Age- and education-adjusted normative data for the Montreal Cognitive Assessment (MoCA) in older adults age 70–99

The original validation study for the Montreal Cognitive Assessment (MoCA) suggests a cutoff score of 26; however, this may be too stringent for older adults, particularly for those with less education. Given the rapidly increasing number of older adults and associated risk of dementia, this study aims to provide appropriate age- and education-adjusted norms for the MoCA. Data from 205 participants in an ongoing longevity study were used to derive normative data. Individuals were grouped based on age (70–79, 80–89, 90–99) and education level (≤12 Years, 13–15, ≥16 Years). There were significant differences between age and education groups with younger and more educated participants outperforming their counterparts. Forty-six percent of our sample scored below the suggested cutoff of 26. These normative data may provide a more accurate representation of MoCA performance in older adults for specific age and education stratifications.     

The Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in the diagnosis of subcortical vascular dementia and Alzheimer’s disease

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer’s disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group’s differences were evaluated using the Quade’s rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).     

Visual associations to retrieve episodic memory across healthy elderly,mild cognitive impairment,and patients with Alzheimer’s disease

Episodic memory tests need to determine the degree to which patients with moderate to severe memory deficits can still benefit from retrieval support. Especially in the case of Alzheimer’s disease (AD), this may support health care to be more closely aligned with patients’ memory capacities. We investigated whether the different measures of episodic memory of the Visual Association Test-Extended (VAT-E) can provide a more detailed and informative assessment on memory disturbances across a broad range of cognitive decline, from normal to severe impairment as seen in AD, by examining differences in floor effects. The VAT-E consists of 24 pairs of black-and-white line drawings. In a within-group design, we compared score distributions of VAT-E subtests in healthy elderly controls, mild cognitive impairment (MCI), and AD (n = 144), as well as in relation to global cognitive impairment. Paired associate recall showed a floor effect in 41% of MCI patients and 62% of AD patients. Free recall showed a floor effect in 73% of MCI patients and 84% of AD patients. Multiple-choice cued recognition did not show a floor effect in either of the patient groups. We conclude that the VAT-E covers a broad range of episodic memory decline in patients. As expected, paired associate recall was of intermediate difficulty, free recall was most difficult, and multiple-choice cued recognition was least difficult for patients. These varying levels of difficulty enable a more accurate determination of the level of retrieval support that can still benefit patients across a broad range of cognitive decline.     

Differences in cognitive performance between informal caregivers and non-caregivers

ABSTRACT

Extensive literature exists documenting the relationship between stress and cognition. Caregiving for an individual with Alzheimer’s disease can be aunique and chronic stress experience due to the increasing dependency of the care-recipient as the disease progresses. The current study examines the relationship between stress and cognitive performance in 47 dementia caregivers compared to 47 noncaregiver control participants matched on age, gender, and education. Participants completed measures assessing stress (measured via the Perceived Stress Scale) and seven domains of cognition including episodic memory, working memory, executive functioning, attention, visuospatial processing, processing speed, and implicit memory. Results showed that caregivers had poorer performance than non-caregivers on certain measures of episodic memory, working memory, and executive functioning; while no significant differences were observed on measures of attention, visuospatial processing, processing speed, or implicit memory. In addition, when controlling for general stress, caregiver performance on measures of processing speed and visuospatial processing was also poorer than non-caregivers. By controlling for levels of general stress that may not be related to caregiving, these results show that differences in cognitive performance are unlikely to be explained by general stress alone.     

前临床期痴呆的认知特征：当前研究进展和未来研究展望

在这篇文章中, 我将讨论从正常老化到痴呆, 这一通常被称为痴呆前临床阶段的认知功能的转变。研究表明, 阿尔茨海默症和血管性痴呆病人在临床确诊之前的几年中, 会出现明显的认知损伤。早期最突出的损伤存在于情节记忆、加工速度以及执行功能。这些功能性损伤与神经生物学研究证实的边缘系统和新皮层区存在多重损伤是相一致的。虽然早在临床诊段之前, 病人组和控制组的平均成绩存在巨大差异, 但同时这两组测试成绩的分布在很大程度上是重叠的。寻求降低这种重叠度的方法是未来研究的一个重要任务。这有可能通过将认知的和其他指标(如基于脑的、基因的、临床的、社会的)相结合构建预测模型来实现。此外, 在未来研究中以下三方面也是急需考虑问题: (a) 找出在 前临床期间认知功能急速下降的时间点: (b) 评估从前临床到临床诊断变化速率中存在的个体差异; (c) 确定特定因素与随后发生的痴呆之间的关联强度是如何随时间向临床确诊推进而逐渐变化的。     

Measuring emotion recognition: Added value in diagnosing dementia of the Alzheimer’s disease type

Neuropsychological tests, particularly for episodic memory, are used to classify patients in memory clinics. Still, the differential diagnosis between dementia of the Alzheimer’s disease type (Dementia-AD), mild cognitive impairment (MCI), or major depressive disorder (MDD) is challenging. However, impairments in other domains, such as emotion recognition, an aspect of social cognition, might have additional value in distinguishing Dementia-AD from MCI and MDD and hence signal progression of neurodegeneration. We evaluated this in patients visiting a memory clinic. Sixty healthy controls (HC) and 143 first time attendants of an academic hospital memory clinic who were eventually classified as Dementia-AD (n = 45), MCI (n = 47), MDD (n = 27), or No Impairment (NI, n = 24) were included. We assessed group differences in Emotion Recognition (Ekman 60 Faces Test (EFT)) and episodic memory (Dutch Rey Auditory Verbal Learning Test (RAVLT)). With multinomial and binomial regression analysis, we assessed whether EFT was added to RAVLT in distinguishing patient groups. Dementia-AD patients had significantly worse emotion recognition than HC, MCI, MDD, and NI groups, but no other between-group differences were found. Episodic memory was impaired in Dementia-AD and MCI patients. We found no memory impairments in the MDD and NI groups. Emotion recognition in addition to episodic memory was significantly better in predicting group membership than episodic memory alone. In conclusion, emotion recognition measurement had added value for differentiation between patients first visiting memory clinics, in particular in distinguishing Dementia-AD from MCI. We recommend the standard inclusion of emotion recognition testing in neuropsychological assessment in memory clinics.     

Association of financial and health literacy with cognitive health in old age

We tested the hypothesis that higher financial and health literacy is associated with better cognitive health in 755 older persons who completed a literacy measure (M = 67.9, SD = 14.5) and then had annual clinical evaluations for a mean of 3.4 years. In proportional hazards models, higher literacy was associated with decreased risk of developing incident Alzheimer’s disease (n = 68) and results were similar for financial and health literacy subscales and after adjustment for potential confounders. In mixed-effects models, higher literacy was related to higher baseline level of cognition and reduced cognitive decline in multiple domains. Among the 602 persons without any cognitive impairment at baseline, higher literacy was associated with a reduced rate of cognitive decline and risk of developing incident mild cognitive impairment (n = 142). The results suggest that higher levels of financial and health literacy are associated with maintenance of cognitive health in old age.     

空间参照框架的产生机制及与认知机能的关系

空间参照框架是个体表征空间方位的方式, 按照表征中心的不同分为自我中心和环境中心两种参照框架。长期对某一参照框架的持续激活可以形成对该空间参照框架的偏好, 不仅会影响个体的神经元结构, 还会对认知机能产生重要影响。偏好环境中心参照框架会增加海马及其附近脑区的灰质, 而偏好自我中心参照框架会增加尾状核的灰质。海马灰质体积增大会增强正常人的空间记忆能力。持续激活环境中心参照框架的个体会增加海马灰质体积, 从而降低患老年痴呆的风险。未来研究应关注, 地域差异、城乡差异等环境差异在空间参照框架与认知机能关系中的影响机制, 并进一步收集空间参照框架训练在老年痴呆病人中干预效果的实证证据。     

Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self-report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview-based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self-report tool. We confirmed three apathy factors in this new caregiver measure (AMI-CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self-reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI-CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under-rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice.     

Examining the reliability of ADAS-Cog change scores

The purpose of this study was to estimate and examine ways to improve the reliability of change scores on the Alzheimer’s Disease Assessment Scale, Cognitive Subtest (ADAS-Cog). The sample, provided by the Alzheimer’s Disease Neuroimaging Initiative, included individuals with Alzheimer’s disease (AD) (n = 153) and individuals with mild cognitive impairment (MCI) (n = 352). All participants were administered the ADAS-Cog at baseline and 1 year, and change scores were calculated as the difference in scores over the 1-year period. Three types of change score reliabilities were estimated using multivariate generalizability. Two methods to increase change score reliability were evaluated: reweighting the subtests of the scale and adding more subtests. Reliability of ADAS-Cog change scores over 1 year was low for both the AD sample (ranging from .53 to .64) and the MCI sample (.39 to .61). Reweighting the change scores from the AD sample improved reliability (.68 to .76), but lengthening provided no useful improvement for either sample. The MCI change scores had low reliability, even with reweighting and adding additional subtests. The ADAS-Cog scores had low reliability for measuring change. Researchers using the ADAS-Cog should estimate and report reliability for their use of the change scores. The ADAS-Cog change scores are not recommended for assessment of meaningful clinical change.     

激素替代治疗对绝经妇女心脏保护效应的重新认识

激素替代疗法（HRT）已有数十年历史,但是否具有心脏保护效应一直存在争议。早期研究提示HRT可维持血管正常功能,但大样本随机对照研究却发现服用雌激素和孕激素妇女的心血管疾病较安慰剂组增加22％,这导致了HRT应用的急剧减少。而2007年妇女健康启动计划——冠状动脉钙化研究（WHI—CACS）却证实HRT能显著降低冠状动脉钙化,再次提起了人们对HRT心脏保护效应的关注。     

Executive dysfunction affects word list recall performance: Evidence from amyotrophic lateral sclerosis and other neurodegenerative diseases

The Rey Auditory Verbal Learning Test (RAVLT) is widely used in clinical practice to evaluate verbal episodic memory. While there is evidence that RAVLT performance can be influenced by executive dysfunction, the way executive disorders affect the serial position curve (SPC) has not been yet explored. To this aim, we analysed immediate and delayed recall performances of 13 non‐demented amyotrophic lateral sclerosis (ALS) patients with a specific mild executive dysfunction (ALSci) and compared their performances to those of 48 healthy controls (HC) and 13 cognitively normal patients with ALS. Moreover, to control for the impact of a severe dysexecutive syndrome and a genuine episodic memory deficit on the SPC, we enrolled 15 patients with a diagnosis of behavioural variant of frontotemporal dementia (bvFTD) and 18 patients with probable Alzheimer's disease (AD). Results documented that, compared to cognitively normal subjects, ALSci patients had a selective mid‐list impairment for immediate recall scores. The bvFTD group obtained low performances with a selectively increased forgetting rate for terminal items, whereas the AD group showed a disproportionately large memory loss on the primary and middle part of the SPC for immediate recall scores and were severely impaired in the delayed recall trial. These results suggested that subtle executive dysfunctions might influence the recall of mid‐list items, possibly reflecting deficiency in control strategies at retrieval of word lists, whereas severer dysexecutive syndrome might also affect the recall of terminal items possibly due to attention deficit or retroactive interference.     

The impact of cognitive interventions on cognitive symptoms in idiopathic Parkinson’s disease: a systematic review

This systematic review addressed efficacy of cognitive stimulation (CS), cognitive training (CT), and cognitive rehabilitation (CR) to improve cognitive functions in Parkinson’s disease (PD) with (PD-MCI) and without mild cognitive impairment (PD-H). Five databases were searched. Twelve CT, four CS, and a combination of CT with CR were found. PD-H benefited from CT or CS compared to active or passive controls in 42.1% of cognitive tests, and in 33.3% of psychological and functional measures. PD-MCI alone, compared with controls, only improved in 6.9% of cognitive measures after CT. PD-H and PD-MCI, alone or together, somehow improved information processing speed, attention, working memory, executive functions, and visual episodic memory. PD-MCI improved better than PD-H in global cognition and planning abilities. The outcomes suggest some efficacy of cognitive interventions in PD. However, small samples, lack of information regarding standardization of interventions, and poor methodological quality limit results validity and prevent firm conclusions.     

年老化对风险决策和模糊决策的影响：来自生理性和病理性老化的证据

随着“全球老龄化”时代的到来, 老年人认知功能的下降引起了研究人员的广泛关注, 其中年老化对决策的影响成为了近年来的一个新关注点。风险决策和模糊决策受生理性老化和病理性老化影响的研究显示, 正常老化个体模糊决策能力受损, 但其风险决策能力受老化影响较小; 而病理性老化个体, 以阿尔兹海默症患者为例, 在两类决策行为上均表现出损伤; 此外, 脑神经机制的研究发现在完成决策任务时正常年老化个体纹状体激活模式与年轻人存在显著差异, 病理性老化个体杏仁核与腹内侧前额叶的功能连接亦存在异常。未来的研究应同时考察并比较两类决策类型, 结合外周和中枢神经证据, 深入探讨老化对决策行为及神经环路造成影响的机制。     

Comparison of Scoring Criteria for Clock Drawing Test

This study compared clock drawings by 42 medically hospitalized patients with a mean age of 51.9 (SD = 10.1) years, using four sets of published scoring criteria to determine comparability of classification and to assess validity by comparison to other measures of cognitive functioning. We found impairment in 20 of 42 cases using the criteria of Mendez et al. (1992); 11 of 42 cases by Sunderland et al. (1989); 9 of 42 cases with Freedman et al. (1994); and 8 of 42 cases according to Rouleau et al. (1992). Kappa coefficients of impairment status between sets of scoring criteria ranged from .41 to .86. Pearson correlations of raw scores between schemes ranged from .72 to .94. All except Sunderland et al. were significantly correlated with the Standardized Mini-Mental State Examination. All correlated significantly with the Wechsler Adult Intelligence Scale–Revised Block Design; however, only Mendez et al. correlated significantly with the Neurobehavioral Cognitive Status Examination. On the basis of these results and our experience, we recommend using the Freedman scoring scheme.     

Alcoholism,Aging, and Cognition: A Review of Evidence for Shared or Independent Impairments

Little is known about the combined effects of aging and alcoholism on cognitive function, in spite of the potential importance of this knowledge. Studies reported to date have focused on whether aging and alcoholism have shared mechanisms (i.e., the premature aging hypothesis) or independent mechanisms. Most have concluded that the effects of aging and alcoholism on cognition operate through independent mechanisms. However, there are reasons to doubt this conclusion. Many of the studies were not optimally designed to discover shared mechanisms because they used a limited range of ages, included several different groups in their analyses, or had low statistical power. Furthermore, interpretation of the patterns of main effects and interactions between aging and alcoholism is not straightforward. Assumptions must be made about the nature of the impairments in order to interpret the data. This review uses several theories of cognitive aging as an organizing heuristic for interpreting the extant data on aging, cognition, and alcoholism. Some potential shared mechanisms for cognitive deficits in aging and alcoholism are identified, such as information processing speed and proactive interference in working memory. In contrast, some potential independent mechanisms are also identified, such as decay from working and long-term memory. These mechanisms should be used as a base to guide necessary further research.     

Divergent effects of healthy ageing on semantic knowledge and control: Evidence from novel comparisons with semantically impaired patients

Effective use of semantic knowledge requires a set of conceptual representations and control processes which ensure that currently relevant aspects of this knowledge are retrieved and selected. It is well-established that levels of semantic knowledge increase across the lifespan. However, the effects of ageing on semantic control processes have not been assessed. I addressed this issue by comparing the performance profiles of young and older people on a verbal comprehension test. Two sets of variables were used to predict accuracy and RT in each group: (1) the psycholinguistic properties of words probed in each trial and (2) the performance on each trial by two groups of semantically impaired neuropsychological patients. Young people demonstrated poor performance for low-frequency and abstract words, suggesting that they had difficulty processing words with intrinsically weak semantic representations. Indeed, performance in this group was strongly predicted by the performance of patients with semantic dementia, who suffer from degradation of semantic knowledge. In contrast, older adults performed poorly on trials where the target semantic relationship was weak and distractor relationships strong – conditions which require high levels of controlled processing. Their performance was not predicted by the performance of semantic dementia patients, but was predicted by the performance of patients with semantic control deficits. These findings indicate that the effects of ageing on semantic cognition are more complex than has previously been assumed. While older people have larger stores of knowledge than young people, they appear to be less skilled at exercising control over the activation of this knowledge.     

The Effects of Adapted Tango on Spatial Cognition and Disease Severity in Parkinson's Disease

The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinson's disease (PD) while controlling for the effects of social interaction. Thirty-three individuals with mild-to-moderate PD (stage I–III) were assigned to twenty 90-min tango (n = 24) or education (n = 9) lessons over 12 weeks. Disease severity, spatial cognition, balance, and fall incidence were evaluated pre-, post-, and 10–12 weeks postintervention. The authors evaluated differences using t tests and analyses of variance. Twenty-three tango and 8 education participants finished. Tango participants improved on disease severity (p = .008), and spatial cognition (p = .021) compared with education participants. Tango participants also improved in balance (p = .038), and executive function (p = .012). Gains were maintained 10–12 weeks postintervention. Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD.     

Brief Cognitive Behavioral Therapy for Insomnia in Parkinson's Disease: A Case Series Study1

Parkinson's disease (PD) patients frequently suffer from insomnia and insomnia can result in reduction of quality of life in PD. Although pharmacotherapy is most applicable for insomnia, it may cause side-effects in PD. The purpose of the study was to investigate the efficacy of brief cognitive behavioral therapy for insomnia (CBTI) in PD. A total of 11 PD patients aged 43–84 years with chronic insomnia received two sessions of CBTI. Patients reported a significant decrease in total score for the Insomnia Severity Index (ISI). The total score for the Parkinson's Disease Sleep Scale (PDSS) improved. Although objective sleep measured by actigraph did not improve, subjective sleep measured by sleep diary improved. Functional impairment measured by the Sheehan Disability Scale (SDS) significantly decreased. These results revealed that brief CBTI was effective in improving insomnia in PD, with improvements extending to functional impairments that had been affected by insomnia. Additionally, this non-pharmacotherapy treatment could be easily applied to PD patients who may have difficulty coming to the clinic frequently due to physical symptoms.