scholarly journals Mild cognitive impairment: the Manchester consensus

2020 ◽  
Author(s):  
Ross A Dunne ◽  
Dag Aarsland ◽  
John T O’Brien ◽  
Clive Ballard ◽  
Sube Banerjee ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sensitivity And Specificity ◽  
Large Scale ◽  
Ecological Validity ◽  
Neuropsychological Testing ◽  
Functional Decline ◽  
Research Participation ◽  
Clinical Syndrome ◽  
Cognitive Testing

Abstract Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer’s disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.

Cognitive training for persons with mild cognitive impairment

2008 ◽  
Vol 20 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Sylvie Belleville
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Training ◽  
Large Scale ◽  
Functional Decline ◽  
Experimental Studies ◽  
Positive Effects ◽  
Randomized Control ◽  
Meta Analyses

ABSTRACTRecent randomized control trials and meta-analyses of experimental studies indicate positive effects of non-pharmacological cognitive training on the cognitive function of healthy older adults. Furthermore, a large-scale randomized control trial with older adults, independent at entry, indicated that training delayed their cognitive and functional decline over a five-year follow-up. This supports cognitive training as a potentially efficient method to postpone cognitive decline in persons with mild cognitive impairment (MCI). Most of the research on the effect of cognitive training in MCI has reported increased performance following training on objective measures of memory whereas a minority reported no effect of training on objective cognitive measures. Interestingly, some of the studies that reported a positive effect of cognitive training in persons with MCI have observed large to moderate effect size. However, all of these studies have limited power and few have used long-term follow-ups or functional impact measures. Overall, this review highlights a need for a well-controlled randomized trial to assess the efficacy of cognitive training in MCI. It also raises a number of unresolved issues including proper outcome measures, issues of generalization and choice of intervention format.

Use of the Telephone-Administered Minnesota Cognitive Acuity Screen to Detect Mild Cognitive Impairment

2011 ◽  
Vol 26 (7) ◽  
pp. 555-562 ◽  
Author(s):  
Geoffrey Tremont ◽  
George D. Papandonatos ◽  
Beth Springate ◽  
Brooke Huminski ◽  
Michael D. McQuiggan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Neuropsychological Testing ◽  
Memory Disorders ◽  
Healthy Controls ◽  
Neurologic Examination ◽  
Psychiatric Conditions ◽  
Work Up

This study determined the sensitivity and specificity of the telephone-administered Minnesota Cognitive Acuity Screen (MCAS) to distinguish mild cognitive impairment (MCI) from healthy controls (HCs) and from Alzheimer’s disease (AD). A total of 100 individuals with MCI, 50 individuals with possible/probable AD, and 50 HCs were screened to exclude medical and psychiatric conditions affecting cognition. In-office evaluation included neuropsychological testing, neurologic examination, and neurodiagnostic work-up. Participants with AD obtained significantly lower MCAS total scores than participants with MCI, who in turn performed worse than the HC group. Sensitivity was 86% and specificity was 78% for distinguishing between MCI and HC. Sensitivity was 86% and specificity was 77% for discriminating between MCI and AD. Sensitivity was 91% and specificity was 78% for discriminating between impaired groups (MCI and AD) and HCs. Results suggest that the MCAS successfully discriminates MCI from HC and AD and has potential as an effective telephone-administered screening tool for memory disorders.

Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment

2021 ◽  
pp. 1-13
Author(s):  
Alexandra L. Clark ◽  
Alexandra J. Weigand ◽  
Kelsey R. Thomas ◽  
Seraphina K. Solders ◽  
Lisa Delano-Wood ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Inflammatory Markers ◽  
Memory Performance ◽  
Cognitive Testing ◽  
Interactive Effects ◽  
Protein Biomarkers ◽  
Age Related ◽  
T Tau

Background: Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer’s disease (AD), although their interactive effects have yet to be fully examined. Objective: The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). Methods: This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1–42 (Aβ 42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. Results: Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ 42 (B = –1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ 42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s <  0.05). Conclusion: PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.

scholarly journals Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society

2021 ◽  
pp. 1-10
Author(s):  
Ramshekhar N. Menon ◽  
Feba Varghese ◽  
Avanthi Paplikar ◽  
Shailaja Mekala ◽  
Suvarna Alladi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Medical Research ◽  
Sensitivity And Specificity ◽  
Linguistically Diverse ◽  
Z Score ◽  
Indian Languages ◽  
Test Protocol ◽  
Indian Council ◽  
Multiple Domain

<b><i>Background/Aims:</i></b> In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. <b><i>Methods:</i></b> Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. <b><i>Results:</i></b> Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of −0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of &#x3e;80% for diagnosis of MCI. <b><i>Conclusions:</i></b> The ICMR-NCTB is a “first of its kind” approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.

scholarly journals A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

2013 ◽  
Vol 5 (3) ◽  
pp. 16 ◽  
Author(s):  
Fábio Henrique De Gobbi Porto ◽  
Lívia Spíndola ◽  
Maira Okada De Oliveira ◽  
Patrícia Helena Figuerêdo Do Vale ◽  
Marco Orsini ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Characteristic Curve ◽  
Neuropsychological Testing ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Elderly Subjects ◽  
Subjective Memory ◽  
Delayed Recall ◽  
Memory Complaints

It is not easy to differentiate patients with mild cognitive impairment (MCI) from subjective memory complainers (SMC). Assessments with screening cognitive tools are essential, particularly in primary care where most patients are seen. The objective of this study was to evaluate the diagnostic accuracy of screening cognitive tests and to propose a score derived from screening tests. Elderly subjects with memory complaints were evaluated using the Mini Mental State Examination (MMSE) and the Brief Cognitive Battery (BCB). We added two delayed recalls in the MMSE (a delayed recall and a late-delayed recall, LDR), and also a phonemic fluency test of letter P fluency (LPF). A score was created based on these tests. The diagnoses were made on the basis of clinical consensus and neuropsychological testing. Receiver operating characteristic curve analyses were used to determine area under the curve (AUC), the sensitivity and specificity for each test separately and for the final proposed score. MMSE, LDR, LPF and delayed recall of BCB scores reach statistically significant differences between groups (P=0.000, 0.03, 0.001 and 0.01, respectively). Sensitivity, specificity and AUC were MMSE: 64%, 79% and 0.75 (cut off &lt;29); LDR: 56%, 62% and 0.62 (cut off &lt;3); LPF: 71%, 71% and 0.71 (cut off &lt;14); delayed recall of BCB: 56%, 82% and 0.68 (cut off &lt;9). The proposed score reached a sensitivity of 88% and 76% and specificity of 62% and 75% for cut off over 1 and over 2, respectively. AUC were 0.81. In conclusion, a score created from screening tests is capable of discriminating MCI from SMC with moderate to good accurancy.

scholarly journals Comparative Effects of Physical Exercise and Other Behavioral Interventions on Functional Status Outcomes in Mild Cognitive Impairment

2021 ◽  
pp. 1-8
Author(s):  
Anne L. Shandera-Ochsner ◽  
Melanie J. Chandler ◽  
Dona E. Locke ◽  
Colleen T. Ball ◽  
Julia E. Crook ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Physical Exercise ◽  
Behavioral Interventions ◽  
Functional Decline ◽  
Well Being ◽  
Control Group ◽  
Lifestyle Modifications ◽  
Clinical Dementia Rating ◽  
Group Sessions

Abstract Objectives: Lifestyle modifications for those with mild cognitive impairment (MCI) may promote functional stability, lesson disease severity, and improve well-being outcomes such as quality of life. The current analysis of our larger comparative effectiveness study evaluated which specific combinations of lifestyle modifications offered as part of the Mayo Clinic Healthy Action to Benefit Independence in Thinking (HABIT) program contributed to the least functional decline in people with MCI (pwMCI) over 18 months. Methods: We undertook to compare evidence-based interventions with one another rather than to a no-treatment control group. The interventions were five behavioral treatments: computerized cognitive training (CCT), yoga, Memory Support System (MSS) training, peer support group (SG), and wellness education (WE), each delivered to both pwMCI and care partners, in a group-based program. To compare interventions, we randomly withheld one of the five HABIT® interventions in each of the group sessions. We conducted 24 group sessions with between 8 and 20 pwMCI–partner dyads in a session. Results: Withholding yoga led to the greatest declines in functional ability as measured by the Functional Activities Questionnaire and Clinical Dementia Rating. In addition, memory compensation (calendar) training and cognitive exercise appeared to have associations (moderate effect sizes) with better functional outcomes. Withholding SG or WE appeared to have little effect on functioning at 18 months. Conclusions: Overall, these results add to the growing literature that physical exercise can play a significant and lasting role in modifying outcomes in a host of medical conditions, including neurodegenerative diseases.

scholarly journals Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria

2003 ◽  
Vol 182 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Anja Busse ◽  
Jeannette Bischkopf ◽  
Steffi G. Riedel-Heller ◽  
Matthias C. Angermeyer
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Longitudinal Study ◽  
Diagnostic Criteria ◽  
Community Sample ◽  
Neuropsychological Testing ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Definitions ◽  
Increased Risk

BackgroundAlthough mild cognitive impairment is associated with an increased risk of developing dementia, there has been little work on its incidence and prevalence.AimsTo report age-specific prevalence, incidence and predictive validities for four diagnostic concepts of mild cognitive impairment.MethodA community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study.ResultsPrevalence rates ranged from 3% to 20%, depending on the concept applied. The annual incidence rates applying different case definitions varied from 8 to 77 per 1000 person-years. Rates of conversion to dementia over 2.6 years ranged from 23% to 47%.ConclusionsMild cognitive impairment is frequent in older people. Prevalence, incidence and predictive validities are highly dependent on the diagnostic criteria applied.

scholarly journals Modifiable Factors Associated with Reversion from Mild Cognitive Impairment to Cognitively Normal Status: A Prospective Cohort Study

2021 ◽  
Author(s):  
Feng Sha ◽  
Ziyi Zhao ◽  
Chang Wei ◽  
Zhirong Yang ◽  
Bingyu Li
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Psychological Factors ◽  
Large Scale ◽  
Cox Regression ◽  
Lifestyle Factors ◽  
Cognitively Normal ◽  
Factors Associated ◽  
Modifiable Factors

Abstract Background Previous studies found that about 24% of the mild cognitive impairment (MCI) patients reverse to cognitively normal (CN) status. However, it is unclear which modifiable factors are associated with this reversion. Method We conducted a prospective community-based cohort study based on 2002-2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Of 35,474 older adults from 22 provinces in China in the 5 waves of CLHLS, 7,422 eligible participants with MCI were included. Multivariable Cox regression with least absolute shrinkage and selection operator (LASSO) penalty for variable selection was adopted to investigate the associations between reversion to CN and potential modifiable dietary/lifestyle, cardiometabolic, and psychological factors. Results Our analysis included 7,422 MCI participants [average age: 90.0 (SD 9.5) years]. Among these participants, 1,604 (21.6%) reversed from MCI to CN with a mean (SD) follow-up of 2.9 (1.8) years. Several dietary/lifestyle factors, including daily consumption of fresh fruits (Hazard Ratio [HR]: 1.28, 95% CI: 1.15 to 1.42; P༜.001), engagement in reading (HR: 1.24, 95% CI: 1.00 to 1.54; P =.047), housework (HR: 1.21, 95% CI: 1.08 to 1.35; P =.001), and mah-jong or other card games (HR: 1.23, 95% CI: 1.08 to 1.39; P =.001), were positively associated with possibility of reversion. Cigarette smoking (HR: 0.92, 95% CI: 0.84 to 1.00; P= .041) and duration of alcohol drinking (HR: 0.97, 95% CI: 0.94 to 0.99; P = .012) were negatively associated with possibility of reversion. None of the modifiable cardiometabolic and psychological factors was found to be significantly associated with reversion to CN. Difference was identified among different age and gender group. Conclusion This study identified several dietary/lifestyle factors associated with MCI reversion that may transfer into large-scale dementia prevention practices.

The Modified Telephone-Administered Minnesota Cognitive Acuity Screen for Mild Cognitive Impairment

2018 ◽  
Vol 31 (3) ◽  
pp. 123-128 ◽  
Author(s):  
Sarah Pillemer ◽  
George D. Papandonatos ◽  
Cara Crook ◽  
Brian R. Ott ◽  
Geoffrey Tremont
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Characteristic Curve ◽  
Neuropsychological Testing ◽  
Cost Effective ◽  
Original Version ◽  
Modest Improvement ◽  
Highly Sensitive ◽  
Risk Of Progression ◽  
Administration Time

Objective: This study aimed to compare the sensitivity and specificity of a modified version of the Minnesota Cognitive Acuity Screen (MCAS-m), by adding learning and recognition memory components, to the original version MCAS to distinguish amnestic mild cognitive impairment (aMCI) from healthy controls (HCs). Methods/Design: A total of 30 individuals with aMCI and 30 HCs underwent neuropsychological testing, neurologic examination, laboratory, and brain imaging tests. Once diagnosis was confirmed, participants completed the MCAS and MCAS-m in counterbalanced order. Results: The average administration time was 12.6 minutes for the MCAS and 13.5 minutes for the MCAS-m. Receiver operating characteristic curve analyses showed that the MCAS-m demonstrated 97% sensitivity and 97% specificity for distinguishing between aMCI and HC versus 97% and 87%, respectively, for the original MCAS in this sample. Conclusions: Both the MCAS and the MCAS-m were highly sensitive when distinguishing between normal cognition and aMCI; however, the MCAS-m demonstrated a 10% increase in specificity compared to the original version. Improved specificity is particularly relevant to screening in larger community samples with lower base rates of MCI than clinic populations. This modified screening measure presents a brief and cost-effective tool for identifying MCI. Given the risk of progression from aMCI to Alzheimer disease dementia (AD), the MCAS-m represents a modest improvement in telephone-administered methods for the early detection of AD.

scholarly journals Reliability and validity of a quick test of cognitive speed (AQT) in screening for mild cognitive impairment and dementia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pouya Farokhnezhad Afshar ◽  
Elisabeth H. Wiig ◽  
Seyed Kazem Malakouti ◽  
Behnam Shariati ◽  
Sara Nejati
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sensitivity And Specificity ◽  
Older Patients ◽  
Reliability And Validity ◽  
Quick Test ◽  
Significant Difference ◽  
Cognitive Speed ◽  
Color Form

Abstract Background Cognitive disorders are one of the important issues in old age. There are many cognitive tests, but some variables affect their results (e.g., age and education). This study aimed to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) in screening for mild cognitive impairment (MCI) and dementia. Methods This is a psychometric properties study. 115 older adults participated in the study and were divided into three groups (46 with MCI, 24 with dementia, and 45 control) based on the diagnosis of two geriatric psychiatrists. Participants were assessed by AQT and Mini-Mental State Examination (MMSE). Data were analyzed using Pearson correlation, independent t-test, and ROC curve by SPSS v.23. Results There was no significant correlation between AQT subscales and age and no significant difference between the AQT subscales in sex, educational levels. The test-retest correlations ranges were 0.84 from 097. Concurrent validity was significant between MMSE and AQT. Its correlation was with Color − 0.78, Form − 0.71, and Color-Form − 0.72. The cut-off point for Color was 43.50 s, Form 52 s, and Color-Form 89 s were based on sensitivity and specificity for differentiating older patients with MCI with controls. The cut-off point for Color was 62.50 s, for Form 111 s, and Color-Form 197.50 s based on sensitivity and specificity measures for differentiating older patients with dementia and MCI. Conclusion The findings showed that AQT is a suitable tool for screening cognitive function in older adults.

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