scholarly journals Predicting Cognitive Decline and Dementia with the Newly Normed SKT Short Cognitive Performance Test

2019 ◽  
Vol 9 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Mark Stemmler ◽  
Johannes Baltasar Hessler ◽  
Horst Bickel
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Performance Test ◽  
Rating Scale ◽  
Cognitive Status ◽  
Traffic Light ◽  
Clinical Dementia Rating ◽  
Kaplan Meier ◽  
Dementia Onset

Objective: The aim of this article was to determine the criterion-related validity of the newly normed SKT (Syndrom-Kurztest) Short Cognitive Performance Test with the onset of dementia as the predicted criterion. Methods: The cognitive ability was tested with the SKT in a sample of 546 cognitively healthy adults aged 65–85 years. New cases of mild cognitive impairment (MCI) or dementia were determined in 3 follow-up investigations at 1-year intervals. Each participant’s cognitive status was rated on the Clinical Dementia Rating Scale. The cognitive status according to the SKT is presented in terms of a traffic light system. Results: Based on Kaplan-Meier estimators, the trajectories of the different SKT traffic light labels were investigated over 3 years. The trajectories were significantly different, representing differential risks for dementia onset. In comparison to the green group, the hazard ratio (HR) for the development of dementia and MCI amounted to HR 6.63 (95% CI 2.75–15.96) and HR 2.34 (95% CI 1.37–3.99), respectively, in the yellow group, and to HR 25.40 (95% CI 10.73–60.14) and HR 3.83 (95% CI 1.86–7.86), respectively, in the red group. Conclusions: The newly normed SKT showed a high predictive validity for the onset of dementia.

scholarly journals Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

2017 ◽  
Vol 24 (2) ◽  
pp. 176-187 ◽  
Author(s):  
Shanna L. Burke ◽  
Miriam J. Rodriguez ◽  
Warren Barker ◽  
Maria T Greig-Custo ◽  
Monica Rosselli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Entorhinal Cortex ◽  
Rating Scale ◽  
Structural Mri ◽  
Diagnostic Group ◽  
Disease Stage ◽  
Clinical Dementia Rating ◽  
Mild Dementia

AbstractObjectives:The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity.Methods:Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group.Results:Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects.Conclusions:Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018,24, 176–187)

Constipation Predicts Cognitive Decline in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-up and Comparison with a Control Group

2021 ◽  
pp. 1-17
Author(s):  
Diego Santos García ◽  
Lucía García Roca ◽  
Teresa de Deus Fonticoba ◽  
Carlos Cores Bartolomé ◽  
Lucía Naya Ríos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Rating Scale ◽  
Cognitive Status ◽  
Control Group ◽  
Cognitive Changes ◽  
Non Motor Symptoms

Background: Constipation has been linked to cognitive impairment development in Parkinson’s disease (PD). Objective: Our aim was to analyze cognitive changes observed in PD patients and controls from a Spanish cohort with regards to the presence or not of constipation. Methods: PD patients and controls recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were followed-up during 2 years. The change in cognitive status from baseline (V0) to 2-year follow-up was assessed with the PD-CRS (Parkinson’s Disease Cognitive Rating Scale). Subjects with a score ≥1 on item 21 of the NMSS (Non-Motor Symptoms Scale) at baseline (V0) were considered as “with constipation”. Regression analyses were applied for determining the contribution of constipation in cognitive changes. Results: At V0, 39.7% (198/499) of PD patients presented constipation compared to 11.4% of controls (14/123) (p < 0.0001). No change was observed in cognitive status (PD-CRS total score) neither in controls without constipation (from 100.24±13.72 to 100.27±13.68; p = 0.971) and with constipation (from 94.71±10.96 to 93.93±13.03; p = 0.615). The PD-CRS total score decreased significantly in PD patients with constipation (from 89.14±15.36 to 85.97±18.09; p < 0.0001; Coehn’s effect = –0.35) compared to patients without constipation (from 93.92±15.58 to 93.14±17.52; p = 0.250) (p = 0.018). In PD patients, to suffer from constipation at V0 was associated with a decrease in the PD-CRS total score from V0 to V2 (β= –0.1; 95% CI, –4.36 – –0.27; p = 0.026) and having cognitive impairment at V2 (OR = 1.79; 95% CI, 1.01 – 3.17; p = 0.045). Conclusion: Constipation is associated with cognitive decline in PD patients but not in controls.

Abstract P56: Diffusion Tensor Imaging at the Time of Stroke is Associated With Cognitive Performance 4 Months Later

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kyle C Kern ◽  
Clinton B Wright ◽  
Richard Leigh
Keyword(s):  
Cognitive Impairment ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Linear Regression ◽  
Cognitive Performance ◽  
Diffusion Tensor ◽  
Cognitive Status ◽  
Cognitive Testing ◽  
Brain Health

Introduction: Cognitive impairment after stroke is associated with stroke severity and baseline brain health. We hypothesized that acute diffusion tensor imaging (DTI) metrics would identify patients at risk for post-stroke cognitive impairment. Methods: Patients were enrolled prospectively in an observational study that involves serial MRI and cognitive testing in patients with recent stroke and moderate white matter disease on MRI but without dementia. DTI was performed at the time of stroke; cognitive testing with the MOCA and the Telephone Interview for Cognitive Status (TICS) were performed 3 months later. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a measure of global white matter microstructural integrity previously validated in cerebral small vessel disease. Fractional anisotropy maps were skeletonized (figure panel A) and a histogram of the corresponding MD values was used to calculate the peak width in the non-stroke hemisphere (panel B). Linear regression was used to test whether acute PSMD in the non-stroke hemisphere, acute stroke volume, or baseline NIHSS predicted cognitive performance 3 months later. Results: Fourteen patients followed-up at a median of 123 days. Patients had a median age of 73 years, mean baseline NIHSS of 1.2 (IQR 0-1.75), mean infarct volume of 4cc (range 0-16cc), mean MOCA of 25 (range 19-30), mean TICS of 33 (range 23-41), and 50% were women. Using multivariable linear regression, only acute PSMD predicted follow-up MOCA (std beta= -0.64, adj R 2 = 0.37, p= 0.013) while compared to baseline NIHSS, PSMD showed a stronger association with follow-up TICS score (std beta= -0.57 vs -0.44, p= 0.017; model adj R 2 = 0.476, p= 0.011)(Panel C). Conclusions: In this cohort of patients with small strokes we found that acute contralateral PSMD provided a measure of brain health that appears to predict cognitive performance at 3 months better than stroke size or severity. These are preliminary findings from an ongoing study.

Treatment of dementia with bosutinib

2020 ◽  
pp. 10.1212/CPJ.0000000000000918
Author(s):  
Kennedy D. Mahdavi ◽  
Sheldon E. Jordan ◽  
Hannah R. Barrows ◽  
Maša Pravdic ◽  
Barshen Habelhah ◽  
...  
Keyword(s):  
Tyrosine Kinases ◽  
Kinase Inhibitors ◽  
Rating Scale ◽  
Cox Regression ◽  
Population Based ◽  
Cognitive Status ◽  
Secondary Outcome ◽  
Clinical Dementia Rating ◽  
Post Intervention

ObjectiveThe pursuit of an effective therapeutic intervention for dementia has inspired interest in the class of medications known as tyrosine kinase inhibitors such as bosutinib.MethodsThirty-one patients with probable Alzheimer's dementia or Parkinson's spectrum disorder with dementia completed 12 months of bosutinib therapy and an additional 12-months of follow-up. The Clinical Dementia Rating scale (as estimated by the Quick Dementia Rating System [QDRS]) was the primary cognitive status outcome measure. Secondary outcome measures included the Repeatable Battery Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment. Cox regression methods were used to compare results with population-based estimates of cognitive decline.ResultsThe present paper reports on cognitive outcomes obtained at 12 months for 31 participants and up to 24 months for a 16-participant subset. Safety and tolerability of bosutinib were confirmed among the study population (Mage = 73.7 years, SDage = 14 years). Bosutinib was associated with less worsening in Clinical Dementia Rating (CDR) scores (HR = −0.62, p < 0.001, 95% confidence interval [CI]: −1.02 to −0.30) and less decline in RBANS performance (HR = −3.42, p < 0.001, 95% CI: −3.59 to −3.72) during the year of treatment than population-based estimates of decline. In the 24-month follow up, wherein 16 patients were observed after 1 year post-intervention, 31.2% of participants exhibited worsened CDR levels compared to their 12-month performances.ConclusionsResults support an overall positive outcome after 1 year of bosutinib. Future studies should explore the relationship between tyrosine kinases and neurodegenerative pathology as well as related avenues of treatment.

scholarly journals Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up

2017 ◽  
Vol 11 (4) ◽  
pp. 381-388 ◽  
Author(s):  
Nilton Custodio ◽  
Rosa Montesinos ◽  
David Lira ◽  
Eder Herrera-Perez ◽  
Yadira Bardales ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Vascular Dementia ◽  
Cognitive Performance ◽  
Vascular Cognitive Impairment ◽  
Cognitive Test ◽  
Stroke Patients ◽  
Clinical Dementia Rating ◽  
Baseline Evaluation ◽  
Box Plot

ABSTRACT. There is limited evidence about the progression of cognitive performance during the post-stroke stage. Objective: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD). Methods: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). Results: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. Conclusion: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

Cross-Validation of the Newly-Normed SKT for the Detection of MCI and Dementia

GeroPsych ◽  
2017 ◽  
Vol 30 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Johannes Baltasar Hessler ◽  
Mark Stemmler ◽  
Horst Bickel
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Sensitivity And Specificity ◽  
Cross Validation ◽  
Performance Test ◽  
Community Dwelling ◽  
Clinical Dementia Rating ◽  
Female Community

Abstract. New regression-based norms for the SKT Short Cognitive Performance Test were introduced but have not been cross-validated for the detection of mild cognitive impairment (MCI) and dementia. We examined 562 (59.6% female) community-dwelling persons (mean age = 75.8, SD = 5.5) at baseline and followed up with up to three annual visits. Participants were classified as being healthy, with MCI, or with dementia according to the Clinical Dementia Rating (CDR) and the SKT. Overall congruency between the ratings was 57.8%. The correlation between SKT and MMSE scores reached r = –0.67. Sensitivity and specificity for MCI and dementia were 0.89 and 0.60 as well as 0.83 and 0.84, respectively. The SKT detected cognitive decline at early stages but produced increased rates of false positives.

scholarly journals Assessment of cognitive impairment and related risk factors in hemodialysis patients

2021 ◽  
Author(s):  
Hristos Karakizlis ◽  
Katharina Bohl ◽  
Jannis Ziemek ◽  
Richard Dodel ◽  
Joachim Hoyer
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Early Stage ◽  
Hemodialysis Patients ◽  
Cognitive Status ◽  
Cognitive Profile ◽  
Cognitive Test ◽  
Regional Government

Abstract Background Cognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. Methods We conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified into no cognitive impairment mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs. 1-year follow-up. Results Of 479 eligible patients, 408 completed all tests at baseline. Only 25% (n = 102) of the patients had no cognitive impairment. Fourteen per cent (n = 57), 36.5% (n = 149), and 24.5% (n = 100) of patients showed mild, moderate, and severe impairment, respectively. In patients with cognitive impairment, all cognitive domains were affected, and impairment was significantly associated with depression and education. The most impaired cognitive performance was immediate memory recall, and the best performance was found in naming ability. No significant  change was observed after 1 year- follow up in any domain. Conclusion Our study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. Furthermore, education has an effect on cognitive test results. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance. Graphic abstract

scholarly journals Psychometric Properties of the Clinical Dementia Rating Scale Sum of Boxes in Parkinson’s Disease

2020 ◽  
pp. 1-9
Author(s):  
Julia Gallagher ◽  
Jacqueline Rick ◽  
Sharon X. Xie ◽  
Pablo Martinez-Martin ◽  
Eugenia Mamikonyan ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Rating Scale ◽  
Clinical Dementia Rating ◽  
Functional Changes ◽  
Dementia Rating Scale ◽  
Normal Cognition ◽  
Domain Scores

Background: A composite measure that assesses both cognitive and functional abilities in Parkinson’s disease (PD) would be useful for diagnosing mild cognitive impairment (MCI) and PD dementia (PDD) and as an outcome measure in randomized controlled trials. The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) was designed to assess both cognition and basic-instrumental activities of daily living in Alzheimer’s disease but has not yet been validated in PD. Objective: To validate the CDR-SOB as a composite cognitive-functional measure for PD patients, as well as to assess its sensitivity to change. Methods: The CDR-SOB and a comprehensive cognitive and functional battery was administered to 101 PD patients at baseline (39 normal cognition [NC], 41 MCI and 21 PDD by expert consensus panel), and re-administered to 64 patients after 1-2 years follow-up (32 NC and 32 cognitive impairment [CI] at baseline). Results: Cross-sectionally, CDR-SOB and domain scores were correlated with corresponding neuropsychological or functional measures and were significantly different between cognitive subgroups both at baseline and at follow-up. In addition, CDR-SOB ROC curves distinguished between normal cognition and dementia with high sensitivity, but did not distinguish well between NC and MCI. Longitudinal changes in the CDR-SOB and domain scores were not significant and were inconsistent in predicting change in commonly-used cognitive and functional tests. Conclusion: The CDR-SOB detects dementia-level cognitive impairment in PD but may not be appropriate for predicting longitudinal combined cognitive-functional changes in patients without significant cognitive impairment at baseline.

scholarly journals Cognitive Impairment Is Not a Predictor of Failure to Adhere to Anticoagulation of Stroke Patients with Atrial Fibrillation

2015 ◽  
Vol 39 (5-6) ◽  
pp. 325-331 ◽  
Author(s):  
Solveig Horstmann ◽  
Timolaos Rizos ◽  
Michaela Saribas ◽  
Evdokia Efthymiou ◽  
Geraldine Rauch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Functional Status ◽  
Cognitive Performance ◽  
Functional Disability ◽  
Cognitive Status ◽  
Stroke Severity ◽  
Detailed Medical History

Background: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) is an effective strategy that is used for stroke prevention in patients with atrial fibrillation (AF). However, OAC is underused particularly in elderly patients, who are often physically disabled or cognitively impaired. We aimed at evaluating the effect of cognitive status and disability on OAC adherence 1 year after stroke or TIA. Methods: In this prospective, single-center, observational study patients with ischemic stroke or TIA were consecutively included between 3/2011 and 9/2012. The detailed medical history, basic demographic variables, cardiovascular risk factors, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), medication including OAC were all recorded. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional status was assessed by recording activities and instrumental activities of daily living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit to reassess the cognitive and functional status (MoCA, ADL and IADL) and to document the current use of OAC. Results: In total, 12 months after the ischemic stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not associated with the absence of OAC treatment. However, regression analysis revealed that patients with AF with physical (ADL) and functional disability (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, respectively) 12 months after a stroke. None of these two factors, however, was independently associated with nonadherence to OAC 12 months after stroke. Although cognitive performance was similar in patients receiving VKA and direct anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 0.12). Conclusions: In stroke and TIA patients with AF, the multifactorial medical and functional constellation rather than cognitive impairment specifically can be an obstacle for long-term OAC.

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