Alcoholism in older Korean men: prevalence,aetiology, and comorbidity with cognitive impairment and dementia in urban and rural communities

BACKGROUND: Alcoholism in the elderly has received little research, particularly outside 'Western' cultures. OBJECTIVES: This study aimed to investigate the prevalence and aetiology of alcoholism, and its comorbidity with cognitive impairment and dementia in an older Korean population. METHODS: 1134 urban and rural community residents aged 65 or over were surveyed in Kwangju, South Korea. Alcoholism was identified by a culturally validated screening scale. RESULTS: Alcoholism was present in 16% of men and 2% of women. In men (n = 457), alcoholism was positively associated with manual occupation and negatively with religions encouraging temperance. In the urban sample, alcoholism was associated with higher education and with dementia. In the rural sample, it was associated with lower education and less strongly with dementia. CONCLUSIONS: The prevalence of alcoholism was high in this population. Associated factors and urban/rural differences reflect traditional attitudes toward drinking.     

Cerebrospinal fluid levels of thiamine in patients with Alzheimer's disease

Summary. Thiamine is an essential cofactor for several important enzymes involved in brain oxidative metabolism, such as the alpha-ketoglutarate dehydrogenase complex (KGDHC), pyruvate-dehydrogenase complex (PDHC), and transketolase. Some investigators reported decreased thiamine-diphosphate levels and decreased activities of KGDHC, pyruvate-dehydrogenase complex and transketolase in the brain tissue of Alzheimer's disease (AD) patients. We measured cerebrospinal (CSF) levels of thiamine-diphosphate, thiamine-monophosphate, free thiamine, and total thiamine, using ion-pair reversed phase high performance liquid chromatography, in 33 patients with sporadic AD and 32 matched controls. The mean CSF levels of thiamine-derivatives did not differ significantly from those of controls, while the mean plasma levels of thiamine-diphosphate, free and total thiamine were significantly lower in the AD-patient group. CSF and plasma thiamine levels were not correlated with age, age at onset, duration of the disease, and scores of the MiniMental State Examination, with the exception of plasma thiamine-diphosphate with MiniMental State Examination (r = 0.41, p < 0.05) in the AD-patients group. CSF and plasma values did not predict dementia progression, assessed with the Minimental State Examination scores. These results suggest that CSF thiamine levels are not related with the risk for and the progression of AD. Received May 19, 2001; accepted January 8, 2002     

艾地苯醌治疗非痴呆型血管认知功能障碍患者的临床观察

目的:观察艾地苯醌治疗慢性脑供血不足致非痴呆型血管性认知功能障碍患者的临床疗效.方法:将52例病例随机分为两组.两组患者均以银杏叶片作为基础用药常规辅助治疗,治疗组同时加用艾地苯醌治疗,两组用药疗程均为12周.结果:治疗后治疗组简易智能量表(MMSE)评分、蒙特利尔认知评价量表(MoCA)评分均明显提高;事件相关电位P300潜伏期缩短,与治疗前比较,差异有统计学意义,且加用艾地苯醌治疗组优于对照组.结论:艾地苯醌治疗慢性脑供血不足致非痴呆型血管性认知功能障碍疗效优于常规治疗.     

Correlates of caregiver burden for Korean elders according to cognitive and functional status

BACKGROUND: Caregiver strain was investigated in a community sample of Korean elders with cohabiting caregivers, and factors associated with this were compared between groups classified by cognitive and functional impairment. METHODS: The study sample consisted of 484 elders and their cohabiting caregivers resident in Kwangju, South Korea. Caregiver burden was measured by the Zarit Burden Interview. Data on the elders' socio-demographics (age, gender, education, and religion) and clinical characteristics (cognitive function (MMSE), activities of daily living (IADL), depressive symptoms, alcoholism, and physical illness), and caregivers' socio-demographic characteristics (age, gender, education, relation to elders, and current employment) and caregiving environments (living area, alternative caregiver, number of rooms, monthly income, and social network) were gathered. Participants were classified into those with (n=61) or without cognitive impairment. The second group was classified into those with (n=68) or without (n=355) functional impairment. RESULTS: Caregiver strain was significantly associated with cognitive impairment. In the group without cognitive impairment, caregiver strain was significantly associated with participant characteristics (IADL impairment, and symptoms of depression and alcoholism). In those with cognitive impairment, caregiver strain was associated with both participant status (depressive symptoms and IADL impairment) and caregiver characteristics (a child caregiver, lower social support, and urban environment). CONCLUSIONS: Individual mental and physical health characteristics predict caregiver strain regardless of cognitive impairment. Caregiver characteristics are most important in the presence of cognitive impairment.     

A study of cognitive functions in female elderly patients with osteoporosis: a multi-center cross-sectional study

Objectives: To investigate changes of cognitive performances in female elderly patients with osteoporosis and to determine whether any impairments can be attributed to dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis.

Methods: This cross-sectional study included 277 postmenopausal women, who were divided into an osteoporosis patients group (n = 170) and an age, gender and educational history matching control group (n = 107). All the subjects completed a set of neuropsychological tests for the elderly for cognitive assessment, which included measures of executive function, episodic memory, attention and processing speed, semantic memory, and visuospatial construction. Blood biomarkers for osteoporosis, as well as diurnal rhythms of cortisol levels were used as cognitive performance correlation parameters in linear multivariate regression analyses.

Results: Individuals with osteoporosis had poorer cognitive scores (P < 0.001). When dividing the osteoporosis patients according to their Mini-Mental State Examination scores into mild cognitive impairment (MCI) and normal cognitive (NC) performance groups, Auditory Verbal Learning trial 1–5 scores were lower (P = 0.006) and Trail Making Test-A scores were higher (P = 0.05) in the MCI compared to the NC group. Further comparison of the MCI and NC groups revealed that declarative memory was inversely associated with cortisol levels (P < 0.001), but this association became marginal when 25-hydroxy vitamin D was included in the linear multivariate regression analyses (P = 0.06).

Conclusions: Patients with osteoporosis are prone to cognitive impairments especially declarative memory deficits. The cognitive impairment may be the result of HPA axis dysregulation but 25-hydroxy vitamin D serum concentrations might be compensatory or even a potent contributing factor.     

Vitamin D insufficiency and mild cognitive impairment: cross‐sectional association

Background: Low serum 25‐hydroxyvitamin D (25OHD) concentrations have been associated with dementia. The association with mild cognitive impairment (MCI) has not yet been explored. Our aim was to examine the association between vitamin D status and MCI status amongst older community‐dwellers with subjective memory complaint. Methods: Ninety‐five non‐demented Caucasian community‐dwellers with subjective memory complaint (mean, 71.1 ± 6.4 years; 54.7% women) included in the Gait and Alzheimer Interaction Tracking (GAIT) study were categorized into two groups according to Winblad et al. consensus criteria [i.e., subjects with MCI or cognitively healthy individuals (CHI)]. Serum 25OHD concentration was divided into quartiles, the fourth quartile corresponding to the highest 25OHD concentration. The cross‐sectional associations between 25OHD concentrations and MCI were modeled using logistic regressions. Age, gender, body mass index, number of comorbidities, education level, Mini‐Mental State Examination score, Frontal Assessment Battery score, Geriatric Depression Scale score, creatinine clearance, and season tested were considered as potential confounders. Results: Compared to CHI, patients with MCI (n = 43; mean, 71.4 ± 5.6 years; 34.9% women) had lower mean serum 25OHD concentrations (P = 0.006) and belonged more often to the lower quartiles compared to the highest quartile (P = 0.03). Increased serum 25OHD concentration was associated with a lower risk of MCI [adjusted odds ratio (OR) = 0.96, P = 0.002]. Accordingly, lower quartiles of 25OHD were positively associated with MCI whilst using the highest quartile as reference (adjusted OR = 25.46, P = 0.002 for the first quartile; adjusted OR = 6.89, P = 0.03 for the second quartile; and adjusted OR = 10.29, P = 0.02 for the third quartile). Conclusions: Low 25OHD concentrations were associated with MCI status in older non‐demented community‐dwellers with subjective memory complaint.     

小牛血清去蛋白肠溶胶囊对血管性轻度认知功能障碍的治疗观察

目的观察小牛血清去蛋白肠溶胶囊对血管性轻度认知功能障碍的治疗作用。方法将50例患者随机分为小牛血清去蛋白肠溶胶囊观察组25例和对照组25例,观察组在基础治疗基础之上给予小牛血清去蛋白肠溶胶囊口服28d,分别对患者治疗前、治疗28d和治疗84d进行简易智能状态检查（MMSE评分）,评估各组患者认知改善情况;同时对其治疗过程中的安全性进行观察。结果小牛血清去蛋白肠溶胶囊组较对照组改善认知功能效果好,观察组治疗84dMMSE评分显著优于对照组同一时间点,且与治疗前相比差异具有显著性（P〈0．05）;不同测量时间的效应差异具有统计学意义（P〈0．05）;两组不良事件发生率差异无统计学意义（P〉0．05）。结论小牛血清去蛋白肠溶胶囊可以有效改善血管性轻度认知功能障碍,安全性好。     

轻度认知功能障碍患者认知功能与内颞叶各结构体积的关系

目的研究轻度认知功能障碍(MCI)患者认知功能与内颞叶各结构体积的关系。方法17例MCI患者和21名正常老年人分别接受临床评估、神经心理检查和头颅MR扫描,在重建的图像上测量内颞叶各结构的体积,并行标准化处理;对神经心理学指标与内颞叶结构MR指标进行相关性分析。结果MCI组和正常老年组的神经心理量表除物体记忆测验(FOM)外,其余各项得分差异均无统计学意义;两组MR内颞叶结构体积比较差异亦均无统计学意义(均P>0.05)。在MCI组中,短时记忆、逻辑记忆(LM)得分与内嗅皮质体积呈正相关(r=0.484、0.529,均P<0.05),无意义图形再认(MGR)、FOM得分与海马体积呈正相关(r=0.502、0.659,均P<0.05),短时记忆、MGR得分与左侧杏仁核体积呈正相关(r=0.557、0.644,均P<0.05);正常老年组短时记忆、LM和数字广度(DS)测验得分与双侧内嗅皮质体积呈负相关(r=-0.448、-0.718,均P<0.05),注意力、计算力与右侧杏仁核、双侧海马体积均呈负相关(r=-0.451、-0.553,均P<0.05)。结论MCI患者的认知功能与内颞叶各结构体积有关;不同的认知功...     

The diffeomorphometry of regional shape change rates and its relevance to cognitive deterioration in mild cognitive impairment and Alzheimer's disease

We proposed a diffeomorphometry‐based statistical pipeline to study the regional shape change rates of the bilateral hippocampus, amygdala, and ventricle in mild cognitive impairment (MCI) and Alzheimer's disease (AD) compared with healthy controls (HC), using sequential magnetic resonance imaging (MRI) scans of 713 subjects (3,123 scans in total). The subgroup shape atrophy rates of the bilateral hippocampus and amygdala, as well as the expansion rates of the bilateral ventricles, for a majority of vertices were found to follow the order of . The bilateral hippocampus and the left amygdala were subsegmented into multiple functionally meaningful subregions with the help of high‐field MRI scans. The largest group differences in localized shape atrophy rates on the hippocampus were found to occur in CA1, followed by subiculum, CA2, and finally CA3/dentate gyrus, which is consistent with the neurofibrillary tangle accumulation trajectory. Highly nonuniform group differences were detected on the amygdala; vertices on the core amygdala (basolateral and lateral nucleus) revealed much larger atrophy rates, whereas those on the noncore amygdala (mainly centromedial) displayed similar or even smaller atrophy rates in AD relative to HC. The temporal horns of the ventricles were observed to have the largest localized ventricular expansion rate differences; with the AD group showing larger localized expansion rates on the anterior horn and the body part of the ventricles as well. Significant correlations were observed between the localized shape change rates of each of these six structures and the cognitive deterioration rates as quantified by the Alzheimer's Disease Assessment Scale‐Cognitive Behavior Section increase rate and the Mini Mental State Examination decrease rate. Hum Brain Mapp 36:2093–2117, 2015. © 2015 Wiley Periodicals, Inc.     

Complex discourse production in mild cognitive impairment: Detecting subtle changes

Background: Mild cognitive impairment (MCI) is characterised by memory impairment that is greater than would be expected for an individual's age and educational background. Differentiating MCI from normal cognition in ageing is a compelling social, clinical, and scientific concern. Of those with MCI, 50% progress to Alzheimer's dementia within 5 years, while many individuals remain stable or return to normal functioning. Importantly, early identification of MCI has important implications for speech‐language pathology intervention.

Aims: The purpose of this study was to investigate whether performance on a complex elicited discourse production task differentiated individuals with MCI from those with normal cognition. The variables of interest were discourse length, complexity, and quality.

Methods & Procedures: Eight individuals with MCI and eight age‐ and gender‐matched controls were tested with the Mini‐Mental State Exam (MMSE), Logical Memory Subtest (LMS) of the Weschsler Memory Scale, and the Boston Naming Test (BNT). For the experimental task, each participant provided a complex, elicited discourse sample that was unconstrained in terms of discourse genre, in response to verbal instructions.

Outcomes & Results: The MMSE and LMS scores differentiated the groups in the expected direction, with the control group outperforming the MCI group. The groups performed comparably on the BNT. Performance on the experimental discourse production task distinguished the groups on measures of length and quality, but not in syntactic complexity.

Conclusions: These findings suggest that performance on a complex elicited discourse production task uncovers subtle differences in the abilities of individuals with MCI, such that measures of length and quality differentiated them from individuals with normal cognition.     

Relation of serum levels of homocysteine,vitamin B12 and folate to cognitive functions in multiple sclerosis patients

Background: Hyperhomocysteinemia, vitamin B12 and folate deficiency have been linked to cognitive dysfunction in multiple sclerosis (MS) patients.

Objective: This study aimed to investigate the relation of serum homocysteine (Hcy), vitamin B12 and folate to cognitive functions in MS patients.

Subjects and Methods: Forty-five MS patients and twenty matched healthy controls were included. Subjects were submitted to cognitive assessment using a selected psychometric battery and measurement of serum levels of homocysteine, B12 and folic acid.

Results: MS patients showed significant worse performance in cognitive scales compared to controls (P ≤ 0.05). Serum homocysteine, vitamin B12 and folate showed no significant difference between patients and controls (P > 0.05). Serum homocysteine was negatively correlated with total score of Addenbrooke's Cognitive Examination (ACE), paced auditory serial addition test and controlled oral word association test scores. Serum vitamin B12 was positively correlated with ACE language, visuospatial and total scores and negatively correlated with trail making B score. Serum folate was significantly positively correlated with ACE language and total scores. Homocysteine was the only significant predictor for cognitive impairment in MS patients.

Conclusion: Serum homocysteine may play a role in cognitive dysfunction in MS patients.     

部分前循环脑梗死与遗忘型轻度认知功能损害患者认知功能的对比研究

目的 比较部分前循环脑梗死(partial anterior circulation infact,PACI)和遗忘型轻度认知损害(amnesic mild cognitive impairment,aMCI)患者的认知损害的特点.方法 选择29例符合牛津社区卒中项目(Oxford Community Stroke Droject,OCSP)分型的PACI患者,35例符合Petersen 诊断标准的aMCI患者,以及60例健康老年人为对照组,采用认知功能筛选测验-C2.1(Cognitive Ability Screening Instrument-C2.1,CASI)评定认知功能.结果 PACI组(86.28±12.04)和aMCI组(89.86±6.03)的CASI总分均比正常对照组(95.57±3.44)低,差异具有统计学意义[F(2)=8.547,P<0.05],而PACI组与aMCI组间无统计学差异.在CASI分领域方面,与对照组相比,PACI组在心算力(P=0.000)和定向力(P=0.021)两方面均较差;与aMCI组比较,PACI组的心算力(P=0.000)较aMCI组差,而短时记忆(P=0.016)和思维流畅性(P=0.005)方面则较好.aMCI组与对照组相比,在短时记忆(P=0.000)、抽象与判断能力(P=0.013)和思维流畅性(P=0.001)方面均较差.结论 PACI患者存在认知损害,尤其在心算力和定向力方面,与aMCI患者相比,可能更好地保留了执行功能,推测缺血性脑卒中与神经退行性变引起的认知损害可能涉及不同认知领域.     

Estrogen and cognitive functioning in men with mild cognitive impairment

Although men do not experience an abrupt cessation of gonadal hormone production at midlife as do women, levels of testosterone (T) decrease gradually with aging. Because estradiol (E₂) arises mainly from the conversion of T in men, the availability of E₂ also decreases with increasing age. In randomized clinical trials, E₂ replacement therapy has been shown to maintain aspects of cognition in postmenopausal women, specifically with regard to verbal memory. The present prospective, randomized, cross-over trial is being undertaken in order to determine whether E₂ will enhance verbal memory in men with Mild Cognitive Impairment (MCI). Men with MCI will randomly receive E₂ or placebo for the first 3 mo of treatment and will then be crossed-over to the other treatment for an additional 3 mo. A battery of neuropsychological tests will be administered at pretreatment and, again, following each 3-mo treatment phase. It is hypothesized that elderly men with MCI will perform better on tests of explicit memory when they are being treated with E₂ compared to their performance under placebo conditions.     

DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia

OBJECTIVES: To design a new, highly sensitive psychometric screening to identify patients with mild cognitive impairment (MCI) and patients with dementia in the early stages of the disease. METHODS: Five tasks were included in the DemTect: a word list, a number transcoding task, a word fluency task, digit span reverse, and delayed recall of the word list. The normation was performed with 145 healthy control subjects (CG). Furthermore, 97 MCI patients and 121 patients with possible Alzheimer's disease (AD) were tested with the DemTect and the MMSE. Classification rates for both tests were analysed. RESULTS: On the basis of the CG data, age-dependant transformation algorithms for the DemTect subtests were defined, and an education correction was provided for the total transformed score. The patient groups scored significantly below the CG in both the DemTect and the MMSE. Compared to the MMSE, classification rates of the DemTect were superior for both the MCI and the AD group, with high sensitivities of 80% and 100%, respectively. CONCLUSIONS: The DemTect is short (8-10 minutes), easy to administer, and its transformed total score (maximum 18) is independent of age and education. The DemTect helps in deciding whether cognitive performance is adequate for age (13-18 points), or whether MCI (9-12 points) or dementia (8 points or below) should be suspected.     

Circulating free nitrotyrosine and cognitive decline

Coppola L, Pastore A, Adamo G, Coppola A, Manzella D, Gombos I, Luongo M, Mastrolorenzo L. Circulating free nitrotyrosine and cognitive decline.
Acta Neurol Scand: 122: 175–181.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To determine if the circulating nitrotyrosine level significantly correlates with parameters measuring cognitive abilities. Materials and methods – One‐hundred and twelve community‐living subjects (ranging in age from 27 to 98 years) were evaluated for cognitive abilities [Mini Mental State Examination (MMSE) score] and circulating free nitrotyrosine plasma level, as well as for several variables that might influence cognitive abilities (age, education) and nitrotyrosine level (body mass index, haematological parameters, cardiovascular and inflammatory indices). Results – In the sub‐group of cognitively impaired subjects (score at MMSE <23.9), but not in that of cognitively not impaired subjects, a significant inverse correlation exists between nitrotyrosine level and MMSE score (r = ?0.378; P < 0.02). Conclusions – The finding, if confirmed by longitudinal studies, could play a role in the management of the subjects with Mild Cognitive Impairment, the clinical condition considered as a transitional state between the changes of cognitive ability in normal aging and dementia.