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Background: The management of modifiable risk factors and comorbidities may impact the future trajectory of cognitive impairment, but easy-to-implement management methods are lacking. Aims: This study investigated the effects of simple but comprehensive cognitive health management practices on the cognitive function of older adults in the community with normal cognition (NC) and mild cognitive impairment (MCI). Methods: The comprehensive cognitive health management programme included a psychiatric assessment of the cognitive risk factors for those in the intervention groups and individualised recommendations for reducing the risks through self-management supported by regular medical professional follow-up. The intervention groups for this study included 84 elderly participants with NC and 43 elderly participants with MCI who received comprehensive cognitive health management. The control groups included 84 elderly participants with NC and 43 elderly participants with MCI who matched the intervention group's general characteristics and scale scores using the propensity matching score analysis. The Montreal Cognitive Assessment (MoCA) scale and Geriatric Depression Scale (GDS) scores were compared after a 1-year follow-up. Results: For older adults with MCI in the intervention group, MoCA scores were higher at the 1-year follow-up than at baseline (24.07 (3.674) vs 22.21 (3.052), p=0.002). For the MoCA subscales, the intervention group's abstract and delayed memory scores had significantly increased during the 1-year follow-up. Furthermore, in a generalised linear mixed model analysis, the interaction effect of group×follow-up was statistically significant for the MCI group (F=6.61, p=0.011; coefficients=5.83). Conclusions: After the comprehensive cognitive health management intervention, the older adults with MCI in the community showed improvement at the 1-year follow-up. This preliminary study was the first to demonstrate an easy-to-implement strategy for modifying the cognitive risk factors of elderly individuals with MCI in the community, providing new insight into early-stage intervention for dementia.
RESUMO
Background: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used tools for cognitive impairment screening. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly. Methods: A total of 2,954 Chinese elderly individuals, including 1,746 normal controls, 599 MCI patients and 249 dementia patients, were consecutively recruited in the study. The optimal cutoffs for MoCA and MMSE were determined using receiver operating characteristic (ROC) analysis among the different age and education levels in the three groups. Furthermore, comparison of ROC curves were made to evaluate the performances of the two tests. Results: The area under the curve(AUC) of the MoCA (0.82) for detecting MCI was significantly higher than that of the MMSE (0.75) (P < 0.001). When the sample was divided according to age and education level, the AUC of the MoCA (0.84) was higher than those of the MMSE (0.71) for MCI (P < 0.001) in the younger and more highly-educated groups. The optimal cutoff scores of the MoCA for the groups aged ≤ 75 years old and education ≤ 6 years, aged > 75 years old and education ≤ 6 years, aged ≤ 75 years old and education > 6 years, aged > 75 years old and education > 6 years in screening for MCI were identified as 19.5, 15.5, 24.5 and 24.5, respectively, and the optimal cutoff scores for dementia were 18.5, 10.5, 18.5 and 20.5, respectively. For MMSE in the above four groups, the cutoff scores to detect MCI were 26.5, 22.5, 28.5 and 26.5, respectively, and the optimal cutoff scores for dementia were 23.5, 19.5, 23.5 and 23.5, respectively. Conclusion: Compared to MMSE, the MoCA is more suitable for discriminating MCI in younger and more highly educated elderly Chinese individuals. However, the MMSE has advantage over MoCA in screening MCI in individuals with lower education levels and the older groups of Chinese elderly.
RESUMO
BACKGROUND: Alzheimer's disease (AD) has high a prevalence rate, high medical costs, and care difficulties, and has become a serious social and economic problem in our aging society. So far, there has not been a reliable and objective diagnostic criteria for AD found. In recent years, there have been many domestic and foreign studies on the biological markers of cerebrospinal fluid in the patients with AD, and high levels of the T-tau, P-tau found in cerebrospinal fluid (CSF) is at this point an indisputable fact. However, the relationship between these markers and the severity of dementia, as well as the development of the disease, should be further studied. OBJECTIVE: Compare the CSF level of total tau (T-tau) and phosphorylated tau at threonine 231 (P-tau231) between patients with moderate to severe Alzheimer's disease (AD) and those with vascular dementia (VD) at baseline, and 6 month follow-up. Observe the differences between patients with AD and control group, as well as the changes as the disease develops. METHODS: There were 11 patients with moderate AD (10 ≤ MMSE ≤ 20), 10 patients with severe AD (MMSE ≤ 9), and 7 age-matched patients with severe VD at baseline, among which 7 AD patients and 6 VD patients completed the 6 months follow-up. CSF levels of T-tau, P-tau231 were measured with sandwich ELISA. RESULT: At baseline, the concentrations of the CSF level of T-tau were 470.08 (263.58) pg/mL in the AD group and 208.76 (42.24) pg/mL in the VD group. This difference was statistically significant (Z= -3.369, p <0.001). The concentrations of CSF level of P-tau231 were 90.94 (49.86) pg/mL in the AD group and 42.96 (13.10) pg/mL in the VD group. This difference was also statistically significant (Z = -3.237, p <0.001). Compared to patients with severe VD, the concentration of CSF T-tau in patients with severe AD was significantly higher (Z= -2.830, p = 0.005), as well as the concentration of CSF P-tau231 (Z = -2.392, p = 0.017). The concentration of CSF P-tau231 in the patients with moderate AD was significantly higher than that in the patients with severe VD (Z = -2.605, p = 0.009). At the 6 months follow-up, there were no statistically significant differences in the changes of CSF T-tau and CSF P-tau231 concentrations between the AD group and VD group. CONCLUSION: The CSF level of T-tau and P-tau231 in the AD patients was significantly higher than that in the VD patients. The concentration of CSF P-tau231 in the moderate AD patients was significantly higher than that in the patients with severe AD. During the 6 months follow-up, the changes of the CSF concentrations of T-tau and P-tau231 between AD group and VD group were not statistically significant.
