Associations between physical activity, sedentary behaviour and cognitive domain performance of people living with mild cognitive impairment in the community.

INTRODUCTION: Physical activity is known to positively influence cognitive performance. For adults with mild cognitive impairment (MCI), the relationship between physical activity levels and cognitive performance is unknown. This cross-sectional study aimed to determine if cognitive performance [as measured by the Montreal Cognitive Assessment (MoCA)] of people living in the community with MCI is associated with their physical activity levels or sedentary behaviour. METHODS: ActivPAL™ accelerometers were used to objectively measure physical activity and sedentary behaviour for seven full days. Cognitive performance was measured using the MoCA. CONSUMER AND COMMUNITY INVOLVEMENT: No involvement other than as research participants RESULTS: Eighty-two participants from the Balance on the Brain randomised controlled trial were included. Most participants were retired (88%), with 33 (40%) reporting a fall in the last year. The median MoCA score was 24 (IQR 22-26). Participants achieved a mean of 6296 (±2420) steps per day and were sedentary for 10.6 (±2) hours per day. The only physical activity outcomes that had a fair, positive correlation were moderate- to vigorous-intensity physical activity measures of total stepping time and total number of steps (with a cadence of ≥100 steps/min) with the orientation MoCA domain score (r(82) = 0.36, p ≤ 0.001 and r(82) = 0.37, p ≤ 0.001, respectively). Higher total sedentary time had a weak, positive correlation with better visuospatial/executive performance (r(82) = 0.23, p = 0.041). The orientation outcomes remained significant when analysed in an adjusted logistic regression model. CONCLUSION: This study found that performance in the MoCA orientation domain had a fair-positive correlation with moderate-intensity physical activity (i.e., stepping time and step count with a cadence of ≥100 steps/min) as measured by a thigh-worn accelerometer for community-dwelling older adults with MCI. When considering the relationship between cognitive domains and sedentary behaviour, consideration may be needed regarding whether cognitive enhancing activities (such as crosswords and other brain games) are being performed, which may confound this relationship. Further investigation is required to confirm these results.

The Memory Assessment Scale: A Population-based Cognitive Impairment Screening Instrument.

This study re-examined the Memory Assessment Scale (MAS), a brief memory test developed in Hawai'i in 1987, to assess whether it remains a valid and reliable cognitive impairment screening tool in Hawai'i. Patients suspected of having neurocognitive dysfunction were divided into 2 groups (those with and without mild cognitive impairment) based on their results on a battery of neuropsychological tests. No differences in MAS scores were found between patients with and without mild cognitive impairment. Further research with the MAS comparing patients with mild cognitive disorder to healthy controls is indicated to further examine the efficacy of this population-based test.

Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis.

OBJECTIVES: To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES: Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS: All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS: Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS: Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.

Repeated High-Definition Transcranial Direct Current Stimulation Modulated Temporal Variability of Brain Regions in Core Neurocognitive Networks Over the Left Dorsolateral Prefrontal Cortex in Mild Cognitive Impairment Patients.

BACKGROUND: Early intervention of amnestic mild cognitive impairment (aMCI) may be the most promising way for delaying or even preventing the progression to Alzheimer's disease. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been recognized as a promising approach for the treatment of aMCI. OBJECTIVE: In this paper, we aimed to investigate the modulating mechanism of tDCS on the core neurocognitive networks of brain. METHODS: We used repeated anodal high-definition transcranial direct current stimulation (HD-tDCS) over the left dorsolateral prefrontal cortex and assessed the effect on cognition and dynamic functional brain network in aMCI patients. We used a novel method called temporal variability to depict the characteristics of the dynamic brain functional networks. RESULTS: We found that true anodal stimulation significantly improved cognitive performance as measured by the Montreal Cognitive Assessment after simulation. Meanwhile, the Mini-Mental State Examination scores showed a clear upward trend. More importantly, we found significantly altered temporal variability of dynamic functional connectivity of regions belonging to the default mode network, central executive network, and the salience network after true anodal stimulation, indicating anodal HD-tDCS may enhance brain function by modulating the temporal variability of the brain regions. CONCLUSION: These results imply that ten days of anodal repeated HD-tDCS over the LDLPFC exerts beneficial effects on the temporal variability of the functional architecture of the brain, which may be a potential neural mechanism by which HD-tDCS enhances brain functions. Repeated HD-tDCS may have clinical uses for the intervention of brain function decline in aMCI patients.

Mild Cognitive Disorder in Post-COVID-19 Syndrome: A Retrospective Cohort Study of 67,000 Primary Care Post-COVID Patients.

Background: Little is known about the impact of COVID-19 on mild cognitive disorder. Objective: The aim of this retrospective cohort study was to investigate whether COVID-19 diagnosis is associated with subsequent mild cognitive disorder (MCD) compared to acute upper respiratory infections (AURI). Methods: This retrospective cohort study used data from the Disease Analyzer database (IQVIA) and included 67,046 patients with first-time symptomatic or asymptomatic COVID-19 diagnoses in 1,172 general practices in Germany between March 2020 and September 2021. Diagnoses were based on ICD-10 codes. Patients diagnosed with AURI were matched to 67,046 patients with COVID-19 using propensity scores based on sex, age, index month, and comorbidities. The index date was the diagnosis date for either COVID-19 or AURI. Associations between the COVID-19 and MCD were studied using conditional Poisson regression models. Results: The incidence of MCD was 7.6 cases per 1,000 person-years in the COVID-19 group and 5.1 cases per 1,000 person-years in the AURI group (IRR = 1.49, 95% CI = 1.22-1.82). The incidence rate ratio decreased strongly with increasing age from 10.08 (95% CI = 4.00-24.42) in the age group≤50 to 1.03 (95% CI = 0.81-1.31) in the age group > 70. In addition, the association between COVID-19 and MCD was significant in women (IRR: 1.70, 95% CI: 1.34-2.16) but not in men (IRR: 1.08, 95% CI: 0.75-1.56). Conclusion: The incidence of MCD was low but significantly higher in COVID-19 than in AURI patients, especially among younger patients. If a cognitive disorder is suspected, referral to a specialist is recommended.

Performance of the Rowland Universal Dementia Assessment Scale in Screening Mild Cognitive Impairment at an Outpatient Setting.

INTRODUCTION: Mild cognitive impairment (MCI) is defined as the symptomatic pre-dementia phase on the continuum of cognitive decline. Early recognition and application of potential interventions could prevent or delay the progression to dementia. The Rowland Universal Dementia Assessment Scale (RUDAS) shows good performance in the screening of dementia but has limited data regarding its diagnostic properties in the screening of MCI. The objectives of this study were to assess the psychometric properties of the Thai version of the RUDAS (RUDAS-Thai) in the screening of MCI, identify associated factors for the RUDAS performance, and determine the optimal cutoff point in detecting MCI. METHODS: This was a cross-sectional study conducted from January 2020 to March 2021. Older patients at the outpatient clinic of an internal medicine department at a tertiary care hospital in Thailand were examined. Baseline data were collected, and the RUDAS-Thai was administered to each patient. Afterward, a geriatrician assessed each patient for MCI. RESULTS: A total of 150 patients were included, of whom 42 cases (28%) had MCI. The overall performance of the test using an area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval 0.75-0.89). At the optimal cutoff point of 25/30, the AUC was 0.76 with sensitivity and specificity of 76.2 and 75%, respectively. The educational level affected the test performance according to regression analysis. For patients with years of education ≤6 and >6, the optimal cutoff points were 25/30 and 26/30, respectively. CONCLUSION: The RUDAS-Thai performed well in differentiating patients with MCI from normal cognition; however, it was affected by educational level. A score of 25/30 or lower for persons with ≤6 years of education or 26/30 or lower for persons with higher than 6 years of education is the optimal cutoff point for indication of developing MCI.

[The influence of the drug recognan (citicoline) on neurodynamic characteristics of mental activity in patients with mild cognitive impairment]. / Vliyanie preparata Rekognan (tsitikolin) na neirodinamicheskie kharakteristiki psikhicheskoi deyatel'nosti u patsientov s legkimi kognitivnymi narusheniyami.

OBJECTIVE: The aim of the study was to study the effect of the drug recognan (citicoline) on the neurodynamic characteristics of mental activity in patients with mild cognitive impairment. MATERIAL AND METHODS: A survey of 58 subjects (17 of them male and 41 female) aged 18-45 years (average age 27.2±12.5 years) was conducted. Clinical diagnosis according to ICD-10 «Mild cognitive impairment¼ (F06.7). The main subgroup included29 people received oral recognan therapy (in solution, 100 mg in 1 ml) for 30 days, with a daily dosage of 500 mg (5 ml of solution). In the control group (29 people) drug therapy was not performed. Tests were used: «Graphic sample¼, the sample on the reciprocal coordination of the hands (Ozeretsky test), test for the compression of fingers, the test «number series¼. The follow-up period was 30 days. All subjects were examined three times (initially, in the middle of the study - on day 15, at the end of the study - on day 30). RESULTS AND CONCLUSION: The results obtained showed that the use of the drug recognan (citicoline) has a positive effect on the indicators of visual-motor coordination and spatial representations, neurodynamic characteristics of movement, and cognitive functions. After a 2-week treatment with recognan improved graphical sample, 84% of patients, with reliable improvement according to the Wilcoxon (p=0.0002), the sample in the compression of the fingers 60%, as well as coordination 60%, the accounting functions in 44%. After a month (30 day) treatment course recomanem there was an increase in indices of samples for the compression of fingers in 71.4% of patients, with significant improvement (p=0.0499) and run the graphical samples of 71.4%, coordination at 46.4%, counting functions - 48% patients.

The role of interleukin-33 in patients with mild cognitive impairment and Alzheimer's disease.

BACKGROUND: The neuroprotective role of interleukin (IL)-33 is supported by numerous preclinical studies, but it remains uninvestigated in clinical studies of Alzheimer's disease (AD). We aimed to examine the association between human blood levels of IL-33 and cognitive preservation in amnestic mild cognitive impairment (aMCI) and AD. METHODS: A total of 100 participants (26 controls, 35 aMCI patients, and 39 AD patients) completed two Mini-Mental State Examinations (MMSEs) over a 1-year interval. In all 100 participants at the second MMSE, we examined the plasma levels of IL-33, IL-ß, IL-1 receptor agonist (IL-1RA), beta amyloid (Aß), and tau and apolipoprotein E (ApoE) genotyping; we also performed Hopkins Verbal Learning Test, Trail Making Test, forward and backward digit span, and Clinical Dementia Rating. RESULTS: IL-33 expression showed a positive trend among controls (1/26 = 3.8%), aMCI (9/35 = 25.7%), and AD (17/39 = 43.6%) (trend analysis: P < 0.001). Patients expressing IL-33 preserved their cognitive function compared with IL-33 non-expressing patients (1-year ΔMMSE, 0.16 ± 1.6 vs - 1.5 ± 2.6; P = 0.006). The cognitive preservation was not associated with the lower levels of Aß, tau, and ApoE ε4, while higher levels of ApoE ε4 and phosphorylated tau were indeed associated with cognitive decline. The aMCI patients with AD conversion during study period had higher proportion of IL-33(-) than non-AD converters (90.9% vs 53.3%, P = 0.04). CONCLUSIONS: IL-33 or its associated signaling pathways may represent a new treatment paradigm for aMCI and AD.

Design and Rationale of the PACt-MD Randomized Clinical Trial: Prevention of Alzheimer's dementia with Cognitive remediation plus transcranial direct current stimulation in Mild cognitive impairment and Depression.

BACKGROUND: By the time Alzheimer's disease and related disorders (ADRD) are diagnosed, efficacy of treatments is limited. Preventive interventions are urgently needed. OBJECTIVE: To design a randomized controlled trial to assess a novel intervention that aims to prevent ADRD in high-risk groups. METHODS: We report on the rationale and describe the design of a multisite randomized controlled trial that aims to prevent ADRD in older persons with: (1) mild cognitive impairment (MCI); (2) remitted major depressive disorder (MDD) without MCI; or (3) remitted MDD with MCI. RESULTS: PACt-MD (Prevention of Alzheimer's dementia with Cognitive remediation plus transcranial direct current stimulation in Mild cognitive impairment and Depression) is a trial that randomized 375 older participants with MCI, MDD, or MCI + MDD to cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) or sham-CR + sham-tDCS for 5 days/week for 8 weeks followed by boosters for 5 days/week once every 6 months until participants progress to MCI or ADRD, or the end of the study. Between boosters, participants are asked to train on CR daily. At baseline, end of 8 weeks, and yearly from baseline, participants undergo clinical, cognitive, and functional assessments. The primary aims are to compare the efficacy of CR + tDCS versus sham + sham in preventing: 1) long-term cognitive decline; and 2) incidence of ADRD or MCI. The secondary aim is to assess for cognitive improvement after the 8-week course. We will also explore the moderating and mediating effects of several biomarkers collected from the participants. CONCLUSION: PACt-MD is unique in combining brain stimulation and a psychosocial intervention to prevent ADRD. PACt-MD is also a platform for studying multi-domain biomarkers that will advance our understanding of the relationships among MCI, MDD, and ADRD.

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.

Multi-atlas based detection and localization (MADL) for location-dependent quantification of white matter hyperintensities.

The extent and spatial location of white matter hyperintensities (WMH) on brain MRI may be relevant to the development of cognitive decline in older persons. Here, we introduce a new method, known as the Multi-atlas based Detection and Localization (MADL), to evaluate WMH on fluid-attenuated inversion recovery (FLAIR) data. This method simultaneously parcellates the whole brain into 143 structures and labels hyperintense areas within each WM structure. First, a multi-atlas library was established with FLAIR data of normal elderly brains; and then a multi-atlas fusion algorithm was developed by which voxels with locally abnormal intensities were detected as WMH. At the same time, brain segmentation maps were generated from the multi-atlas fusion process to determine the anatomical location of WMH. Areas identified using the MADL method agreed well with manual delineation, with an interclass correlation of 0.97 and similarity index (SI) between 0.55 and 0.72, depending on the total WMH load. Performance was compared to other state-of-the-art WMH detection methods, such as BIANCA and LST. MADL-based analyses of WMH in an older population revealed a significant association between age and WMH load in deep WM but not subcortical WM. The findings also suggested increased WMH load in selective brain regions in subjects with mild cognitive impairment compared to controls, including the inferior deep WM and occipital subcortical WM. The proposed MADL approach may facilitate location-dependent characterization of WMH in older individuals with memory impairment.

How common are neurocognitive disorders in patients with chronic kidney disease and diabetes? Results from a cross-sectional study in a community cohort of patients in North Wales, UK.

OBJECTIVE: Chronic kidney disease (CKD) affects nearly 9% of global populations and is strongly associated with older age. Neurocognitive disorders (NCDs), which include mild cognitive impairment and dementia, are rising as a result of ageing populations throughout the world. This investigation's aim is to report the frequency of mild to major NCD in a clinical cohort of adults with mild to moderate CKD and diabetes. SETTING: Glan Clwyd District general Hospital, North Wales, UK. PARTICIPANTS: We enrolled 178 patients with CKD and diabetes, aged 55 years and over with an estimated glomerular filtration rate <60 >15 mL/min/1.73 m2, attending a specialist renal and diabetic outpatient clinic. OUTCOME MEASURES: Frequency of mild and major NCD and the association with the stage of CKD was assessed in all patients attending the specialist clinic. The diagnosis of NCD was based on patient and informant interview, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental Disorders version 5. RESULTS: This investigation found 86/178 (48%) of the cohort with an NCD ranging from mild (n=49) to major symptoms (n=37). No association was found with NCD and the stage of CKD. Mild and major NCD was associated poorer outcomes in several cognitive domains, including, language, executive, memory, fluency and attention function (p<0.05). CONCLUSIONS: This is the first UK investigation to report that cognitive changes occur in a significant number of older adults with CKD and diabetes. The unexpected finding was that prior to cognitive assessment, not any of the cohort had a pre-existing diagnosis of cognitive impairment, suggesting that the current prevalence and incidence rates of NCD in the general population are possibly significantly underestimated. Our findings also suggest that the cognitive function of patients with CKD should be screened and monitored routinely as part of their overall care management.

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.

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.

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.

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.

[Characteristics of anxiety in patients of older age groups with different types of mild cognitive disorder]. / Osobennosti proiavleniia trevogi u patsientov starshikh vozrastnykh grupp s raznymi tipami umerennogo kognitivnogo rasstroistva.

AIM: To study the structure of anxiety symptom complex in patients of older age groups with amnestic, disregulatory and polymodal types of mild cognitive impairment (MCI) and determine the clinical efficacy of 2-ethyl-6-methyl-3-hydroxypyridine succinate (mexidol). MATERIAL AND METHODS: Thirty-two patients over 55 years of age with MCI (ICD-10 item F 06.7) seeking medical help due to anxiety were included in the study. Inclusion criteria were the compensation of concomitant diseases, absence of relevant stressful events during the last year, absence of depression. Clinical-psychopathological method and psychometric scales (HAM-A, GDS, MMSE, CGI-S, CGI-I) and a stressful life events list were used. Reduction of the total score on the HАМ-А was the main criterion of the efficacy of 4-week treatment with mexidol (375 mg daily). RESULTS AND CONCLUSION: At baseline, mean scores on the HAM-A and MMSE were 39,9+3.18 and 25.7+0.6 respectively. The study of the anxiety structure in patients with amnestic, disregulatory and polymodal types of MCI revealed the different phenomenology of anxiety symptom complex. Repeated assessment of anxiety on the HAM-A was performed on 1, 2 and 4 week of treatment with mexidol. The improvement of mental state was noted in all types of MCI but the better results were obtained in disregulatory and polymodal types. The rate of anti-anxiety effect was higher in the disregulatory type of MCI. In all patients, mexidol improved attention stability and autonomic function.

'It's definitely not Alzheimer's': Perceived benefits and drawbacks of a mild cognitive impairment diagnosis.

OBJECTIVES: To understand the perceived benefits and drawbacks of a mild cognitive impairment (MCI) diagnosis from the perspective of those living with the label. METHODS: Participants were included if they had recently (within 6 months) received a MCI diagnosis. We also recruited close family members to gain their perspectives. Each was interviewed separately with a semi-structured topic guide covering three areas: (1) experience of cognitive impairments and changes in the individual; (2) impact of cognitive impairment(s) on daily activities and social relationships; and (3) experience of the diagnosis process and living with the label. Transcribed interviews were stored in Nvivo® . Grounded theory procedures of memo writing, open coding, constant comparison, and focused coding were used to derive conceptual themes. RESULTS: Eighteen dyads were interviewed. The overarching themes surrounding diagnosis benefits and drawbacks were as follows: (1) emotional impact of the diagnosis; (2) practical benefits and limitations of the diagnosis, in terms of (a) understanding one's symptoms and (b) access to clinical support. Although participants were glad to have clinical support in place, they expressed frustration at the lack of clarity, and the lack of available treatments for MCI. Consequently, living with MCI can be characterized as an ambivalent experience. CONCLUSION: As a clinical label, MCI appears to have little explanatory power for people living with cognitive difficulties. Work is needed to clarify how clinicians and patients communicate about MCI, and how people can be helped to live well with the label. Despite an emerging body of prognostic studies, people with MCI are likely to continue living with significant uncertainty. Statement of contribution What is already known on this subject? Mild cognitive impairment is a state of cognitive decline between normal cognitive ageing and dementia. This clinical category has been an important domain of academic debate over recent years. From a clinical perspective, diagnosing MCI is a helpful way to enable communication between health professionals, and a diagnosis can be important for patients in need of support and education. However, diagnosis can be fraught with difficulties, while patients have reported significant uncertainty about the label. This study aimed to examine the perceived benefits and drawbacks of receiving a MCI diagnosis. What does this study add? The emotional impact of a MCI diagnosis is complex and raised conflicting and fluctuating emotions in our participants' accounts - most notably worry and relief. Participants were glad to have clinical support available to call on; however, they were frustrated at the lack of 'treatments' available for MCI and were often anxious to slow any cognitive decline down Health psychologists will have an important role to play in understanding and improving clinical communication about MCI.

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.