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Faster cognitive decline in the years prior to MR imaging is associated with smaller hippocampal volumes in cognitively healthy older persons  [PDF]
Debra A. Fleischman,Lei Yu,Konstantinos Arfanakis,S. Duke Han,Patricia A. Boyle,David A. Bennett
Frontiers in Aging Neuroscience , 2013, DOI: 10.3389/fnagi.2013.00021
Abstract: Early identification of persons at risk for cognitive decline in aging is critical to optimizing treatment to delay or avoid a clinical diagnosis of mild cognitive impairment (MCI) or dementia due to Alzheimer's disease (AD). To accomplish early identification, it is essential that trajectories of cognitive change be characterized and associations with established biomarkers of MCI and AD be examined during the phase in which older persons are considered cognitively healthy. Here we examined the association of rate of cognitive decline in the years leading up to structural magnetic resonance imaging with an established biomarker, hippocampal volume. The sample comprised 211 participants of the Rush Memory and Aging Project who had an average of 5.5 years of cognitive data prior to structural scanning. Results showed that there was significant variability in the trajectories of cognitive change prior to imaging and that faster cognitive decline was associated with smaller hippocampal volumes. Domain-specific analyses suggested that this association was primarily driven by decline in working memory. The results emphasize the importance of closely examining cognitive change and its association with brain structure during the years in which older persons are considered cognitively healthy.
Adiposity Predicts Cognitive Decline in Older Persons with Diabetes: A 2-Year Follow-Up  [PDF]
Angela Marie Abbatecola,Fabrizia Lattanzio,Liana Spazzafumo,Anna Maria Molinari,Michele Cioffi,Raffaele Canonico,Luigi DiCioccio,Giuseppe Paolisso
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0010333
Abstract: The mechanisms related to cognitive impairment in older persons with Type 2 diabetes (DM) remains unclear. We tested if adiposity parameters and body fat distribution could predict cognitive decline in older persons with DM vs. normal glucose tolerance (NGT).
The Effect of Cognitive Decline and Neuropsychiatric Symptoms on Activities of Daily Living in the Dementia Patients  [PDF]
Aynur ?ZGE,Osman ?ZGüR YALIN,Hakan KALEA?ASI,Seda BAYRAM
N?ropsikiyatri Ar?ivi , 2008,
Abstract: Objective: Neuropsychiatric symptoms of people with dementia are frequently reported, but knowledge about the effects of cognitive and neuropsychiatric symptoms on daily activities in various dementia subtypes is conflicting. In this study, we investigated the influence of cognitive and neuropsychiatric symptoms on daily activities in mild cognitive impairment (MCI), Alzheimer Disease (AD) and Vascular Dementia (VD) patients. Method: Eighteen MCI, 40 AD, 17 VD patients and 23 healthy volunteers, making a total of 98 persons, were admitted to the study. All patients were evaluated with cognitive, neuropsychiatric and functionality scales found in the Dokuz Eylül dementia database registry, and patients were diagnosed according to DSM-IV and international study group criteria. Results: All groups were matched according to sex and education. We showed NPI (neuropsychiatric inventory for all frequency, severity, caregiver distress scores) and cognitive decline (MMSE scores) as being more prominent among AD; it has a significantly negative effect on Blessed functionality scale and instrumental daily living scale, and results were correlated with each other in all three groups. Discussion: Our results suggest that patients who have complaints of forgetfulness should be given a cognitive evaluation in addition to neuropsychiatric and functional scales determination. (Archives of Neuropsychiatry 2008; 45: 14-8)
Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment  [PDF]
Cameron J. Camp, Kathleen Fox, Michael J. Skrajner, Vincent Antenucci, Jessica Haberman
Advances in Aging Research (AAR) , 2015, DOI: 10.4236/aar.2015.42005
Abstract: The primary objective of the study was to determine whether a distanced-based educational in-tervention would result in positive health outcomes for persons with both DM and cognitive impairment. Older adults with Type 2 diabetes (Diabetes Mellitus—DM) who also have cognitive impairment such as Mild Cognitive Impairment (MCI) or early stage dementia are both challenged and at risk when attempting to live independently. The ability to effectively monitor blood glucose levels and diet and exercise regimens often is severely constrained by the combination of DM and the presence of Mild Cognitive Impairment (MCI) or early stage dementia. We describe an exploratory study funded by the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK) in which Certified Diabetic Educators (CDEs) were linked with 40 older adult with DM and cognitive impairment using iPads and the internet. CDEs presented personalized education sessions to participants, and 18 of the participants also received a cognitive intervention called Spaced Retrieval (SR), which is designed to train the effective use of strategies to enhance medication compliance and reach other goals. Blood glucose and cholesterol measures were assessed at baseline and at 2-, 4-, and 6-month post intervention. Hemoglobin A1c (HbA1c) levels initially declined from baseline after treatment but returned to baseline levels after 6 months. For low-density lipoprotein (LDL) cholesterol, a significant interaction effect was found for the Group × Time interaction. LDL levels increased from baseline after treatment for the control group, but showed decline after baseline in the SR group. Goals that were initially learned were retained, in general, at short-term follow-up, and self-efficacy increased significantly after training. Results show the need for follow-up and support after initial treatment, as well as the need to see if the effects produced by SR can be replicated and sustained with continued contact.
Mild cognitive impairment  [PDF]
Pavlovi? Dragan M.,Pavlovi? Aleksandra M.
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0908434p
Abstract: Mild cognitive impairment (MCI) is a syndrome that spans the area between normal ageing and dementia. It is classified into amnestic and non-amnestic types, both with two subtypes: single domain and multiple domains. Prevalence of MCI depends on criteria and population and can vary from 0.1 to 42% persons of older age. In contrast to dementia, cognitive deterioration is less severe and activities of daily living are preserved. Most impaired higher cognitive functions in MCI are memory, executive functions, language, visuospatial functions, attention etc. Also there are depression, apathy or psychomotor agitation, and signs of psychosis. Aetiology of MCI is multiple, mostly neurodegenerative, vascular, psychiatric, internistic, neurological, traumatic and iatrogenic. Persons with amnestic MCI are at a higher risk of converting to Alzheimer's disease, while those with a single non-memory domain are at risk of developing frontotemporal dementia. Some MCI patients also progress to other dementia types, vascular among others. In contrast, some patients have a stationary course, some improve, while others even normalize. Every suspicion of MCI warrants a detailed clinical exploration to discover underlying aetiology, laboratory analyses, neuroimaging methods and some cases require a detailed neuropsychological assessment. At the present time there is no efficacious therapy for cognitive decline in MCI or the one that could postpone conversion to dementia. The treatment of curable causes, application of preventive measures and risk factor control are reasonable measures in the absence of specific therapy.
Mild Cognitive Impairment: Statistical Models of Transition Using Longitudinal Clinical Data  [PDF]
Erin L. Abner,Richard J. Kryscio,Gregory E. Cooper,David W. Fardo,Gregory A. Jicha,Marta S. Mendiondo,Peter T. Nelson,Charles D. Smith,Linda J. Van Eldik,Lijie Wan,Frederick A. Schmitt
International Journal of Alzheimer's Disease , 2012, DOI: 10.1155/2012/291920
Abstract: Mild cognitive impairment (MCI) refers to the clinical state between normal cognition and probable Alzheimer’s disease (AD), but persons diagnosed with MCI may progress to non-AD forms of dementia, remain MCI until death, or recover to normal cognition. Risk factors for these various clinical changes, which we term “transitions,” may provide targets for therapeutic interventions. Therefore, it is useful to develop new approaches to assess risk factors for these transitions. Markov models have been used to investigate the transient nature of MCI represented by amnestic single-domain and mixed MCI states, where mixed MCI comprised all other MCI subtypes based on cognitive assessments. The purpose of this study is to expand this risk model by including a clinically determined MCI state as an outcome. Analyses show that several common risk factors play different roles in affecting transitions to MCI and dementia. Notably, APOE-4 increases the risk of transition to clinical MCI but does not affect the risk for a final transition to dementia, and baseline hypertension decreases the risk of transition to dementia from clinical MCI. 1. Introduction Mild cognitive impairment (MCI) often refers to the clinical condition between normal cognition and probable Alzheimer’s disease (AD). However, persons diagnosed with MCI may progress to non-AD forms of dementia, remain MCI until death, and in some instances recover to a normal cognitive state [1–3]. There has been considerable effort to refine diagnostic criteria, separate MCI into amnestic and nonamnestic subtypes, and identify the underlying etiologies of MCI [1, 4, 5]. However, whether MCI is a true precursor to dementia remains controversial [6–9] despite evidence of AD neuropathology in amnestic MCI [10, 11]. This is due in part to the description of “back transitions” (i.e., recovery to normal cognition) that have been reported in longitudinal studies [3, 9, 12, 13]. Although the long-term prognosis for such cases is unclear, patients with a Clinical Dementia Rating (CDR) global score of 0.5 often have AD pathology at autopsy regardless of back transitions to CDR global scores of 0 [14]. Back transitions are likely heterogeneous in origin and may be explained by misclassification of either the MCI or normal state, interclinician differences in application of diagnostic criteria, within-patient variability due to medical illness or psychosocial factors, or resistance to cognitive decline due to cognitive reserve [15–18]. In a previous study we investigated MCI as defined by cognitive test performance alone.
Thickness in Entorhinal and Subicular Cortex Predicts Episodic Memory Decline in Mild Cognitive Impairment
A. C. Burggren,B. Renner,M. Jones,M. Donix,N. A. Suthana,L. Martin-Harris,L. M. Ercoli,K. J. Miller,P. Siddarth,G. W. Small,S. Y. Bookheimer
International Journal of Alzheimer's Disease , 2011, DOI: 10.4061/2011/956053
Abstract: Identifying subjects with mild cognitive impairment (MCI) most likely to decline in cognition over time is a major focus in Alzheimer's disease (AD) research. Neuroimaging biomarkers that predict decline would have great potential for increasing the efficacy of early intervention. In this study, we used high-resolution MRI, combined with a cortical unfolding technique to increase visibility of the convoluted medial temporal lobe (MTL), to assess whether gray matter thickness in subjects with MCI correlated to decline in cognition over two years. We found that thickness in the entorhinal (ERC) and subicular (Sub) cortices of MCI subjects at initial assessment correlated to change in memory encoding over two years (ERC: =0.34; =.003) and Sub (=0.26; =.011) but not delayed recall performance. Our findings suggest that aspects of memory performance may be differentially affected in the early stages of AD. Given the MTL's involvement in early stages of neurodegeneration in AD, clarifying the relationship of these brain regions and the link to resultant cognitive decline is critical in understanding disease progression.
Combining functional scales and cognitive tests in screening for mild cognitive impairment at a university-based memory clinic in Brazil
Abreu, Izabella Dutra de;Nunes, Paula Villela;Diniz, Breno Satler;Forlenza, Orestes Vicente;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000400008
Abstract: objective: to determine the diagnostic accuracy of the mini-mental state examination combined to the informant questionnaire on cognitive decline in the elderly for the identification of mild cognitive impairment. method: 191 elderly subjects were assessed with the mini-mental state examination, and their informants were assessed with the informant questionnaire on cognitive decline in the elderly. subjects were divided into three groups according to their cognitive state (controls: n = 67, mild cognitive impairment: n = 65 and dementia: n = 59), which was ascertained by clinical and neuropsychological evaluation. the diagnostic accuracy of each test in the discrimination of diagnostic groups (mild cognitive impairment vs. controls, mild cognitive impairment vs. dementia and dementia vs. controls) was examined with the aid of roc curves. we additionally verified if the combination of both tests would increase diagnostic accuracy for mild cognitive impairment and control identification. results: the combination of the mini-mental state examination and the informant questionnaire on cognitive decline in the elderly scores did not increase the mini-mental state examination diagnostic accuracy in the identification of patients with mild cognitive impairment. conclusions: the present data do not warrant the combination of the mini-mental state examination and the informant questionnaire on cognitive decline in the elderly as a sufficient diagnostic tool in the diagnostic screening for mild cognitive impairment.
Relation of neuropathology with cognitive decline among older persons without dementia  [PDF]
Patricia A. Boyle,Lei Yu,David A. Bennett
Frontiers in Aging Neuroscience , 2013, DOI: 10.3389/fnagi.2013.00050
Abstract: Objective: Although it is now widely accepted that dementia has a long preclinical phase during which neuropathology accumulates and cognition declines, little is known about the relation of neuropathology with the longitudinal rate of change in cognition among older persons without dementia. We quantified the burden of the neuropathologies of the three most common causes of dementia [i.e., Alzheimer’s disease (AD), cerebrovascular disease (CVD), and Lewy body disease (LBD)] and examined their relation with cognitive decline in a large cohort of persons without dementia proximate to death.
Designing clinical trials for assessing the effects of cognitive training and physical activity interventions on cognitive outcomes: The Seniors Health and Activity Research Program Pilot (SHARP-P) Study, a randomized controlled trial
Claudine Legault, Janine M Jennings, Jeffrey A Katula, Dale Dagenbach, Sarah A Gaussoin, Kaycee M Sink, Stephen R Rapp, W Jack Rejeski, Sally A Shumaker, Mark A Espeland, the SHARP-P Study Group
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-27
Abstract: SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA) and/or cognitive training intervention (CT) in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment.Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004), the interventions produced marked changes in cognitive and physical performance measures (p≤0.05), and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p = 0.01). Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome) or 2,000 participants (categorical outcome).Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible.Clinicaltrials.gov Identifier: NCT00688155There is growing interest in non-pharmacological interventions for preventing, reducing, or postponing cognitive decline in late life [1-3]. The efficacy of approaches such as physical activity, strength and cognitive training for improving brain health has not been established [4]; however, results from small, short-term trials are encouraging and support the larger, more definitive trials necessary to establish efficacy and prevention guidelines [5-16].
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