认知功能电话问卷修订版在认知功能损害早期测查中的应用

目的　检测认知功能电话问卷修订版 (TICS m)在认知功能损害早期测查时的信度和效度。方法　认知功能损害组患者 64例,对照组为社区健康老人 52名。由 2名神经科医师独立、盲法检查TICS m。做操作者工作特征(ROC)曲线,计算诊断效度。结果　TICS m各部分面访与电话访问的Pearson相关系数在 0 79~0 96之间,重测信度Pearson相关系数在 0 89 ~0 98之间。TICS m诊断痴呆( <28分)和轻度认知功能损害( <33分)的敏感性分别为 99%和 89%,特异性为 90%和92%,优于细微精神状态检查(MMSE)。TICS m总分和记忆力部分的敏感性较高。结论　TICS m具有很好的信度和效度,可用于认知功能损害早期的临床和流行病学筛查。TICS m对早期认知功能损害的诊断效度优于MMSE。     

Prevention of CIND by physical activity: different impact on VCI-ND compared with MCI

BACKGROUND: Cognitive impairment that does not meet the criteria for dementia ("Cognitive Impairment, No Dementia" -- CIND) is a heterogeneous category with an increased risk of dementia. While greater physical activity is generally associated with a lower odds of both dementia and CIND, whether this effect applies across subgroups is not known. OBJECTIVES: To investigate the association between physical activity and the risk of vascular CIND (VCI-ND) or mild cognitive impairment (MCI). METHODS: In the Canadian Study of Health and Aging community-dwelling cohort, of 4683 people who were not impaired at baseline, 3945 remained without cognitive impairment at 5 years, 454 were diagnosed with CIND, and 284 with dementia. Incident CIND and VCI-ND (n=163) and MCI (n=100) subtypes were investigated in relation to baseline physical activity, stratified by sex. RESULTS: In women, moderate-high exercise was associated with a lower odds of CIND (OR=0.62, 95% CI=0.46-0.84) and VCI-ND (0.34, 0.18-0.63) relative to low exercise. There was no association for men or for MCI. CONCLUSION: Exercise appears to reduce the risk of VCI-ND in women. Whether the lack of an effect of exercise on the odds of MCI reflects that 'prevented AD' is indistinguishable from MCI is an intriguing possibility that merits further study.     

Validity of Brief Cognitive Assessment Tool modifications for older adults with visual and motor limitations

Introduction: The prevalence of cognitive, sensory, and physical impairments is expected to grow alongside increasing life expectancy. These chronic conditions pose challenges for geriatric assessment. We examined whether Brief Cognitive Assessment Tool (BCAT) modifications to accommodate visual and motor limitations would retain strong validity for identifying mild cognitive impairment (MCI) and dementia.

Method: Psychometric analyses were performed on archival data (N = 458) from community-dwelling older adults and residents of assisted living facilities and nursing homes in Maryland, USA (age ≥ 50 years). Participants completed a brief testing battery, including the BCAT, and were assigned a cognitive diagnosis (normal cognition, MCI, mild dementia, moderate dementia, severe dementia) by licensed clinical psychologists.

Results: Receiver operator characteristic curve analyses evidenced excellent diagnostic validity of BCAT modification cutoffs for identifying the cognitive categories. Contextual memory and executive control factors, which explained over 80% of variance in cognitive diagnoses, may account for the preservation of validity despite BCAT modifications.

Conclusions: The results indicate strong psychometric evidence for the BCAT modifications and provide cutoffs for identifying MCI and staging dementia. For clinicians, the score guidelines are preferable to the guesswork involved with adjusting cutoffs to accommodate visual and motor limitations.     

An assessment of Movement Disorder Society Task Force diagnostic criteria for mild cognitive impairment in Parkinson's disease

Background and purpose

Cognitive impairment is one of the most disabling non‐motor symptoms of Parkinson's disease. Mild cognitive impairment constitutes a major risk for the development of Parkinson's disease dementia in the course of the disease. A Movement Disorder Society Task Force proposed diagnostic criteria for mild cognitive impairment in Parkinson's disease (PD‐MCI), comprising two operational levels: Level I and Level II. The objective of our study was to test the accuracy of Level I versus Level II diagnostic criteria.

Methods

Eighty‐six consecutive patients with Parkinson's disease were screened and 68 patients without dementia or depression were included in the study. We used the Montreal Cognitive Assessment, Mini‐Mental State Examination and Addenbrooke's Cognitive Evaluation‐R screening tools for Level I and an extensive neuropsychological battery for Level II assessment. We first diagnosed PD‐MCI on the basis of Level II assessment and then calculated sensitivity, specificity and area under the receiver–operator characteristics curve, comparing the performance of the three screening batteries.

Results

None of the three screening batteries proposed for Level I assessment provided satisfactory combined sensitivity and specificity for detecting PD‐MCI, and their performance was similar. Using the Level II criteria, 29 patients (43%) were diagnosed as having PD‐MCI. Lowest cut‐off levels that provided at least 80% sensitivity were 24 for the Montreal Cognitive Assessment, 29 for the Mini‐Mental State Examination and 87 for the Addenbrooke's Cognitive Evaluation‐R. However, specificity levels were below 80% at these cut‐off levels.

Conclusions

We conclude that Level I assessment alone using screening batteries is not sufficiently sensitive/specific to detect PD‐MCI.     

Clinical application of the Polish adaptation of the Montreal Cognitive Assessment (MoCA) test in screening for cognitive impairment

Background and purposeThe Montreal Cognitive Assessment (MoCA) test is a brief cognitive screening tool with high sensitivity and specificity for detecting mild cognitive impairment (MCI). The aim of this study was to evaluate the usefulness of MoCA and compare it with the Mini-Mental State Examination (MMSE) in the early detection of cognitive decline in MCI.Material and methodsA group of 115 subjects (36 meeting DSM-IV criteria for Alzheimer disease (AD) [Clinical Dementia Rating (CDR) = 1], 42 meeting Petersen's criteria for MCI [CDR = 0.5], and 37 cognitively intact controls [CDR = 0]) was recruited for the study in the university-based Alzheimer out-patient clinic. All participants underwent general medical, neurological, and psychiatric examinations. The MoCA, the MMSE, CDR and the short (15-item) version of the Geriatric Depression Scale were also applied.ResultsBoth MCI and AD groups exhibited impaired performance on MoCA compared to controls. Polish versions of the MMSE and MoCA tests were comparable in discriminating mild dementia from both MCI and control groups. The Polish version of the MoCA test performed marginally better than MMSE in discriminating MCI from controls. We propose to use the MoCA test to screen for MCI using an optimal cut-off score of 24 and to screen for dementia using a cut-off score of 19.ConclusionsThe Polish version of the MoCA seems effective in the detection of deteriorated cognitive performance and appropriate for differentiating impaired from preserved cognitive function in a Polish population.     

CERAD test performances in amnestic mild cognitive impairment and Alzheimer's disease

OBJECTIVES: The aim of the study was to examine the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test performances cross-sectionally in patients suffering from amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Moreover, we wanted to determine the sensitivity to amnestic MCI and mild AD, as well as the specificity of different CERAD subtests in our study groups. MATERIAL AND METHODS: Fifteen healthy elderly individuals, 15 amnestic MCI patients and 15 probable AD patients suffering from mild dementia were tested with the CERAD neurocognitive dementia screening test. RESULTS: Significant differences were found in all CERAD tests except Constructional praxis (copy) and Clock drawing between the controls and the AD group. The MCI group was differentiated from the controls only in the Wordlist learning test. In the language tests the sensitivity to MCI and AD was quite low and the specificity very high. In the savings scores the sensitivity to AD was high, but the specificity rather low. The Wordlist recognition test screened no false positives using the current cut-off score and the sensitivity to AD was 0.6, but only one MCI patient was detected using the current cut-off score. Raising the cut-off score also raised the sensitivity to MCI without dramatic loss of specificity. Cut-off scores for the Wordlist learning test and Wordlist delayed recall, which have been found to differentiate normal aging from dementia, are lacking in the Finnish CERAD. The current data indicates that the Wordlist learning test might be relatively sensitive to MCI. CONCLUSIONS: The results indicate that the Finnish CERAD test battery with its current cut-off scores has low sensitivity to MCI, and using it as a sole cognitive screening instrument for MCI and preclinical dementia might result in false negatives.     

Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome

BACKGROUND: Mild Cognitive Impairment (MCI) is a borderline state between age-associated cognitive decline and mild dementia. MCI is separated from mild dementia by an absence of global intellectual deterioration and the preservation of activities of daily living (ADL). However, even mild degrees of cognitive deterioration are known to have negative effects on complex ADL. OBJECTIVES: To examine whether patients with MCI have impaired ADL as compared to healthy controls, which areas of ADL are particularly involved, and whether limitations on ADL are associated with demographical or clinical data. METHODS: Forty-eight patients with MCI diagnosed according to research criteria and 42 cognitively unimpaired controls were enrolled. Cognitive function was inter alia assessed by the MMSE, complex ADL by the ADCS-MCI-ADL scale. Frequency distributions were compared between patients and controls using chi-square tests. Mean values were examined for statistically significant differences using Kruskal-Wallis tests. A Bonferroni correction for multiple comparisons was applied to the comparison of the 18 areas of the ADCS-MCI-ADL scale. Associations between ADL and biographical or clinical data were analysed using non-parametric correlations. RESULTS: The overall score on the ADCS-MCI-ADL scale was significantly lower in the MCI group. Patients performed significantly worse on 14 out of 18 activities. Activities involving memory or complex reasoning were particularly impaired, whereas more basic activities were unimpaired. There were no statistically significant associations of the ADCS-MCI-ADL overall score with age, years of formal education, gender, or number of cognitive domains affected in the group of MCI patients. However, there was a statistically significant association between the ADCS-MCI-ADL and the MMSE score. CONCLUSION: MCI patients may be impaired in complex ADL. Copyright (c) 2006 John Wiley & Sons, Ltd.     

Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study

BACKGROUND: Little is known about the prevalence and correlates of behavioral and psychiatric symptoms of dementia in community-dwelling elders with dementia or mild cognitive impairment (MCI). METHODS: 512 people with Mini-Mental State Examination (MMSE) scores < 24 or a decline of at least 4 points over two administrations, and their knowledgeable informants (KIs) were enrolled in the MMCS. The classification of subjects as having dementia or MCI was based on a neuropsychological battery of four tests, not a clinical diagnostic evaluation. The sample for this study included 454 subjects (dementia n = 333; MCI n = 121) and their KIs. Demographic and health-related characteristics of subjects and KIs were obtained during KI interviews. Multivariate logistic regression was used in statistical analysis. RESULTS: Compared to dementia subjects, those classified as MCI had a lower prevalence (47.1% vs 66.1%) of any symptoms (psychosis, depression, or agitation), and of agitation (24.8% vs 45.1%). Symptoms of psychosis and depression also were less prevalent, even though differences did not reach statistical significance. In the dementia group symptoms were associated with a report of a physician's diagnosis of dementia, greater functional impairment, and a KI who was a child/child-in-law. In those with MCI, symptoms were correlated with being white, greater functional impairment, and a younger, less educated, KI. CONCLUSIONS: Psychiatric and behavioral symptoms were common in community-residing elders with cognitive impairment, but their prevalence and correlates differed by study classification as having dementia or MCI. Identifying and treating these symptoms may benefit patients with cognitive impairment and their families. Longitudinal studies on the predictors, changes in prevalence, and effectiveness of treatments for psychopathology of dementia are needed.     

Validation of TICS for detection of dementia and mild cognitive impairment among individuals characterized by low levels of education or illiteracy: a population-based study in rural Greece

Abstract

Objective: The efficacy of the most widely used tests for dementia screening is limited in populations characterized by low levels of education. This study aimed to validate the face-to-face administered Telephone Interview for Cognitive Status (TICS) for detection of dementia and mild cognitive impairment (MCI) in a population-based sample of community dwelling individuals characterized by low levels of education or illiteracy in rural Greece. Methods: The translated Greek version of TICS was administered through face-to-face interview in 133 elderly residents of Velestino of low educational level (<12 years). We assessed its internal consistency and test–retest reliability, its correlation with sociodemographic parameters, and its discriminant ability for cognitive impairment and dementia, as defined by a brief neurological evaluation, including assessment of cognitive status and level of independence. Results: TICS was characterized by adequate internal consistency (Cronbach’s α: .72) and very high test–retest reliability (intra-class correlation coefficient: .93); it was positively correlated with age and educational years. MCI and dementia were diagnosed in 18 and 10.5% of the population, respectively. Its discriminant ability for detection of dementia was high (Area under the curve, AUC: .85), with a sensitivity and specificity of 86 and 82%, respectively, at a cut-off point of 24/25. TICS did not perform well in differentiating MCI from cognitively normal individuals though (AUC: .67). Conclusion: The directly administered TICS questionnaire provides an easily applicable and brief option for detection of dementia in populations of low educational level and might be useful in the context of both clinical and research purposes.     

The rate of conversion of mild cognitive impairment to dementia: predictive role of depression

BACKGROUND: Mild cognitive impairment (MCI) is a condition referring to the persons with cognitive deficits measurable in some form or another, but not meeting criteria for dementia, and who have an increased risk of becoming demented. OBJECTIVE: To establish the rate of progression to dementia in MCI, to investigate the risk of conversion for amnestic vs multiple-domains subtypes, and to identify the predictors of progression. METHODS: MCI (n = 105) individuals enrolled in a longitudinal study received annual clinical and psychometric examinations for up to a mean of 3 years. The diagnosis of MCI according to Mayo Clinic Petersen's Criteria was conducted by a panel of specialists. RESULTS: After 3 years of follow-up, 23 of 105 subjects with MCI were diagnosed with dementia. 40 showed cognitive decline not dementia, 34 were stable and showed no cognitive decline or improvement, while eight showed cognitive improvement. CONCLUSIONS: We conclude that conversion rate from MCI to DSM-IIIR dementia was 21.9% over a period of 3 years. The occurrence of depressive symptoms may constitute a predictor for those who are more likely to progress to dementia. The risk of conversion to dementia was higher among the subjects with an evidence of impairment extending beyond memory than with those who suffered only from memory deficits, and the subjects who converted to dementia in this subtype had significantly higher baseline plasma total homocysteine levels than non-converters.     

Cognitive domains associated with performance on the telephone interview for cognitive status-modified

Global cognitive screening tests are increasingly used in clinical and research settings. However, many have not been developed following systematic psychometric principles; thus, construct validity is not clearly defined. It is the aim of this study to identify the cognitive domains that are associated with the total score from the Telephone Interview for Cognitive Status-modified (TICS-m). Data came from 104 women (75 years of age and older) who were participants in a longitudinal study of dementia and had been given the TICS-m and a battery of standardized neuropsychological tests. Factor analysis of all these neuropsychological tests yielded six interpretable factors. episodic memory for words, episodic memory for contextual information, working memory, episodic memory for nonverbal information, attention, and visuospatial processing efficiency. The TICS-m score showed modest associations with several distinct cognitive domains, including episodic memory for words and nonverbal information and attention.     

Conceptualization of mild cognitive impairment: a review

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.     

Cognitive Impairment Questionnaire (CIMP‐QUEST): reported topographic symptoms in MCI and dementia

Åstrand R, Rolstad S, Wallin A. Cognitive Impairment Questionnaire (CIMP‐QUEST): reported topographic symptoms in MCI and dementia.
Acta Neurol Scand: 2010: 121: 384–391.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – The Cognitive Impairment Questionnaire (CIMP‐QUEST) is an instrument based on information obtained by key informants to identify symptoms of dementia and dementia‐like disorders. The questionnaire consists of three subscales reflecting impairment in parietal‐temporal (PT), frontal (F) and subcortical (SC) brain regions. The questionnaire includes a memory scale and lists non‐cognitive symptoms. The reliability and validity of the questionnaire were examined in 131 patients with mild cognitive impairment (MCI) or mild dementia at a university‐based memory unit. Methods/Results – Cronbach alpha for all subscales was calculated at r = 0.90. Factor analysis supported the tri‐dimensionality of CIMP‐QUEST’s brain region‐oriented construct. Test–retest reliability for a subgroup of cognitively stable MCI‐patients (n = 25) was found to be r = 0.83 (P = 0.0005). The correlation between the score on the cognitive subscales (PT + F + M) and Informant Questionnaire on Cognitive Decline in the Elderly was r = 0.83 (P = 0.0005, n = 123). The memory subscale correlated significantly with episodic memory tests, the PT subscale with visuospatial and language‐oriented tests, and the SC and F subscales with tests of attention, psychomotor tempo and executive function. Conclusions – CIMP‐QUEST has high reliability and validity, and provides information about cognitive impairment and brain region‐oriented symptomatology in patients with MCI and mild dementia.     

Prevalence of mild cognitive impairment: a population-based study in elderly subjects

OBJECTIVES: Mild cognitive impairment (MCI) has been suggested as a term for a boundary area between normal aging and dementia, especially Alzheimer's disease (AD). In follow-up studies, more than 50% of MCI subjects have been converted to dementia in 3-4 years. However, the epidemiology of MCI is not well known. This study was designed to determine the prevalence of MCI in an elderly population. METHODS: A total of 806 subjects (60-76 years of age) from a population-based random sample of 1150 subjects living in the city of Kuopio in eastern Finland were evaluated. Neuropsychological tests and a structured interview including the modified Clinical Dementia Rating (CDR) were used to apply the diagnostic criteria of MCI as proposed by Mayo Clinic Alzheimer's Disease Research Centre. Thus, subjects having a test score more than 1.5 SDs below the age appropriate mean in memory tests and a CDR score of 0.5 but no dementia, were diagnosed as having MCI. RESULTS: A total of 43 subjects, 5.3%, met the MCI criteria. MCI was more prevalent in older and less-educated subjects, but no difference was found between men and women. The CDR appeared to be the most important part of the criteria. The memory tests had less impact on prevalence variables. CONCLUSIONS: The low prevalence of MCI indicate that in a population-based study design its criteria may identify a more homogeneous group of subjects at the lower end of the cognitive continuum as contrasted with various other criteria of cognitive impairment in the elderly population. This is compatible with follow-up studies showing a high probability of dementia in the MCI group. Thus, probable candidates for trials of preventive intervention for dementia can be screened from the elderly population using these diagnostic criteria.     

Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment

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.     

Predictors of cognitive impairment in an early stage Parkinson's disease cohort

The impact of Parkinson's disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini‐Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen‐month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non‐motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non‐motor features, suggesting that this reflects a faster progressive phenotype. © 2014 International Parkinson and Movement Disorder Society     

Rey verbal learning test is a useful tool for differential diagnosis in the preclinical phase of Alzheimer's disease: comparison with mild cognitive impairment and normal aging

OBJECTIVE: To confirm that performance in verbal learning and memory test (Rey's Auditory Verbal Learning Test-RAVLT) is a helpful early neuropsychological marker of dementia of Alzheimer's type (DAT). METHODS: RAVLT was administered as part of a more extensive neuropsychological battery at baseline evaluation in 116 unselected patients referred by subjective memory complaints (SMC). Patients were followed longitudinally for 2 years (average interval of 27.7+/-4 months). Seventy patients were included in the study: 27 developed probable DAT; 17 were diagnosed as cognitively normal persons and 26 were diagnosed with Mild Cognitive Impairment (MCI). Remaining patients abandoned or they did not meet the criteria for DAT, MCI or control. Performance on RAVLT at the baseline evaluation was compared between groups. RESULTS: Patients diagnosed two years later with probable DAT showed lower results, more frequently performed a score of zero at the delayed recall test (Trial 6) and had a percentage of forgetting (difference between Trials 5 and 6) higher than 75%. Score at delayed recall test and percentage of forgetting correlated with functional scales such as MMSE, Geriatric Depression Screening, Informant Questionnaire and Blessed's Dementia Rating. CONCLUSIONS: RAVLT could help to identify those patients with SMC who would progress to DAT over a few years, and also to differentiate between the preclinical phase of Alzheimer's disease, mild cognitive impairment and normal aging. A score of zero at the delayed recall test or a percentage of forgetting > or =75% in patients with SMC is suggestive of probable DAT in the future.     

Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n=72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n=88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly with depression.     

The Telephone Interview for Cognitive Status (Modified): relation with a comprehensive neuropsychological assessment

The modified Telephone Interview for Cognitive Status (TICS-m) is a widely used screening instrument for (Alzheimer's) dementia. Psychometric evaluation of the TICS-m is limited. This study examined the relation between the TICS-m and a comprehensive neuropsychological assessment in older persons (n = 243) without cognitive deficits. The TICS-m total score correlated with multiple cognitive domains (range r = .22-.49). Factor analysis of the TICS-m items yielded four interpretable factors: "verbal memory," "orientation/mental tracking," "language/reasoning," and "attention/working memory," which also showed (modest) correlations with the neuropsychological assessment (r = .02-.48). The TICS-m appears to reflect a "general cognitive ability" rather than, for example, memory functioning alone.     

老年高血压病患者认知功能障碍程度与磁共振弥散加权成像表观弥散系数的关系

目的:研究老年高血压病患者认知功能障碍程度与头颅各部位磁共振弥散加权成像(MR-DWI)的表观弥散系数(ADC)值的关系,探讨轻度认知功能障碍(MCI)早期诊断和评估的参考指标。方法:入选60~80岁的老年高血压病患者40例进行现状调查。运用蒙特利尔认知量表(MoCA)和临床痴呆评定量表(CDR)对入选患者进行认知功能评定并分组:认知功能正常组8例、轻度认知功能障碍(MCI)组22例和痴呆组(VaD)10例。行MR-DWI检查,测算头颅各解剖部位ADC值。采用SPSS16.0软件进行数据统计分析。结果:①认知功能正常组和MCI组与VaD组比较,MoCA和CDR评分差异均有显著统计学意义(P<0.01)。②认知功能正常组和MCI组与VaD组比较,舒张压差异有统计学意义(P<0.01),收缩压差异无统计学意义(P>0.05)。③认知功能正常组和MCI组与VaD组比较,左侧半卵圆中心、右侧海马和左侧内囊ADC值差异有统计学意义(P<0.05)。④认知功能正常组与MCI组比较,右侧海马ADC值差异有统计学意义(P<0.0167);MCI组与VaD组比较,左侧内囊差异有统计学意义(P<0.0167)。结论:老年高血压病患者收缩压水平与认知功能相关。左侧半卵圆中心、右侧海马、左侧内囊区功能结构变化与认知功能密切相关。早期右侧海马区改变显著,后期左侧内囊区改变明显。