Cognitive Functioning in Alzheimer's Disease and Vascular Dementia: Further Evidence for Similar Patterns of Deficits

The purpose of the present study was to examine possible differences in patterns of cognitive performance between population-based samples of Alzheimer's disease (AD; n = 51) and vascular dementia (VaD; n = 14) patients between 75 and 96 years of age. The two demented groups were comparable in age, years of education, gender distribution, and severity of dementia. The selection of cognitive tasks (letter and category fluency, Block design, Clock reading and setting, and episodic face recognition) was thought to address some of the inconsistencies in previous research. The main finding was that AD and VaD patients were comparable on most tasks, although robust dementia-related deficiencies were found when comparing the results of the demented participants with those of the control participants. These findings suggest that AD and VaD may affect several basic cognitive functions in an equal manner.     

Self-reported Memory Compensation: Similar Patterns in Alzheimer's Disease and Very Old Adult Samples

Evidence pertaining to self-reported use of memory compensation techniques was collected using the Memory Compensation Questionnaire (MCQ). Five forms of everyday memory compensation were evaluated: (a) external memory aids, (b) internal mnemonic strategies, (c) investing and managing processing time, (d) applying more effort, and (e) reliance on human memory aids. The sample was derived from the Kungsholmen Project in Stockholm, Sweden, and consisted of (n =85) healthy older adults (M age=81.80 years; M MMSE=28.34) and (n =21) diagnosed Alzheimer's Disease (AD) patients (M age=81.80 years; M MMSE=23.55). Participants were tested on two occasions, 6 months apart. Results showed that the MCQ was a largely reliable instrument in these two groups. Moreover, we observed substantial sample similarity in frequency of using the five forms of everyday memory compensation techniques. The healthy sample reported using the external techniques more than the AD sample. Over the 6-month interval, however, AD patients differentially increased their use of others to assist them in everyday memory performance. Results are interpreted in terms of insight into changes in memory skills and in the implementation of effective memory support systems.     

Cytokines in Alzheimer's Disease and Vascular Dementia

The levels of interleukin 1β, interleukin 6, and interleukin 10 were elevated in the serum of patients with dementia. No statistically significant correlation was recorded in the interleukin levels among patients with Alzheimer's disease and vascular dementia. Also, no significant correlation was observed in the interleukin levels in the serum and the severity of dementia. However, a significant correlation was found between IL-6 and tumor necrosis factor-α (TNF-α) levels and age. The levels of IL-1β and IL-6 were positively correlated with hypertension, and IL-2 levels were negatively correlated. No correlation was found between depressive symptoms and levels of cytokines in the serum.     

不同严重程度血管性痴呆与老年性痴呆的神经心理特点

目的 探讨不同严重程度的血管性痴呆（vascular dementia,VaD）与老年性痴呆（Alzheimer disease,AD）
的神经心理学特点。
方法 对广东省人民医院神经科门诊及病房的252例痴呆患者（VaD组127例,AD组125例）,和正常对
照组159例进行一组神经心理量表检查。神经心理量表包括：简易精神状态检查（mini-mental state
examination,MMSE）、Fuld物体记忆测验（fuld object memory,FOM）、言语流畅性测验（rapid verbal
retrieve,RVR）、数字广度测验（digit span,DS）和积木测验（block design,BD）。分析这两种类型不同
严重程度的痴呆患者认知障碍的特点。
结果 两种类型的轻、中、重度痴呆患者神经心理检查有统计学差异（P <0.01）。轻度痴呆患者MMSE、
RVR评分在VaD、AD组间存在统计学差异（P <0.05）,在中、重度痴呆患者,神经心理评分在VaD、AD组
间无统计学差异（P >0.05）。
结论 神经心理量表评估有助于VaD、AD的严重程度分级,RVR测验可辅助鉴别诊断轻度VaD和AD。     

EEG Analysis in Patients with Senile Dementia and Alzheimer's Disease

Abstract: An EEG frequency analysis using the wave-form recognition method was performed in different stages of senile dementia (SD), evaluated according to the Hasegawa Dementia Rating Scale (HDS), and the differences in EEG changes between patients with Alzheimer's disease (AD) and patients with SD were studied.
We found that the EEG changes in the SD patients correlated with HDS, and that an increase in slow theta (4–5.8 Hz) and a decrease in fast theta (7–7.8 Hz) waves were early changes in the SD patients.
Furthermore, delta and slow theta waves increased mainly in the anterior frontal and temporal areas in the severe SD patients.
The AD patients showed more severe EEG abnormalities than the SD patients and showed severe focal abnormalities in the temporal area.     

Patterns of Word-List Generation in Mild Cognitive Impairment and Alzheimer's Disease

Patients with amnestic mild cognitive impairment (aMCI) have been described as exhibiting greater impairment on tests of category fluency than letter fluency. This has been offered as evidence that this condition represents pre-clinical Alzheimer's disease (AD). We hypothesized that this pattern of differential impairment is dependent on the specific semantic categories and initial letters selected, and is not specific to AD and aMCI. A total of 40 cognitively normal older adults, 74 MCI patients—25 “amnestic single domain” (aMCI), 27 “amnestic multiple domain”, and 22 non-amnestic—and 29 AD patients were tested with multiple forms of semantic-category and initial-letter fluency tasks. The pattern of deficits within and across groups was highly dependent on the specific categories and letters chosen. Overall, aMCI patients did not demonstrate greater impairment in category than letter fluency. In fact, the level and pattern of their performance resembled that of cognitively normal older adults much more than AD patients. MCI patients with deficits in multiple cognitive domains performed most like AD patients. These findings indicate that verbal fluency performance is highly influenced by the specific tasks used, and impairment on semantic fluency is not characteristic of pure amnestic MCI.     

Dementia Rating Scale Performance: A Comparison of Vascular and Alzheimer's Dementia

Differences in the pattern of neuropsychological dysfunction associated with Alzheimer's disease (AD) and vascular dementia (VaD) were examined using the Dementia Rating Scale (DRS). We examined three groups of patients: (1) Patients with AD; (2) patients with single stroke (CVA); and (3) patients with multiple cerebral infarctions (MI). Comparisons of cognitive dysfunction were conducted on patients that met the DRS criteria for dementia. Dementia groups were similar in age, education, and severity of dementia. Comparisons of the AD and two VaD groups across the specific DRS-scales (Attention, Conceptualization, Construction, Initiation/Perseveration, and Memory) indicated that patients with AD were more impaired on the DRS-Memory while the patients with VaD were more impaired on the DRS-Construction. Additionally, patients with VaD related to MI scored lower on the DRS-Initiation/Perseveration as compared to patients with AD, and patients with AD scored lower on the DRS-Conceptualization as compared to patients with VaD related to CVA. These results are indicative of qualitative differences in the pattern of cognitive deficits associated with the two types of dementia.     

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.     

Dimensions of Cognitive Ability in Dementia: Differential Sensitivity to Degree of Impairment in Alzheimer's Disease

The purpose of this study was to identify dimensions of cognitive functioning in demented elderly persons and examine sensitivity of these dimensions to different degrees of cognitive impairment in Alzheimer's disease. Participants included 210 demented elderly patients and 89 normal controls. Principal components analysis of neuropsychological test scores for the demented patients yielded the following six components: (1) Memory/Learning, (2) Spatial/Nonverbal, (3) Verbal/Lexical Knowledge, (4) Verbal Fluency, (5) Visual Paired Associates, and (6) Verbal Attention Span. All dimensions discriminated among normal controls and three groups of patients with probable Alzheimer's disease defined by decreasing Mini-Mental State Exam scores. Differential sensitivity of cognitive dimensions was observed as a function of level of cognitive impairment.     

Verbal Fluency Patterns in Two Subgroups of Patients With Alzheimer's Disease

Previous research has identified two subgroups of patients with Alzheimer's disease (AD) based on performance discrepancies on semantic and visual-constructional measures: Left AD (LAD) and Right AD (RAD). In this study, verbal fluency performances (Animal Fluency [AF] and Letter Fluency [FAS]) of these two subgroups were examined. It was hypothesized that LAD patients would perform worse on AF compared to FAS, due to an underlying breakdown of left-hemisphere semantic networks. On the other hand, the RAD group, which theoretically has a relatively preserved semantic system, yet difficulties retrieving overlearned information, was not expected to differ on the two fluency tasks. These predictions were based on the notion that the AF task requires intact retrieval and semantic processes, whereas the FAS task is reliant on retrieval processes alone. Patients were classified into subgroups on the basis of performance discrepancies on the Boston Naming Test (BNT) and Copy tasks: LAD (BNT<Copy); RAD (BNT>Copy). A split-plot ANOVA using demographically corrected standard T-scores revealed a significant main effect for fluency task, and a significant subgroup×fluency task interaction. LAD patients performed poorer on AF compared to FAS; there was no fluency task difference for the RAD group. Analysis of within-subcategory response clustering on AF revealed more instances of serial subclass exemplar responses by RAD members. These results support the loss theory in explaining the semantic deficit of LAD, and suggest that retrieval difficulties underlie the fluency problems of RAD.     

新疆石河子城区血管性痴呆和老年性痴呆的流行病学调查

目的探讨新疆石河子城区老年人血管性痴呆及老年性痴呆的发病情况。方法于1995年1～3月对石河子城区50岁以上老年人群进行随机抽样调查。共调查6个住宅小区计2687人，其中尼佳1380人，女性1307人。结果发现血管性痴呆的患病率为1．38％（37／2687），老年性痴呆患病率为0．41％（11／2687），老年性痴呆无性别及职业差异。血管性痴呆男性患病率（1．88％，26／1380）明显高于女性（0．84％，11／1307）（x2=4．6310，P＜0．05），无职业差异。随年龄增长，两种痴呆患病率均有明显增加，且两者均有显著性意义（P＜0．01）。调查结果还表明，无论哪种痴呆，文化程度低的人群患病率高。结论降低痴呆的重要措施是提高人群的教育、文化水平。     

血管性认知功能障碍非痴呆型患者外周血炎性标记物的临床研究

目的探讨血管性认知功能障碍非痴呆型(VCI-ND)患者外周血炎性标记物的变化特征。方法选择VCI-ND患者44例为VCI-ND组,另选择认知功能正常者24例为对照组,采用流式细胞仪、免疫浊度法及血液分析仪分别测定两组患者CD64指数和白介素6(IL-6)、C-反应蛋白(CRP)及白细胞计数和中性粒细胞比率。结果与对照组比较,VCI-ND组CD64指数、IL-6、CRP及中性粒细胞比率明显增高,差异有统计学意义(P<0.05),而白细胞计数则差异无统计学意义(P>0.05);行非条件Logistic回归分析,提示IL-6水平增高是VCI-ND的危险因素。结论炎症反应参与VCI-ND的病理过程,IL-6可能是VCI-ND早期的血清炎性标记物,IL-6水平与认知功能程度下降相关,但中性粒细胞CD64指数与认知功能障碍的关系尚不明确。     

The Effect of Cognitive Training in Patients with Mild Cognitive Impairment and Early Alzheimer's Disease: A Preliminary Study

Background and Purpose

The objective of this study was to determine the benefits of cognitive training in patients with amnestic mild cognitive impairment (aMCI) and those with early Alzheimer''s disease (AD).

Methods

Eleven patients with aMCI and nine with early AD (stage 4 on the Global Deterioration Scale) participated in this study. Six participants with aMCI and six with AD were allocated to the cognitive training group, while five participants with aMCI and three with AD were allocated to a wait-list control group. Multicomponent cognitive training was administered in 18 weekly, individual sessions. Outcome measures were undertaken at baseline, and at 2 weeks and 3 months of follow-up.

Results

In the trained MCI group, there were significant improvements in the delayed-recall scores on the Seoul Verbal Learning Test at both the 2-week and 3-month follow-ups compared with baseline (baseline, 1.6±1.5; 2 weeks, 4.4±1.5, p=0.04; 3 months, 4.6±2.3, p=0.04). The phonemic fluency scores (1.0±0.8 vs. 5.0±1.8, p=0.07) and Korean Mini-Mental State Examination scores (18.8±0.5 vs. 23.8±2.2, p=0.07) also showed a tendency toward improvement at the 2-week follow-up compared to baseline in the trained AD group.

Conclusions

This study provides evidence of the effectiveness of cognitive training in aMCI and early AD. The efficacy of cognitive training programs remains to be verified in studies with larger samples and a randomized design.     

尼莫地平改善脑血管病患者认知功能的有效性观察

目的 该研究旨在观察尼莫地平片对血管性认知损害的短期疗效。方法 前瞻性开放性自身对照研究。64例神经内科门诊脑血管病患者,在常规二级预防药物的基础上,口服尼莫地平60～90 mg/d,12～24周。应用简明精神状态量表（mini mental state examination,MMSE）和北京版蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）作为认知评估工具,观察治疗前后患者认知功能的变化。结果 三个月治疗后认知成绩总分显著高于治疗前,分别为：MMSE（26.3±2.7）vs（25.6±2.9）,P =0.039;MoCA（20.5±4.6）vs（19.0±4.1）,P =0.000,差异有显著性;治疗后MoCA的记忆分测验成绩显著高于治疗前,分别为（1.8±1.7）vs（1.1±1.2）,P =0.000,差异有显著性。结论 尼莫地平可有效地提高脑血管病患者的认知功能     

A Meta‐Analysis of fMRI Activation Differences during Episodic Memory in Alzheimer's Disease and Mild Cognitive Impairment

Functional MRI (fMRI) has the potential to be used as a tool to detect biomarkers related to classifying Alzheimer's disease (AD) and its prodromal stage, mild cognitive impairment (MCI). Previous meta‐analyses suggest that during episodic memory tasks, MCI patients exhibit hyperactivation in the medial temporal lobe (MTL) while AD patients exhibit hypoactivation, compared to healthy older adults (HOAs). However, these previous studies have methodological weaknesses that limit the generalizability of the results. This quantitative meta‐analysis re‐examines the activation associated with episodic memory in AD and MCI as compared to cognitively normal populations to assess these commonly cited activation differences. A whole‐brain activation likelihood estimation based meta‐analysis was conducted on fMRI studies that examined episodic memory in HOA (n = 200), MCI (n = 131), and AD populations (n = 89; total n = 409). Diffuse activation was exhibited in the HOA sample, while activation was more limited in the clinical populations. Additionally, the HOA sample showed more activation in the right hippocampus compared to the AD sample. The MCI studies showed greater activation in the cerebellum compared to the HOA sample, potentially indicating a compensatory mechanism for verbal encoding. MTL hypoactivation in the AD sample is consistent with previous studies, but more evidence of MCI hyperactivation is needed before considering MTL activation as an early biomarker for the AD disease process.