多发性硬化患者的认知功能损害

目的研究多发性硬化(multiplesclerosis,MS)患者认知功能损害的形式、特点及相关影响因素,了解认知功能损害对患者生活功能的影响。方法将66例MS患者分为脊髓型和脑/脑脊髓型两组,另外选择健康对照30名,采用神经心理学测验的方法系统评价记忆、语言、信息处理速度、执行功能及整体认知功能,并进行生活功能评定,所有MS患者同时接受头颅及脊髓磁共振成像(MRI)检查。结果神经心理学测试发现,与健康对照组相比,脑/脑脊髓型MS组瞬时记忆和长延迟记忆受损明显(P<0.05),执行功能损害显著(P<0.01),信息处理速度下降(P<0.01)。单纯脊髓型也存在认知功能损害,以执行功能损害及信息处理速度下降为主(P<0.05)。记忆、执行功能等认知功能测验成绩与头颅MRI所见病变相关(r=-0.319～-0.543,P<0.05)。认知功能测验成绩与病程长短、复发次数无明显相关。执行性画钟作业(CLOX)及Stroop测验反应错误数与扩展功能障碍状态量表(EDSS)有相关性(r=-0.325及0.372,P<0.05)。操作性日常生活能力(IADL)及MS生活影响量表(MSIS29)得分与记忆、执行功能等认知测验成绩呈负相关(r=-0.325～-0.537,P<0.05)。结论MS的认知功能损害以记忆、信息处理速度、执行功能为主,整体认知功能及语言功能相对保存。认知功能损害影响患者的生活功能,与病程长短、复发次数无明显相关。     

简易精神状态量表和蒙特利尔认知评测量表对急性期缺血性脑血管病患者认知功能障碍筛查能力的比较研究

目的 比较简易精神状态量表（Mini-Mental State Examination,MMSE）和蒙特利尔认知评测量表（Montreal Cognitive Assessment,MoCA）对急性期缺血性脑血管病患者认知功能障碍的筛查能力。方法 对筛选的107例发病7 d内的短暂性脑缺血发作（transient ischemic attack,TIA）或脑梗死患者应用MMSE及MoCA量表进行认知功能障碍的评测,比较经两量表评测筛查出认知障碍患者的比例。根据患者教育程度对应的MMSE临界值筛选出MMSE评分在正常范围的患者,以MoCA量表评分26分为临界值将受试者分为MoCA评测正常组与异常组,比较两组在各个认知领域的得分。结果 107例患者MMSE平均分25.89±3.65分,MoCA平均分20.67±4.56分。MMSE评测异常者8例（7.5%）,正常者99例（92.5%）。MoCA评测异常者98例（91.6%）,正常者9例（8.4%）。MoCA评测正常者MMSE评测均正常。MMSE评测正常的99例患者中,MoCA评测正常者9例（9.1％,9/99）,评测异常者（<26分）90例（90.9％,90/99）。MoCA评测异常组在视空间与执行能力、命名、延迟记忆等认知领域得分低于MoCA评测正常组（P＜0.05）。结论 MoCA量表在筛查急性缺血性脑血管病患者认知障碍方面可能比MMSE量表更敏感,MMSE正常MoCA评测异常的患者认知损害主要表现在视空间执行功能、命名、延迟记忆等方面。     

进行性核上性麻痹和多系统萎缩的认知和影像特征

目的 分析进行性核上性麻痹（PSP）和多系统萎缩（MSA）的认知特征和影像学特点。方法连续纳入2018-01—2021-01天津市环湖医院76例很可能的PSP患者,85例很可能的多系统萎缩的帕金森亚型（MSA-P型）患者。收集所有患者的一般资料及临床资料,并完成MMSE、MoCA及影像评估。通过分析2组在整体认知及认知分领域的差异,绘制ROC曲线,评估MMSE和MoCA在2组中的特异度和敏感度。结果 PSP与MSA-P患者在发病年龄、性别、高血压、糖尿病、整体认知方面差异有统计学意义（P<0.05）,MMSE分领域差异主要表现在复述和视空间（P<0.05）,MoCA分领域差异主要表现在视空间与执行、语言和抽象方面（P<0.05）。MMSE鉴别PSP与MSA的截点值26(AUC=0.68,敏感度65.3%,特异度81.1%,P<0.05),MoCA鉴别PSP与MSA的截点值19(AUC=0.73,敏感度0.70%,特异度60%,P<0.05)。结论 PSP认知功能损害程度较MSA重,MMSE和MoCA评分及特征性影像成像可用于区分MSA和PSP。     

画钟测验对轻度血管性认知障碍和血管性痴呆的诊断作用

目的 探讨画钟测验(clock drawing test, CDT)对识别轻度血管性认知障碍(mild vascular cognitive impairment, mVCI)和轻度血管性痴呆(mild vascular dementia, mVD)患者的敏感度和特异度.方法 mVCI患者80例,mVD患者30例,正常对照80名.由独立的神经心理评估医师盲法检测CDT,采用3分法、阿尔茨海默病协作研究组方法(AD cooperative study)和Rouleau方法进行评分,并进行简易精神状态(mini-mental state examination, MMSE)及其他量表的检测.应用操作者特征性曲线(receiver operating characteristic curve, ROC)确定3种评分方法的CDT对区别mVCI和正常对照以及mVD与正常对照的敏感度和特异度.结果 3组间在年龄、性别和教育程度上匹配.在区别mVCI和正常对照中,3种评分方法CDT的敏感度分别为63.7%、65.0%、68.7%,特异度分别为87.5%、86.2%、78.7%.3种评分方法的CDT对区别mVD和正常对照均有较高的敏感度(90.0%、90.0%、83.3%)和特异度(87.5%、86.2%、95.0%).结论 对识别mVD, CDT是一种有效的筛查手段;但是对识别mVCI, CDT的作用有限.     

轻度血管性认知障碍影响因素分析

目的 探讨轻度血管性认知障碍（mild vascular cognitive impairment,mVCI）的影响因素。 方法 选取2015年8月-2018年10月收治于邯郸市第一医院神经内科的发病14 d内急性缺血性卒中 的患者为研究对象,行简易精神状态检查表、蒙特利尔认知评估量表测评,对其认知功能进行评估, 并根据其得分情况分为mVCI组及认知正常组。对比两组患者的临床资料的差异,采用单因素分析和 多因素Logistic回归分析探讨mVCI的影响因素。 结果 最终共纳入205例患者,mVCI组97例,认知正常组108例。①单因素分析显示,mVCI组患者低 文化程度（P =0.006）、高血压（P =0.032）、糖尿病（P =0.041）及吸烟（P =0.026）的比例显著高于 认知功能正常组,差异有统计学意义。mVCI组患者的血浆同型半胱氨酸水平（P =0.016）、TG水平 （P =0.040）、TC水平（P =0.026）以及匹兹堡睡眠质量指数（P＜0.001）显著高于认知正常组,差异有 统计学意义。②多因素Logistic回归分析显示,同型半胱氨酸水平升高（OR 1.139,95%CI 1.012～1.283, P =0.031）和主观睡眠质量差（OR 1.301,95%CI 1.107～1.530,P =0.001）是mVCI发生的独立危险因素, 而文化程度高（OR 0.652,95%CI 0.434～0.978,P =0.039）是mVCI 的保护性因素。 结论 高同型半胱氨酸血症及睡眠质量差是mVCI的独立危险因素,而文化程度高是mVCI的保护性 因素。     

皮质下脑梗死所致血管性认知障碍患者认知功能与脑白质病变的相关性研究

目的 分析皮层下脑梗死所致血管性认知障碍 （subcorticalvascular cognitive impairment, SVCI） 脑白质 变性与认知功能评分的相关性。 方法 连续入组皮层下脑梗死患者91例, 根据神经心理学蒙特利尔认知评估 （Montreal Cognitive Assessment, MOCA） 分为皮层下脑梗死所致血管性认知障碍 （subcortical vascular cognitive impairment, SVCI） 组 （49例） 和无认知障碍的皮质下梗死 （subcortical infarcts, SI） 组 （42例） , 分析其临床、 认知 障碍、 神经影像学特征, 并探讨认知障碍与白质损伤的相关性。 结果 SVCI组糖尿病发病率高于SI组 （38.78% vs 16.67%, P =0.02） , SVCI组脑白质病变患者37 例 （75.51%） 。 脑白质损害程度与MOCA执行功能 （ Rs =-0.415, P =0.028） 、 瞬时记忆 （ Rs =-0.577, P =0.001） 、 注意 （ Rs =-0.382, P =0.001） 、 延迟记忆 （ Rs =-0.389, P =0.041） 等4个分量表以及MOCA 量表总分 （ Rs =-0.495, P =0.002） 成负相关。 结论 SVCI患者糖尿病比例高于SI患者, 白质病变多见, 且白质病变的程度可以反映不同程度的认知 损害。     

急性脑梗死患者认知障碍与梗死部位的相关研究

目的分析急性脑梗死患者不同病灶部位认知障碍的特点。方法采用中文版蒙特利尔认知评估量表(MoCA)对97例单发病灶急性脑梗死患者和20例无脑卒中对照者进行认知功能评估,探讨MoCA 7个分项目(视空间与执行功能EF、命名NAM、注意力ATT、语言功能包括复述与流畅性LANG、抽象概括能力ABS、记忆能力包括瞬时记忆及近记忆MEM、定向力ORT)的评估结果与患者头部MRI影像结果中所示梗死部位之间的关系。结果 (1)97例急性脑梗死患者中MoCA26分者共73例,血管性认知障碍(VCI)总的发生率约为75.26%。(2)额叶部位梗死患者EF与ATT损害明显;颞叶部位梗死患者MEM、EF与ORT损害明显;丘脑部位梗死可能与ATT、LANG、EF损害有关;顶叶部位梗死可能与ORT、EF损害有关;枕叶、基底节部位梗死可能与EF损害有关。小脑、脑桥部位梗死在MoCA总分及分测验中均未显示有统计学意义的变化(P0.05)。结论脑梗死后认知障碍的发生率高;急性脑梗死患者不同梗死部位认知功能损害特点不同。     

认知障碍简明评价表对帕金森病患者轻度认知功能障碍的诊断价值

目的探讨认知障碍简明评价表(Cog-12量表)对帕金森病(PD)患者轻度认知功能障碍的诊断价值。方法将85例PD患者按认知障碍诊断标准分为认知功能正常组(45例)、轻度认知功能障碍组(PD-MCI)组(40例)。采用Cog-12量表、蒙特利尔认知评估量表(MoCA)及MMSE量表对患者进行测评,分析3个量表对PD患者轻度认知障碍的筛查能力。结果与认知功能正常组比较,PD-MCI组Cog-12量表评分显著升高,MoCA、MMSE量表评分显著降低(均P0.001)。Cog-12对PD患者MCI的鉴别能力明显优于MoCA、MMSE(AUC_(Cog-12)=0.958,敏感度为85.7%,特异度为75%;AUC_(MMSE)=0.798,敏感度为52.4%,特异度为26.5%;AUC_(MoCA)=0.907,敏感度为71.4%,特异度为21.5%)。当Cog-12界值为7.5分时,其敏感性为85.7%。结论 Cog-12量表可有效检测PD患者的认知功能损伤,可应用于临床PD患者认知功能的筛查。     

初发腔隙性梗死病人与代谢综合征关系的研究

目的 探讨腔隙性梗死病人代谢综合征的患病率及与各亚型之间的关系.方法 选择138例初发腔隙性梗死患者及年龄、性别相匹配的138例初发动脉硬化性皮层梗死患者,根据有无白质损害,观察腔隙性梗死患者代谢综合征的患病率及与腔隙性梗死亚型的关系.结果 皮层梗死组代谢综合征的患病率（45.7%）高于腔隙性梗死组（35.9%）（P〈0.01）.无白质损害的腔隙性梗死患者代谢综合征的患病率高于有白质损害者,皮层梗死组代谢综合征患病率高于有白质损害的腔隙性梗死组.结论 代谢综合征的患病率与不伴白质损害的腔隙性梗死明显相关,皮层梗死的患病率高于有白质损害的腔隙性梗死,与各型梗死之间的发病机制不同有关.     

P300和总脑小血管病评分对脑小血管病患者认知 障碍评估的临床价值

目的 本研究旨在评估 P300、总脑小血管病（CSVD）评分对 CSVD 患者认知障碍程度的 检测作用，并探讨认知功能筛查量表与之匹配程度。方法 纳入 2018 年 10 月至 2020 年 6 月就诊于 连云港东方医院神经内科并诊断CSVD的患者72例，同时纳入同期评价的年龄、性别与之匹配的34名 健康体检者设为对照组。所有纳入者均在一周内检查简易智力状态检查量表（MMSE）和蒙特利尔 认知评估量表（MoCA）和 P300、总 CSVD 评分。CSVD 患者根据认知功能筛查量表（MMSE、MoCA）分 为认知障碍组和非认知障碍组，分析 3 组间 MMSE、MoCA 评分与 P300 潜伏期、P300 波幅、总 CSVD 评分的关系。结果 认知障碍组和非认知障碍组在中央点（Cz）记录的P300 潜伏期均长于对照组 （P＜ 0.001），认知障碍组P300 潜伏期长于非认知障碍组［（397.471±35.911）ms比（342.584±14.502）ms， P＜ 0.001］。认知障碍组和非认知障碍组的总 CSVD 评分高于对照组（P＜ 0.001），认知障碍组总 CSVD 评 分 高 于 非 认 知 障 碍 组（P＜ 0.001）。 相 关 分 析 显 示 MMSE、MoCA 评 分 与 P300 潜 伏 期（r=-0.768， P＜ 0.001；r=-0.824，P＜ 0.001）、总 CSVD 评 分 之 间（r=-0.816，P＜ 0.001；r=-0.896，P＜ 0.001）存 在 强负相关关系。当 P300-Cz 潜伏期为 348.4 ms 时，CSVD 患者诊断认知障碍的敏感度为 94.3%，特异 度为 83.1%。当总 CSVD 评分为 2 分时，CSVD 患者诊断认知障碍的敏感度为 82.9%，特异度 97.2%。 结论 P300 潜伏期、总 CSVD 评分可能是 CSVD 患者认知功能障碍的早期预测指标，且较 MMSE、MoCA 量表可能更客观地反映认知功能     

The validity of the Brain Injury Cognitive Screen (BICS) as a neuropsychological screening assessment for traumatic and non-traumatic brain injury

Objective: The Brain Injury Cognitive Screen (BICS) was developed as an in-service cognitive assessment battery for acquired brain injury patients entering community rehabilitation. The BICS focuses on domains that are particularly compromised following TBI, and provides a broader and more detailed assessment of executive function, attention and information processing than comparable screening assessments. The BICS also includes brief assessments of perception, naming, and construction, which were predicted to be more sensitive to impairments following non-traumatic brain injury. The studies reported here examine preliminary evidence for its validity in post-acute rehabilitation. Method: In Study 1, TBI patients completed the BICS and were compared with matched controls. Patients with focal lesions and matched controls were compared in Study 2. Study 3 examined demographic effects in a sample of normative data. Results: TBI and focal lesion patients obtained significantly lower composite memory, executive function and attention and information processing BICS scores than healthy controls. Injury severity effects were also obtained. Logistic regression analyses indicated that each group of BICS memory, executive function and attention measures reliably differentiated TBI and focal lesion participants from controls. Design Recall, Prospective Memory, Verbal Fluency, and Visual Search test scores showed significant independent regression effects. Other subtest measures showed evidence of sensitivity to brain injury. Conclusions: The study provides preliminary evidence of the BICS’ sensitivity to cognitive impairment caused by acquired brain injury, and its potential clinical utility as a cognitive screen. Further validation based on a revised version of the BICS and more normative data are required.     

Domain-specific accuracy of the Montreal Cognitive Assessment subsections in Parkinson's disease

ObjectiveThe Montreal Cognitive Assessment (MoCA) is among the most widely adopted screening tools for cognitive impairment because it includes tests in multiple domains and is available in 55 languages. The MoCA is often the only formal cognitive assessment available when comprehensive neuropsychological testing is not practical, such as rural clinical settings or large retrospective and multi-lingual research settings. However, the MoCA domain-specific subsections have never been formally assessed for sensitivity or specificity. Therefore, in Parkinson's disease, we examined whether the subsections of the MoCA could identify cognitive impairment within specific cognitive domains.MethodsWe administered a comprehensive neuropsychological battery to 85 Parkinson's disease participants, who were then categorized as with or without cognitive impairment, with respect to global cognition and in five cognitive domains. We then assessed the domain-specific categorization of the MoCA subsections compared to the full neuropsychology battery.ResultsAll MoCA subsections predicted impairment in their respective cognitive domain. However, the executive subsection showed the highest sensitivity and specificity (89.3% and 82.5%, respectively), followed by visuospatial (93.3% and 45.7%, respectively) and memory (84.6% and 56.5%, respectively).ConclusionThe MoCA is a useful screening tool for PD global cognitive and executive functions. The MoCA is also highly sensitive to visuospatial and memory impairment, but with limited specificity and accuracy these subsections should be interpreted with caution.     

Cognitive impairment in relapsing and primary progressive multiple sclerosis: mostly a matter of speed.

Based on the assumption that cognitive impairment in MS is consistent with subcortical dementia, a battery of neuropsychological tests was assembled that included measures of executive function (Tower of London and Wisconsin Card Sorting Test), verbal learning and memory (a paired associates learning test), and speeded information processing (Stroop Color Word Interference Test). The battery was administered to patients with relapsing and primary progressive MS and to healthy controls. Differences between patients and controls occurred on several of the measures. However, when differences with respect to fatigue and depression were statistically controlled, the only differences that remained significant involved measures relating to the speed of information processing. Patients performed more slowly than controls, with the disparity being greater for relapsing patients than for those with primary progressive disease. The slowing was evident on measures of automatic as well as controlled processing and regardless of whether speed was an explicit feature of successful performance or recorded unobstrusively while the patient concentrated on planning a correct solution to a problem. Parallels were noted between cognitive slowing associated with MS and that of normal aging.     

Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction

Previous frequency estimates of cognitive dysfunction in multiple sclerosis have ranged from 54 to 65 percent. These studies may overestimate the frequency in the general MS population, since the patients in these studies were recruited from clinic populations. In the present study, we administered a comprehensive neuropsychological test battery to 100 community-based MS patients and 100 demographically matched healthy controls. Of 31 cognitive test indices examined, 48 MS patients and five controls were impaired on four or more test indices, yielding an overall frequency rate of 43% for the MS group. The pattern of cognitive decline was not uniform: MS patients were more frequently impaired on measures of recent memory, sustained attention, verbal fluency, conceptual reasoning, and visuospatial perception, and less frequently impaired on measures of language and immediate and remote memory. We developed a brief (20-minute) screening battery empirically by selecting the four most sensitive test indices from the comprehensive battery. The brief battery yielded a sensitivity value of 71% and a specificity value of 94% in discriminating cognitively intact from impaired MS patients, as defined by the comprehensive battery. Cognitive impairment was not significantly associated with illness duration, depression, disease course, or medication usage, but was significantly (albeit weakly) correlated with physical disability.     

Cognitive impairments in acute lacunar stroke

Background – The present study investigated the prevalence of cognitive deficits in acute lacunar stroke, validated the Mini Mental State Examination (MMSE) in detecting cognitive impairments in lacunar patients, and identified predictors of such deficits. Methods – Seventy‐one patients with lacunar stroke performed a comprehensive cognitive screening between day 2 and day 7 of their stay. The test battery included Trail Making Test A, Verbal Fluency, Object Learning Test, Ullevål Aphasia Screening, and Assessment of Stroke and other Brain Damage regarding motor apraxia, rational apraxia and visuospatial ability. Results – Exactly 57.7% scored outside cutoff in at least one of the cognitive tests. Using a rigorous cutoff for MMSE (28/29 points) and the test battery as comparison, the sensitivity and specificity of MMSE were 0.69 and 0.67, respectively. Only male sex was significantly related to the presence of cognitive deficits (pathologic score on at least one of the tests – odds ratio 4.41, 95% confidence interval 1.45–13.43). Conclusion – Many lacunar stroke patients suffer cognitive problems. Male patients are at particular risk. MMSE failed to identify 30% of the patients diagnosed with cognitive deficits, and we suggest that lacunar stroke patients be offered a comprehensive cognitive screening, even when MMSE is normal.     

Neurocognitive testing supports a broader concept of mild cognitive impairment

The narrow concept of mild cognitive impairment (MCI) as an early form of Alzheimer s disease has been broadened by research that established the existence of alternative forms of the condition that may presage other forms of dementia. The research presented here was a naturalistic, cross-sectional study of patients in a community referral clinic-patients with MCI and mild dementia-compared to normal controls. A comprehensive, computerized neurocognitive screening battery developed by one of the authors (CNS Vital Signs) was administered to all of the subjects. Participants consisted of 36 patients with MCI and 53 patients with mild dementia, diagnosed by standard criteria, and 89 matched normal controls. Multivariate analysis indicated significant differences among the three groups for all 15 primary test variables and for all five of the domain scores. Tests of memory, processing speed, and cognitive flexibility were the most cogent discriminators between normal controls and MCI patients, and between MCI patients and patients with mild dementia. The same three tests also had the greatest sensitivity and specificity. The results of this study indicate that computerized testing can differentiate among normal controls, MCI patients, and patients with mild dementia. Also, in a diverse group of MCI and mild dementia patients, impairments in memory, processing speed, and cognitive flexibility were the most prominent observed deficits.     

A factor analytic investigation of the Mercy Evaluation of Multiple Sclerosis

Abstract

Objective: Neurocognitive deficits commonly are an accompanying feature of Multiple Sclerosis (MS). A brief, yet comprehensive neuropsychological battery is desirable for assessing the extent of these deficits. Therefore, the present study examined the validity of the Mercy Evaluation of Multiple Sclerosis (MEMS) for use with the MS population. Methods: Archival data from individuals diagnosed with MS (N = 378) by independent neurologists was examined. Cognitive domains assessed included processing speed and attention, learning, and memory, visuospatial, language, and executive functioning. A mean battery index was calculated to provide a general indicator of cognitive impairment within the current sample. Results: Overall performance across participants was found to be in the lower limits of the average range. Results of factor analytic statistical procedures yielded a four-factor solution, accounting for 67% of total variance within the MEMS. Four neurocognitive measures exhibited the highest sensitivity in detecting cognitive impairment, constituting a psychometrically established brief cognitive screening battery, which accounted for 83% of total variance within the mean battery index score. Conclusion: Overall, the results of the current study suggest appropriate construct validity of the MEMS for use with individuals with MS, as well as provide support for previously established cognitive batteries.     

皮质下小血管病所致轻度血管性认知障碍的危险因素及临床特征

目的 明确皮质下小血管病所致轻度血管性认知障碍(mild vascular cognitive impairment due to subcortical small vessel disease,mVCI-SSVD)的危险因素及临床特征.方法 收集56例mVCI-SSVD患者的人口学资料、血管危险因素、现病史、既往史,并进行详细的神经系统体检及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和Hachinski缺血积分(Hachinski ischemic score,HIS)评分.将mVCI-SSVD患者的人口学资料、血管危险因素与80名健康对照老人进行比较,最终明确mVCI-SSVD患者的危险因素及临床特征.结果 患者组吸烟史[39.3%(22/56)]、高血压[67.9%(38/56)]、糖尿病[25.0%(14/56)]等血管危险因素阳性比例高于健康对照组[21.3%(17/80),47.5%(39/80),11.3%(9/80)],2组之间的OR值[2.32(95% CI1.05～5.13),2.15(95% CI 1.02～4.54),2.26(95% CI 0.86～5.92)]均有统计学意义(P=0.039、0.045、0.047),而高脂血症和心脏病与对照组比较差异无统计学意义.50.0%(28/56)的mVCI-SSVD患者有明确的卒中病史,26.8%(15/56)的患者认知障碍急性起病,局灶体征见于20例患者(35.7%).HIS≤4分24例(42.9%),NIHSS评分0分38例(67.9%).结论 吸烟、高血压、糖尿病是mVCI-SSVD的危险因素,而高脂血症和心脏病不增加mVCI-SSVD的风险;与大血管病变导致的认知障碍不同,约一半的mVCI-SSVD患者缺乏卒中病史,多数患者认知障碍慢性起病,缺乏明显的局灶体征.

Abstract：

Objective To determine the risk factors and clinical features of mild vascular cognitive impairment due to subcortical small vessel disease (mVCI-SSVD).Methods Detailed demographic data,vascular risk factors, past and present history were collected and carefully neurological examination, National Institutes of Health Stroke Scale (NIHSS), as well as Hachinski ischemic score (HIS) were performed on 56 mVCI-SSVD patients.Further, the demographic data and vascular risk factors of mVCI-SSVD patients were compared with those of 80 normal control subjects.Results Proportions of smoking (39.3% (22/56)), hypertension (67.9% (38/56)), and diabetes (25.0% (14/56)) were higher in the patient group than in the normal control group (21.3% (17/80) , 47.5% (39/80), 11.3% (9/80)).Odds ratio (2.32(95% CI 1.05-5.13),2.15 (95% CI 1.02-4.54),2.26(95% CI 0.86-5.92)) between the two groups was statistically significant (P value: 0.039, 0.045, 0.047).There was no difference in terms of hyperlipidemia and cardiac disease between groups.Fifty percent (28/56) mVCI-SSVD patients had a clear stroke history.Twenty-six point eight percent (15/56) patients developed the cognitive impairment with an acute onset.Neurological focal signs presented in 20 patients (35.7%).Twenty four (42.9%) patients with HIS ≤ 4 points.Thirty eight cases (67.9%) scored 0 on NIHSS.Conclusions Current study suggested that smoking, hypertension, and diabetes may be risk factors for mVCI-SSVD.While hyperlipidemia and cardiac disease do not increase the risk of mVCI-SSVD.Unlike mVCI caused by large vessel disease, about half mVCI-SSVD patients lack of stroke history.Most patients show a relatively insidious onset and free of significant neurological focal signs.     

Neurocognitive indicators for a conversion to psychosis: comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis

The study aims to identify potential neurocognitive indicators of an enhanced risk for developing psychosis. N=44 patients meeting clinical inclusion criteria for initial prodromal states (IPS) who developed psychosis within a median interval of 10 months were compared to N=39 IPS patients not developing psychosis within a minimum interval of 1 year (median 36 months), and to N=44 healthy controls on a comprehensive neuropsychological test battery (pattern recognition, divided and sustained attention, spatial and verbal working memory, verbal/visual memory, speed of processing, executive and intellectual functions). IPS patients who converted to psychosis performed worse than healthy controls on all broad neurocognitive domains. They were more impaired than IPS patients not developing psychosis on the Subject Ordered Pointing Task (SOPT; working memory), verbal memory functions, verbal executive, verbal IQ and speed of processing tests. After a Bonferroni-Holms adjustment for multiple testing differences on SOPT, Digit-Symbol Test, and verbal IQ remained significant (effect sizes d=0.54-0.88). Neurocognitive predictors had a sensitivity of 0.75 and a specificity of 0.79. Results support several cognitive domains as indicators of vulnerability to psychosis, and additionally suggest that subtle deficits in verbal abilities (working and long-term memory, executive and intellectual functions) and decreased speed of processing may help to predict conversion to psychosis in a clinically defined IPS group.     

Towards practical cognitive assessment for detection of early dementia: a 30-minute computerized battery discriminates as well as longer testing

Early detection of cognitive decline may lead to more effective treatment. Clinical cognitive assessment is essential for early detection, but must be brief with easily interpretable results. The present study defines and evaluates a 30-minute cognitive battery consisting of a subset of tests that comprise a longer computerized battery recently validated in detecting mild cognitive impairment (MCI). Participants were from three tertiary care memory clinics and an assisted living facility (final group: N=161) with consensus diagnoses of cognitively healthy, MCI, or mild dementia. A comprehensive NeuroTrax battery evaluated memory, executive function, visual spatial perception, verbal function, information processing speed, and motor skills. Validity of a single summary measure ('MCI Score') designed for dementia detection and built exclusively from tests of memory, executive function, and visual spatial perception was evaluated with receiver operating characteristic (ROC) analysis. Discriminant validity (area under the curve: AUC) was at least as large for the 6-parameter MCI Score as for a 20-parameter score necessitating administration of the entire battery. Further, the MCI Score had a larger AUC with reduced variance relative to its constituent parameters. AUC for distinguishing dementia was 0.886; AUC for distinguishing cognitively healthy was 0.823. Finally, the MCI Score discriminated among all three diagnostic groups (ANOVA; F[2,150]=52.54, p<0.001). Hence a reduced NeuroTrax battery (30 minutes) with MCI Score is a useful clinical tool for summarizing cognitive data relevant to early dementia detection.