of daily living (ADLs), and effects of age, education, and gender were negligible. From a DRS total score, a corresponding ROIL score range and its specific associated impairments were determined. Functional impairments were noted even at mild levels of cognitive impairment. The DRS is helpful for determining the level of assistance that is likely needed in daily care and planning future care needs.     

The impact of goal cues on everyday action performance in dementia

Everyday action performance is impaired as a consequence of dementia. Omissions (i.e., not performing task steps) are a frequent source of error in everyday tasks among dementia patients. External cues or notes are often suggested to improve everyday functioning and might specifically address omission errors; however, the efficacy of such strategies has not been evaluated. Thus, the primary aim of this study was to assess the efficacy of goal cues (i.e., reminders of everyday task objectives) for improving dementia patients' everyday action performance. Forty-four participants with mild to moderate dementia were administered the Naturalistic Action Test (NAT), a performance-based test that includes three everyday tasks. After participants indicated that they had completed each task, they were presented with a cue card restating the task goals. Videotapes were used to code task performance as well as responses to the cues. Most participants checked their work and showed significant improvement in task accomplishment/omission errors, but not commission errors, after the cues. However, effect sizes for the differences were small, and the proportion of cases in the impaired range did not differ before versus after the cues. Therefore, although statistically significant, we concluded that the goal cues did not meaningfully or clinically improve everyday functioning.     

Effects of Virtual Reality-Based Cognitive Training in the Elderly with and without Mild Cognitive Impairment

ObjectiveThis study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. MethodsA total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. ResultsAfter the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. ConclusionWe conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.     

Frontal Dysfunction Underlies Depression in Mild Cognitive Impairment: A FDG-PET Study

Objective

Depression is a very common symptom in people with mild cognitive impairment (MCI), a preclinical stage of Alzheimer''s disease (AD), and in those with clinically evident AD. Moreover, MCI individuals with depression show a higher conversion rate to clinical AD than those without depression. This study aimed to elucidate the functional neuroanatomical substrate of depression in MCI.

Methods

Thirty-six patients were recruited from a University Hospital-based cohort; 18 of these subjects had MCI with depression (MCI_D); the remaining 18 subjects were age- and gender-matched, and had MCI with no depression (MCI_ND). For comparison, 16 cognitively normal (CN) elderly individuals were also included. All subjects underwent Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) scanning and regional cerebral glucose metabolism was compared among the three groups by a voxel-based method. The relationship between severity of depression, as measured by Hamilton Rating Scale for Depression (HRSD) scores, and glucose metabolism was also investigated.

Results

MCI_D showed lower glucose metabolism in the right superior frontal gyrus than MCI_ND. There was a significant negative correlation between HRSD score and glucose metabolism at the same frontal region for overall MCI subjects. When compared with CN, both MCI_D and MCI_ND showed decreased glucose metabolism in the precuneus, while MCI_D had, in addition, reduced metabolism in other diffuse brain regions.

Conclusion

Given previous observations on depression in AD, our results suggest that functional disruption of the frontal region, known to be associated with primary or other secondary depression, underlies depression in preclinical AD as well as clinically evident AD.     

同型半胱氨酸与高血压患者轻度认知障碍的相关性

目的 探讨同型半胱氨酸（homocysteine,Hcy）与高血压患者轻度认知障碍的相关性。方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血压患者,根据其血浆Hcy水平,将患者分为单纯型高血压组（Hcy<15 μm m ol/L）与H型高血压组（Hcy≥15 μmmol/L）,采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性,并采用Logistic回归分析高血压患者轻度认知功能障碍的影响因素。结果 共纳入原发性高血压患者113例,其中单纯型高血压组49例,H型高血压组64例。H型高血压组患者的MMSE和MoCA评分均低于单纯型高血压组（分别为24.94±1.83 vs 27.96±1.54和23.45±2.47vs 27.24±1.80,均P <0.001）。相关分析显示,Hcy水平与MMSE和MoCA评分存在负相关性（分别为r =-0.513和r =-0.500,均P＜0.001）。多因素Logistic回归分析显示,高龄（OR 1.236,95%CI 1.124～1.361）、H型高血压（OR 22.218,95%CI 8.243～59.654）是高血压患者轻度认知功能障碍的独立危险因素。结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素。     

同型半胱氨酸与高血压患者轻度认知障碍的相关性

目的 探讨同型半胱氨酸（homocysteine,Hcy）与高血压患者轻度认知障碍的相关性。
方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血
压患者,根据其血浆Hcy水平,将患者分为单纯型高血压组（Hcy<15 μm m ol/L）与H型高血压组
（Hcy≥15 μmmol/L）,采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性,并采用Logistic回归
分析高血压患者轻度认知功能障碍的影响因素。
结果 共纳入原发性高血压患者113例,其中单纯型高血压组49例,H型高血压组64例。H型高血压
组患者的MMSE和MoCA评分均低于单纯型高血压组（分别为24.94±1.83 vs 27.96±1.54和23.45±2.47
vs 27.24±1.80,均P <0.001）。相关分析显示,Hcy水平与MMSE和MoCA评分存在负相关性（分别为r =-
0.513和r =-0.500,均P＜0.001）。多因素Logistic回归分析显示,高龄（OR 1.236,95%CI 1.124～1.361）、
H型高血压（OR 22.218,95%CI 8.243～59.654）是高血压患者轻度认知功能障碍的独立危险因素。
结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素。     

The Contribution of Prospective Memory Performance to the Neuropsychological Assessment of Mild Cognitive Impairment

Objective: Prospective memory difficulties are a feature of the amnestic form of mild cognitive impairment (aMCI). Although comprehensive test batteries of prospective memory are suitable for clinical practice, they are lengthy, which has detracted from their widespread clinical use. Our aim was to investigate the utility of a brief screening measure of prospective memory, which can be incorporated into a clinical neuropsychological assessment. Methods: Seventy-seven healthy older adults (HOA) and 77 participants with aMCI were administered a neuropsychological test battery, including a prospective memory screening measure (Envelope Task), a retrospective memory measure (CVLT-II), and a multi-item subjective memory questionnaire (Prospective and Retrospective Memory Questionnaire; PRMQ) and a single-item subjective memory scale. Results: Compared with HOA participants, participants with aMCI performed poorly on the Envelope Task (η² = .38), which provided good discrimination of the aMCI and HOA groups (AUC = .83). In the aMCI group, there was a small but significant relationship between the Envelope Task and the single-item subjective rating of memory, with the Envelope Task accounting for 5–6% of the variance in subjective memory after accounting for emotional status. This relationship of prospective memory and subjective memory was not significant for the multi-item questionnaire (PRMQ); and, retrospective memory was not a significant predictor of self-rated memory, single-item, or multi-item. Conclusion: A brief screening measure of prospective memory, the Envelope Task, provides useful support to traditional memory measures in detecting aMCI.     

Diagnosis of possible Mild Cognitive Impairment in Parkinson's disease: Validity of the SCOPA-Cog

The detection of cognitive decline in Parkinson's disease (PD), at the Mild Cognitive Impairment (MCI) stage, has prognostic and treatment implications. The Movement Disorders Society (MDS) has recently published criteria and guidelines for the diagnosis of possible and probable PD-MCI. In the present study we assessed the ability of the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog) to discriminate possible PD-MCI cases from patients with PD-dementia (PDD) and from cognitively intact PD subjects. Hundred-and-thirteen consecutive PD patients underwent the MMSE, the Dementia Rating Scale and an interview on independence in daily living, and were classified as cognitively intact (n = 49), or as possible PD-MCI (n = 33) or PDD (n = 31), according to MDS criteria. Logistic regression analysis was carried out with PD-MCI diagnosis (yes/no) as an outcome variable, and age, education and the SCOPA-Cog total score as covariates. Classification of cases according to the regression model was used for constructing Receiver Operating Characteristic (ROC) curves. Area Under the Curve (AUC) was 0.92 [95% CI 0.86–0.98], for the differential diagnosis between PD-MCI and cognitively normal patients, and 0.97 [95% CI 0.80–1.00], for the differential diagnosis between PD-MCI and PDD. Sensitivity and specificity were 90% and 73% for the PD-MCI versus no cognitive impairment differentiation, at the cutpoint ≥24, and 93% and 97% for the PD-MCI versus PDD discrimination, at the cutpoint ≥17. The SCOPA-Cog is a quick and psychometrically sound PD-specific scale. Our findings support its use for the screening of possible PD-MCI.     

Odor Identification and Self-reported Olfactory Functioning in Patients with Subtypes of Mild Cognitive Impairment

Olfactory dysfunction is a very early symptom of Alzheimer's disease (AD), and olfactory dysfunction has also been found in mild cognitive impairment (MCI). The goal of the present study was to compare odor identification ability and self-reported olfactory functioning in patients with different types of MCI. We included 104 elderly participants classified into two groups: patients with mild cognitive impairment (MCI) and elderly controls (EC). Based on their performance in neuropsychological testing the study population was divided into four groups of participants based on cognitive features: amnestic MCI single domain (11), amnestic MCI multiple domain (19), non-amnestic MCI single domain (21) and non-amnestic MCI multiple domain (13), respectively. The MCI patients were compared to 40 elderly controls (EC) controls with no cognitive deficit. Comparison for odor identification revealed a significant difference between amnestic MCI multiple domain patients and the EC group. No other group comparison was significant. Statistical analyses for self-reported olfactory functioning revealed no significant group differences between any subgroup of MCI patients and the control group. Correlational analyses indicated that odor identification ability was related to cognition whereas no relationship was found for self-reported olfactory functioning. The present study showed that amnestic MCI patients with additional deficits in other cognitive domains have a specific odor identification impairment. Together with cognitive testing, olfactory testing may more accurately help predict whether or not a patient with MCI will convert to AD in the near future.     

轻度认知障碍与卒中后抑郁关系的研究进展

轻度认知障碍（mild cognitive impairment,MCI）是认知正常和痴呆之间的过渡状态,MCI与 卒中后抑郁（post-stroke depression,PSD）关系密切。MCI常伴发抑郁,而PSD亦被认为是MCI向痴呆进展 的重要危险因素。本文就MCI与PSD关系的研究进展进行综述,着重介绍MCI和PSD关系的新进展,包 括流行病学、相关机制及治疗。     

Prevalence and Clinical Aspects of Mild Cognitive Impairment in Parkinson's Disease: A Meta-Analysis

Mild cognitive impairment associated with Parkinson's disease (PD) is a risk factor for the development of dementia. Despite the importance of early identification of mild cognitive impairment in PD, its prevalence and clinical correlates are still debated. The present meta-analysis provides a robust estimate of prevalence rate of mild cognitive impairment in PD according to the Movement Disorder Society clinical criteria and to explore the differences between PD patients with and without mild cognitive impairment in demographic, clinical, and neuropsychiatric features. A systematic literature search was performed up to April 2019 using PsycInfo (PROQUEST), PubMed, and Scopus. From 4706 titles and abstracts, 41 studies were selected (n = 7053 patients). Pooled mild cognitive impairment prevalence was 40% on a total sample of 7053 PD patients (95% confidence interval = 36–44; Q = 490.14, P < 0.0001; I² = 91.84%) with a higher frequency for the multiple domain subtype (31%; 95% confidence interval = 23–41, Q = 93.24; P < 0.0001; I² = 92.49%). Meta-regression analysis revealed that stage of PD moderate prevalence estimates of mild cognitive impairment (β = 2.80; P = 0.008). Mild cognitive impairment in PD was associated with older age, lower education, longer disease duration, higher levodopa equivalent daily dose, more severe motor symptoms, and postural instability/gait difficulty motor subtype, poorer quality of life, higher levels of apathy, and depression. The present meta-analysis indicated that mild cognitive impairment in PD is a frequent cognitive status deserving to be early detected by means of standardized cognitive assessments in clinical practice. © 2019 International Parkinson and Movement Disorder Society     

Yes/No Versus Forced-Choice Recognition Memory in Mild Cognitive Impairment and Alzheimer's Disease: Patterns of Impairment and Associations with Dementia Severity

Memory tests are sensitive to early identification of Alzheimer's disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n?=?37), MCI (n?=?37), and cognitively intact older adults (normal controls, NC; n?=?35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (<120 DRS) on forced-choice recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed.     

记忆测试预测遗忘型轻度认知障碍患者海马形态改变的研究

目的 明确何种类型的记忆测试能更好地预测1年后遗忘型轻度认知障碍向阿尔茨海默病（Alzheimer’s disease,AD）转变相关的海马形态学改变。方法 用海马冠状位磁共振扫描T1像0～4分的视觉等级评分法,比较3组遗忘型轻度认知障碍患者的海马萎缩程度,分组为听觉记忆受损组（n =30）、视觉记忆受损组（n =28）、视觉与听觉记忆均受损组（n =44）。患者均接受了多奈哌齐、艾斯能或加兰他敏中的任一药物治疗。结果 基线资料显示听觉记忆受损组存在较高比例（80%）的海马萎缩,高于视觉记忆受损组海马萎缩的比例（43%）,视觉与听觉记忆均受损组海马萎缩的比例达91%,且萎缩的皮层更广泛。1年后,听觉记忆受损组、视觉记忆受损组和视觉听觉记忆均受损组向临床痴呆的转化率分别为20.0%、10.7%和31.8%。有极高比例的听觉记忆受损患者（50%）和视觉听觉记忆均受损者（68.2%）出现双侧海马萎缩或萎缩程度较前加重,而仅有较少比例（28.6%）的视觉记忆受损患者出现双侧海马的轻度萎缩。结论 听觉记忆受损和视觉听觉记忆均受损的遗忘型轻度认知障碍患者更可能是AD的前期状态,听觉记忆测试较视觉记忆测试更能敏感预测1年后遗忘型轻度认知障碍患者海马萎缩程度