Perfil clínico neuropsicológico del deterioro cognitivo subtipo posible Alzheimer / Clinical and Neuropsychological Profile of Possible Alzheimer subtype neurocognitive disorder

Introducción: La enfermedad de Alzheimer se presenta con diferentes fenotipos neuropsicológicos y se considera que el deterioro de la memoria es su afectación más sobresaliente; no obstante, estudios recientes sugieren que los trastornos en las funciones ejecutivas pueden constituir marcadores muy tempranos de la enfermedad. Objetivos: Caracterizar los perfiles clínicos y neuropsicológicos que constituyen marcadores fenotípicos de los trastornos neurocognitivos subtipo posible Alzheimer. Métodos: Se realizó un estudio descriptivo y transversal de 39 enfermos con edades comprendidas entre 57-85 años, clasificados según los criterios del DSM-5, con deterioro cognitivo leve y mayor, catalogados desde el punto de vista etiológico en el subtipo posible Alzheimer. Se evaluaron múltiples dominios cognitivos (atención compleja, memoria y aprendizaje, funciones ejecutivas, lenguaje, funciones motoras y perceptuales) y se hizo una evaluación detallada de las funciones ejecutivas mediante un grupo de test neuropsicológicos específicos. Resultados: El análisis estadístico demostró que entre los dos grupos de estudio con deterioro cognitivo existen diferencias significativas en cuanto al nivel de funcionamiento cognitivo en todos los dominios explorados, excepto en la percepción y funciones motoras. Así mismo, los resultados demostraron que el nivel de rendimiento para cada función evaluada dentro del dominio de las funciones ejecutivas es significativamente diferente entre ambos grupos con deterioro cognitivo, excepto para la orientación espacial. Conclusiones: El perfil neuropsicológico del deterioro cognitivo subtipo posible Alzheimer se caracterizó por una afectación en múltiples dominios, con predominio de la disfunción ejecutiva focalizada en las áreas de la flexibilidad mental e inhibición de automatismos.

Introduction: Alzheimer disease is presented with different neuropsychological phenotypes and it is considered that the memory disorder is its most important one; however, recent studies suggest that the dysfunctions in the executive functions can constitute very early markers of the disease. Objectives: To characterize the clinical and neuropsychological profiles that constitutes phenotypical markers of the neurocognitive disorders possible Alzheimer subtype. Methods: A descriptive and cross-sectional study of 39 sick persons with ages between 57-85 years, classified according to the DSM-5 criteria, with cognitive mild and major disorder, classified from the etiological point of view in the possible Alzheimer subtype was carried out. Multiple cognitive domains were evaluated (complex attention, memory and learning, executive functions, language, motor and perceptual functions) and a detailed evaluation of the executive functions was made by means of a group of specific neuropsychological tests. Results: The statistical analysis demonstrated that comparing the two study groups with cognitive disorder, significant differences exist as for the level of cognitive performance in all the explored domains, except in the perception and motor functions. Likewise, the results demonstrated that the yielding level for each function evaluated within the domain of the executive functions is significantly different between both groups with cognitive disorder, except for the space orientation. Conclusions: The neuropsychological profile of the cognitive disorder Alzheimer possible subtype was characterized by a disorder in multiple domains, with predominance of the focused executive dysfunction in the areas of the mental flexibility and inhibition of automatisms.

Rendimiento Diagnóstico De Minimental Frente Al Dsm-5 En Trastorno Cognitivo: Experiencia De Una Cohorte En Colombia / Diagnostic Performance Of Minimental Against Dsm-5 In Cognitive Disorder. Experience Of A Cohort In Colombia

Resumen Antecedentes: Las herramientas de cribado cognitivo son útiles en el escenario clínico e investigación. MiniMental (MMSE) es uno de los instrumentos más utilizados en Colombia. El objetivo de este trabajo es determinar el rendimiento operativo del MMSE, frente a los nuevos criterios del DSM-5 para el diagnóstico de trastorno cognitivo. Materiales y métodos: Estudio de prueba diagnóstica ensamblado en una cohorte colombiana, se evaluó una muestra consecutiva de 200 participantes mayores de 50 años (66.5,+/-8.86) que representaron todo el espectro de la condición de interés, la prueba índice (MMSE) fue comparada con el estándar clínico de referencia (consenso diagnóstico y clasificación por criterios DSM-5). Resultados: Para trastorno cognitivo leve (TCL), el rendimiento diagnóstico de MMSE fue: Sensibilidad 45.3%(IC95% 33.7 a 57.4), especificidad 96.9% (IC95% 91.4 a 99.0) y exactitud del 76.9% (IC 95% 69.5 a 82.4) a un punto de corte de 26 y para trastorno cognitivo mayor (TCM) fue: Sensibilidad 76.32% (IC 95% 60.8-87.0) y especificidad 97.53% (IC 95% 93.8-99.0) en el punto de corte de 24. Conclusiones: MMSE continúa siendo una alternativa válida para diagnóstico de TCM, sin embargo, tiene limitada validez para la detección de TCL, por lo que nuevas herramientas con objetivo de cribado de TCL deben ser consideradas.

Abstract Background: Cognitive screening tools are useful in the clinical and research setting. MiniMental (MMSE) is one of the most used instruments in Colombia, the objective of this work is to determine its performance against the new criteria for the diagnosis of cognitive disorder (DSM-5). Materials and methods: Diagnostic test study, assembled in a Colombian cohort, we evaluated a consecutive sample of 200 participants older than 50 years (66.5,+/-8.86) that represented the whole spectrum of the condition of interest, the index test (MMSE) was compared with the clinical reference standard (consensus diagnosis and classification by criteria DSM-5). Results: For mild cognitive impairment (MCI), the diagnostic performance of MMSE was: Sensitivity 45.3% (95% CI 33.7 to 57.4), specificity 96.9% (95% CI 91.4 to 99.0) and 76.9% accuracy (95% CI 69.5 to 82.4) at a cut-off point of 26 and, for major cognitive disorder (MCD) was: Sensitivity 76.32% (95% CI 60.8-87.0) and specificity 97.53% (95% CI 93.8-99.0) at the cut-off point of 24. Conclusions: MMSE is a valid alternative for the diagnosis of MCD, however it has limited validity for the detection of MCI, so new tools for the purpose of screening of MCI should be considered.

Effect of Xingnao Kaiqiao acupuncture on clinical efficacy of patients with mild cognitive impairment after stroke and its mechanism / 中国中西医结合急救杂志

Objective To observe the effect of Xingnao Kaiqiao acupuncture on the clinical efficacy of patients with mild cognitive impairment (MCI) after stroke and to explore its mechanism. Methods A prospective randomized controlled clinical trial method was conducted, 128 patients with MCI after stroke admitted to Department of Acupuncture and Moxibustion of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from September 2015 to May 2017 were enrolled, and they were divided into a control group and an observation group according to the random number table method, 64 cases in each group. The control group took 40 mg of nimodipine, 3 times a day; on the basis of the treatment in control group, the observation group was additionally given acupuncture therapy for arousing the brain and opening the orifices or resuscitation as the interference, the main acupoints applied were renzhong, neiguan (bilateral) and sanyinjiao (bilateral), the scalp points used were mainly baihui joining qianding (GV-21WHO), xinhui (GV-22WHO) joining qianting and benshen (GB-13WHO, bilateral), once a day, 5 times a week; the therapeutic course was 10 weeks in both groups. The differences in scores of Montreal cognitive assessment scale (MoCA), mini-mental state examination (MMSE), and in the levels of serum amyloid A (SAA) andβ-amyloid (Aβ) between the two groups before and 6 and 10 weeks after treatment were compared. Results With the prolongation of therapeutic time, the MoCA and MMSE scores of the two groups were increased significantly after treatment compared with those before treatment, the levels of SAA and Aβ were obviously lower than those before treatment, and the degrees of changes of the above indexes in the observation group were more marked than those in the control group, after treatment for 10 weeks, there were statistical significant differences in MoCA and MMSE scores between the observation and control groups (MoCA score: 25.32±2.54 vs. 22.67±3.17, MMSE score: 28.38±2.74 vs. 24.36±3.27), while after 6 weeks of treatment, the statistical significant differences in SAA and Aβlevels appeared between the two groups [SAA (μg/L): 74.52±25.64 vs. 103.36±27.53, Aβ (ng/L): 95.32±25.64 vs. 127.27±29.73, both P ＜ 0.05], and the situation persisted to 10 weeks after treatment [SAA (μg/L): 57.36±18.24 vs. 84.37±25.56, Aβ (ng/L): 55.47±21.36 vs. 92.74±23.57, both P ＜ 0.05]. Conclusion Resuscitation acupuncture possibly can inhibit the expression protein levels of serum SAA and Aβto improve the cognitive function of patients with MCI after stroke.

Working Memory Span in Normal Control, Mild Cognitive Impairment and Alzheimer's Disease

OBJECTIVE: The purposes of this study were to compare the working memory span between mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the Korean elderly population and to evaluate the effectiveness of the working memory span tests. METHODS: 32 normal controls (NC), 26 patients with MCI and 28 AD patients at a mild stage were participated in this study. We used newly devised working memory span tests (Word span test and Dot matrix) according to the components of working memory ;central executive, phonological loop, and visuospatial sketchpad. And the results were compared with the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K). To evaluate the effectiveness of the working memory tests and CERAD-K to screen MCI and AD, receiver operating characteristic curves were plotted. RESULTS: All subsets of the two working memory span tests showed significant decline in verbal and visuospatial working memory in AD. But there was no significant difference between NC and MCI. Compared to CERAD-K, the two working memory tests showed good effectiveness to discriminate AD. CONCLUSION: This study showed that working memory span tests could be effective diagnosing tools for detecting AD. But for the MCI, the working memory impairment was not prominent than episodic memory impairment. This is supposed to result from the various kinds of working memory components, especially the episodic buffer.

Extrapyramidal Signs and Risk of Progression from Mild Cognitive Impairment to Dementia: A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer's disease (AD) and to other types of dementia. METHODS: Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. RESULTS: A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53–0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p < 0.001). CONCLUSION: EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.

The Effect of Computer-Based Cognitive Training Program On Cognition

BACKGROUND: Effective non-pharmacological cognitive program to prevent Alzheimer's dementia or slow its progression are an urgent international priority. The effect of computer-based cognitive training program has not been demonstrated yet in dementia. The purpose of this study is to know whether the computer-based cognitive training improved cognitive abilities in patients with mild cognitive disorder and early stage of dementia. METHODS: Totally 20 participants (14 with MCI and 6 with mild Alzhiemer dementia) participated in this study. To test the effectiveness of computer-based cognitive training programs to cognition, all patient were randomly allocated to an intervention group (n=10) or a control group (n=10) An intervention group received regularly computer-based cognitive training totally 20 times for 10 weeks. Neuropsychological examinations were conducted before and after this period. RESULTS: After 10 weeks, intervention group showed a significant change in language of K-MMSE compared with baseline cognitive examinations. Also, there was improvement in attention (backward digit span), calculation, memory, and frontal function for the intervention group as compared with controls. Patients with mild cognitive disorder showed marked improvements in language and visuospatial capacity, while patients with dementia showed no or slight improvement in these fields. CONCLUSIONS: Computer-based cognitive training program might have beneficial effect on general cognitive function in both mild cognitive disorder and dementia. Especially, conspicuous effectiveness showed in patients with mild cognitive disorder.