scholarly journals How to Prepare for the SCE in Neurology

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Riona Mc Ardle ◽  
◽  
Silvia Del Din ◽  
Alison Yarnall ◽  
◽  
...  
Keyword(s):  
Gait Analysis ◽  
Accurate Diagnosis ◽  
Dementia Diagnosis ◽  
Care Plans ◽  
Diagnosis Of Dementia ◽  
Disease Subtypes ◽  
Novel Targets ◽  
Disease Stages ◽  
Potential Use ◽  
Gait Impairments

Gait, the way that we walk, requires complex cognitive functions. Gait may be a useful early marker for dementia diagnosis, as gait impairments precede and reflect cognitive decline. Early diagnosis of dementia enables individuals and their families to make informed decisions about their care plans, and allows researchers to understand preclinical and prodromal disease stages, providing novel targets for drug therapies. As such, a range of biomarkers are being developed to improve early and accurate diagnosis, including gait analysis. This editorial will outline how gait analysis can support the clinical diagnosis of dementia, including evidence of unique signatures of gait which can aid the identification of cognitive impairment and discrete dementia disease subtypes, the potential use of wearable technology to assess gait in the clinic and the real world, and key recommendations for the future implementation of gait into the diagnostic toolkit for dementia.

P1-260: CAN GAIT ANALYSIS AID DIFFERENTIAL DIAGNOSIS OF DEMENTIA DISEASE SUBTYPES?

2006 ◽  
Vol 14 (7S_Part_7) ◽  
pp. P380-P381
Author(s):  
Ríona Mc Ardle ◽  
Brook Galna ◽  
Alan Thomas ◽  
Lynn Rochester
Keyword(s):  
Differential Diagnosis ◽  
Gait Analysis ◽  
Diagnosis Of Dementia ◽  
Disease Subtypes ◽  
Differential Diagnosis Of Dementia

A Systematic Review of Expressive and Receptive Prosody in People With Dementia

2021 ◽  
Vol 64 (10) ◽  
pp. 3803-3825
Author(s):  
Chorong Oh ◽  
Richard J. Morris ◽  
Xianhui Wang
Keyword(s):  
Diagnostic Tool ◽  
Methodological Quality ◽  
Primary Diagnosis ◽  
Speech Analysis ◽  
Prosodic Features ◽  
Medical Subject Headings ◽  
Dementia Diagnosis ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
Potential Use

Purpose This review was designed to provide a systematic overview of prosody in people with a primary diagnosis of dementia (PwD) and evaluate the potential use of prosodic features for diagnosis of dementia. Method A systematic search of five databases was conducted using Medical Subject Headings and keywords. Studies included in the review were evaluated for their methodological quality using the modified Joanna Briggs Institute checklist. Results A total of 14 articles were identified as being relevant for this review. Among the 14 articles, the methodological quality ranged, with eight rated as weak, four rated as moderate, and two rated as strong. Ten of the 14 articles had people with Alzheimer's disease (AD) as participants, and the remaining four had people with frontotemporal dementia as participants. Four articles focused on receptive prosody, another six focused on expressive prosody, and the remaining four articles were investigations into both. The 14 articles presented inconsistent findings, and various tasks were used to measure prosodic features in PwD in the articles. Prosody was studied as a diagnostic tool for dementia in four of the articles, all of which were based on expressive prosody in individuals with AD. Among the four articles, three proposed the use of automatic speech analysis for diagnosis of AD. Conclusions This review demonstrates that prosody in PwD is an underinvestigated area. In particular, it was concerning that most articles were of weak methodological quality. Nevertheless, it was found that prosody may be a potential diagnostic tool for assessing dementia. More studies that replicate the existing studies and those with stronger methodology are needed to confirm that receptive and/or expressive prosody can be used for dementia diagnosis.

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis

2021 ◽  
pp. 1-13
Author(s):  
Elena Tsoy ◽  
Alissa Bernstein Sideman ◽  
Stefanie D. Piña Escudero ◽  
Maritza Pintado-Caipa ◽  
Suchanan Kanjanapong ◽  
...  
Keyword(s):  
Older Adult ◽  
Adult Population ◽  
Dementia Diagnosis ◽  
Cognitive Assessments ◽  
Middle Income ◽  
Global Perspectives ◽  
Dementia Patients ◽  
Diagnosis Of Dementia ◽  
Theme Identification ◽  
Diagnostic Decision Making

Background: Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. Objective: To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. Methods: This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. Results: Four domains with subthemes emerged illustrating participants’ perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. Conclusion: BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

scholarly journals Machine-learning based identification of undiagnosed dementia in primary care: a feasibility study

BJGP Open ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. bjgpopen18X101589 ◽  
Author(s):  
Emmanuel A Jammeh ◽  
Camille, B Carroll ◽  
Stephen, W Pearson ◽  
Javier Escudero ◽  
Athanasios Anastasiou ◽  
...  
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Case Control ◽  
Classification Model ◽  
Dementia Diagnosis ◽  
Machine Learning Classification ◽  
Primary Care Data ◽  
Dementia Risk ◽  
Diagnosis Of Dementia ◽  
Read Codes

BackgroundUp to half of patients with dementia may not receive a formal diagnosis, limiting access to appropriate services. It is hypothesised that it may be possible to identify undiagnosed dementia from a profile of symptoms recorded in routine clinical practice.AimThe aim of this study is to develop a machine learning-based model that could be used in general practice to detect dementia from routinely collected NHS data. The model would be a useful tool for identifying people who may be living with dementia but have not been formally diagnosed.Design & settingThe study involved a case-control design and analysis of primary care data routinely collected over a 2-year period. Dementia diagnosed during the study period was compared to no diagnosis of dementia during the same period using pseudonymised routinely collected primary care clinical data.MethodRoutinely collected Read-encoded data were obtained from 18 consenting GP surgeries across Devon, for 26 483 patients aged >65 years. The authors determined Read codes assigned to patients that may contribute to dementia risk. These codes were used as features to train a machine-learning classification model to identify patients that may have underlying dementia.ResultsThe model obtained sensitivity and specificity values of 84.47% and 86.67%, respectively.ConclusionThe results show that routinely collected primary care data may be used to identify undiagnosed dementia. The methodology is promising and, if successfully developed and deployed, may help to increase dementia diagnosis in primary care.

scholarly journals Assessing the concurrent validity of a gait analysis system integrated into a smart walker in older adults with gait impairments

2019 ◽  
Vol 33 (10) ◽  
pp. 1682-1687 ◽  
Author(s):  
Christian Werner ◽  
Georgia Chalvatzaki ◽  
Xanthi S Papageorgiou ◽  
Costas S Tzafestas ◽  
Jürgen M Bauer ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Gait Speed ◽  
Concurrent Validity ◽  
Stride Length ◽  
Gait Parameters ◽  
Stance Time ◽  
Absolute Agreement ◽  
Analysis System ◽  
Smart Walker ◽  
Gait Impairments

Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system with the GAITRite® system for measuring spatiotemporal gait parameters in potential users of the smart walker. Design: Criterion standard validation study. Setting: Research laboratory in a geriatric hospital. Participants: Twenty-five older adults (⩾65 years) with gait impairments (habitual rollator use and/or gait speed <0.6 m/s) and no severe cognitive impairment (Mini-Mental State Examination ⩾17). Main measures: Stride, swing and stance time; stride length; and gait speed were simultaneously recorded using the smart walker–integrated gait analysis system and the GAITRite system while participants walked along a 7.8-m walkway with the smart walker. Concurrent criterion-related validity was assessed using the Bland–Altman method, percentage errors (acceptable if <30%), and intraclass correlation coefficients for consistency (ICC3,1) and absolute agreement (ICC2,1). Results: Bias for stride, swing and stance time ranged from −0.04 to 0.04 seconds, with acceptable percentage errors (8.7%–23.0%). Stride length and gait speed showed higher bias (meanbias (SD) = 0.20 (0.11) m; 0.19 (0.13) m/s) and not acceptable percentage errors (31.3%–42.3%). Limits of agreement were considerably narrower for temporal than for spatial-related gait parameters. All gait parameters showed good-to-excellent consistency (ICC3,1 = 0.72–0.97). Absolute agreement was good-to-excellent for temporal (ICC2,1 = 0.72–0.97) but only poor-to-fair for spatial-related gait parameters (ICC2,1 = 0.37–0.52). Conclusion: The smart walker–integrated gait analysis system has good concurrent validity with the GAITRite system for measuring temporal but not spatial-related gait parameters in potential end-users of the smart walker. Stride length and gait speed can be measured with good consistency, but with only limited absolute accuracy.

Differentiating dementia disease subtypes with gait analysis: feasibility of wearable sensors?

2020 ◽  
Vol 76 ◽  
pp. 372-376 ◽  
Author(s):  
Ríona Mc Ardle ◽  
Silvia Del Din ◽  
Brook Galna ◽  
Alan Thomas ◽  
Lynn Rochester
Keyword(s):  
Gait Analysis ◽  
Wearable Sensors ◽  
Disease Subtypes

Standardising Dementia Diagnosis Across Linguistic and Educational Diversity: Study Design of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB)

2019 ◽  
Vol 26 (2) ◽  
pp. 172-186
Author(s):  
Gowri K. Iyer ◽  
Avanthi Paplikar ◽  
Suvarna Alladi ◽  
Aparna Dutt ◽  
Meenakshi Sharma ◽  
...  
Keyword(s):  
Medical Research ◽  
Test Battery ◽  
Diagnostic Tools ◽  
Indian Languages ◽  
Dementia Diagnosis ◽  
Middle Income ◽  
Indian Council ◽  
Diagnosis Of Dementia ◽  
Neurocognitive Test ◽  
Educational Diversity

AbstractObjectives:While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings.Methods:A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India.Results:Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed.Conclusions:A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.

scholarly journals Against the stream: early diagnosis of dementia, is it so desirable?

2019 ◽  
Vol 43 (3) ◽  
pp. 123-125 ◽  
Author(s):  
Carol Brayne ◽  
Sarah Kelly
Keyword(s):  
Clinical Practice ◽  
Early Diagnosis ◽  
Empirical Evidence ◽  
Treatment Options ◽  
Evidence Base ◽  
Current Evidence ◽  
Dementia Diagnosis ◽  
Case Identification ◽  
Current Evidence Base ◽  
Diagnosis Of Dementia

SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services.Declaration of interestNone.

The Potential of Gait Analysis to Contribute to Differential Diagnosis of Early Stage Dementia: Current Research and Future Directions

2007 ◽  
Vol 26 (1) ◽  
pp. 19-32 ◽  
Author(s):  
Debra Morgan ◽  
Melanie Funk ◽  
Margaret Crossley ◽  
Jenny Basran ◽  
Andrew Kirk ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Gait Analysis ◽  
Early Stage ◽  
Lewy Bodies ◽  
Classification Systems ◽  
Assessment Tools ◽  
Diagnostic Process ◽  
Future Research ◽  
Timely Access ◽  
Diagnosis Of Dementia

ABSTRACTEarly differential diagnosis of dementia is becoming increasingly important as new pharmacologic therapies are developed, as these treatments are not equally effective for all types of dementia. Early detection and differential diagnosis also facilitates informed family decision making and timely access to appropriate services. Information about gait characteristics is informative in the diagnostic process and may have important implications for discriminating among dementia subtypes. The aim of this review paper is to summarize existing research examining the relationships between gait and dementia, including gait classification systems and assessment tools, gait patterns characteristic of different dementias (Alzheimer's disease, vascular dementia, dementia with Lewy Bodies, and fronto-temporal dementia), and the utility of gait analysis in early-stage diagnosis. The paper concludes with implications for future research.

Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?

2015 ◽  
Vol 28 (3) ◽  
pp. 359-369 ◽  
Author(s):  
Bernhard Michalowsky ◽  
Tilly Eichler ◽  
Jochen René Thyrian ◽  
Johannes Hertel ◽  
Diana Wucherer ◽  
...  
Keyword(s):  
Primary Care ◽  
Resource Utilization ◽  
Healthcare Cost ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Community Dwelling ◽  
Total Healthcare Cost ◽  
Dementia Diagnosis ◽  
Medication Treatment ◽  
Diagnosis Of Dementia

ABSTRACTBackground:It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs.Method:This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models.Results:Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients).Conclusion:There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.

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