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PubMedDate not supplied

The characteristics of patients with uncertain/mild cognitive impairment on the Alzheimer disease assessment scale-cognitive subscale.

The performances of the uncertain/mild cognitive impairment (MCI) patients on the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale were compared with those of normal controls, Alzheimer disease patients with CDR 0.5, and Alzheimer disease patients with CDR 1.0. The Uncertain/MCI group was significantly different from normal controls and Alzheimer disease CDR 0.5 or 1.0 groups on the ADAS-Cog except on a few non-memory subtests. Age was significantly correlated with total error score in the normal group, but there was no significant correlation between age and ADAS-Cog scores in the patient groups. Education was not significantly correlated with the ADAS-Cog scores in any group. Regardless of age and educational level, there were clear differences between the normal group and the Uncertain/MCI group, especially on the total error scores. We found that the total error score of the ADAS-Cog was the most reliable variable in detecting patients with mild cognitive impairment. The present study demonstrated that the ADAS-Cog is a promising tool for detecting and studying patients with mild cognitive impairment. The results also indicated that demographic variables such as age and education do not play a significant role in the diagnosis of mild cognitive impaired patients based on the ADAS-Cog scores.

Aged↗

PubMed2005

Sleep apnea-related cognitive deficits and intelligence: an implication of cognitive reserve theory.

Cognitive deficits in patients with obstructive sleep apnea syndrome (OSAS) are well demonstrated, but the pathophysiology of these deficits is still controversial, as the relationship between OSA severity and cognitive deficits is usually weak. Our study considers the possible relationship between OSA-related cognitive deficits and the overall intellectual function of OSA patients. Forty-seven OSA patients and 36 normal individuals underwent a neuropsychological battery test assessing attention and alertness. According to the resulting IQ score, patients and controls were divided into a high-intelligence group (IQ > or = 90th percentile) and a normal-intelligence group (50 < or = IQ < 90%ile). Between the two patient groups there were no significant differences noticed, regarding OSA severity or sleepiness. High-intelligence patients showed the same attention/alertness performance compared with the high-intelligence controls. On the contrary, patients with normal-intelligence showed attention/alertness decline compared with the normal-intelligence control group. The two patient groups were re-examined with the same battery test after at least 1 year of CPAP treatment. At re-examination neither patient group showed any differences regarding attention and alertness compared with the control groups. We assume that high-intelligence may have a protective effect against OSA-related cognitive decline, perhaps due to increased cognitive reserve.

Adolescent↗

PubMed2005

Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort.

OBJECTIVES: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent-living adults. DESIGN: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial. SETTING: Six field sites in the United States. PARTICIPANTS: Two thousand eight hundred two independent-living subjects aged 65 to 94. MEASUREMENTS: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form-36 (SF-36) Health Survey. RESULTS: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal-lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF-36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline. CONCLUSION: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent-living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.

Activities of Daily Living↗

PubMed2006

Multiple cognitive deficits in amnestic mild cognitive impairment.

OBJECTIVE: To determine if more widespread cognitive deficits are present in a narrowly defined group of patients with the amnestic form of mild cognitive impairment (MCI). METHODS: From a larger sample of patients clinically diagnosed as meeting the criteria of Petersen et al. for amnestic MCI, we selected 22 subjects who had Clinical Dementia Rating scores of zero on all domains besides memory and orientation. These MCI subjects with presumably isolated memory impairments were compared to 35 age-matched normal controls and 33 very mild Alzheimer's disease (AD) patients on a battery of neuropsychological tests. RESULT: In addition to the expected deficits in episodic memory, the amnestic MCI group performed less well than the controls but better than the AD group on design fluency, category fluency, a set shifting task and the Stroop interference condition. Over half the amnestic MCI group (vs. none of the normal controls) scored at least 1 standard deviation below control means on 4 or more of the nonmemory cognitive tasks. CONCLUSIONS: Isolated memory impairment may be fairly uncommon in clinically diagnosed amnestic MCI patients, even when the criteria for amnestic MCI are fairly narrow. Additional cognitive impairments are likely to include fluency and executive functioning. These more diffuse deficits argue for comprehensive cognitive assessments, even when the patient and family are reporting only memory decline, and are consistent with the increase in attention paid to the heterogeneity of MCI.

Aged↗

PubMed2005

Population-based study of medical comorbidity in early dementia and "cognitive impairment, no dementia (CIND)": association with functional and cognitive impairment: The Cache County Study.

OBJECTIVE: Authors investigated medical comorbidity in persons with dementia and "Cognitive Impairment, No Dementia" (CIND). METHODS: The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N=149), CIND (N=225), or without cognitive impairment (N=321) were identified and studied. Participants received comprehensive clinical evaluations and were rated on the General Medical Health Rating (GMHR), a global measure of seriousness of medical comorbidity. Participants and informants also completed the Mini-Mental State Exam and provided self-report information about comorbid medical conditions and functioning in activities of daily living. RESULTS: There were few differences in number or type of comorbid medical conditions between persons with CIND and dementia, but persons with dementia were prescribed more medications. Stroke was more common in dementia participants, but other illnesses common in old age were not significantly different across cognitive groups. Medical comorbidity was more serious in both dementia and CIND, such that both groups were less likely to have "little to no" comorbidity. Seriousness of medical comorbidity was significantly associated with worse day-to-day functioning and cognition. CONCLUSIONS: Persons with CIND and dementia have more serious medical comorbidity than comparable persons without cognitive impairment. This comorbidity may play a role in the progression of CIND and dementia. Future studies should investigate the role of medical comorbidity and its treatment on dementia onset or progression, as well as the mechanisms mediating its neuropathologic effects.

Activities of Daily Living↗

PubMedDate not supplied

Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms.

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n=72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n=88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly with depression.

Aged↗

PubMed1983

Changes in cognition with pharmacotherapy and cognitive therapy.

A treatment trial comparing cognitive therapy and pharmacotherapy, alone and in combination, in depressed out-patients, indicated that outcome on cognitive variables was similar to outcome on mood and severity measures, pharmacotherapy being less effective than cognitive therapy or the combined treatment in a hospital and a general practice sample. While combined treatment was superior to cognitive therapy in the hospital out-patients, the two treatments were equivalent in the general practice. Significant effects were obtained on measures of views of self, the world and the future, whose validity was demonstrated. The pattern of change through treatment showed the same order of progress for responders, while non-responders to cognitive therapy tended to do worst. The specificity of treatment effect is discussed.

Adolescent↗

PubMed2002

Validity of admissions measures in predicting performance outcomes: the contribution of cognitive and non-cognitive dimensions.

BACKGROUND: Admissions committees face the daunting task of selecting a small number of candidates who are most likely to succeed in medical school from a large pool of seemingly suitable applicants. While numerous studies have shown moderate correlations among measures of academic performance, predictors of the non-cognitive domain (e.g. interpersonal, communication, ethical) remain elusive, in part because of the absence of a sound criterion measure. PURPOSE: We examined the utility of several cognitive and non-cognitive criteria used in the admissions processes in predicting both cognitive and non-cognitive dimensions of the licencing examinations of the Medical Council of Canada (LMCC). METHODS: Predictors included: undergraduate GPA, undergraduate science GPA, an autobiographical letter, scores from a simulated tutorial, a personal interview and the MCAT. Of specific interest was the relation between measures of communication and problem-exploration skills as assessed during the admissions process and Part II of the LMCC Examination, a multi-station OSCE. RESULTS: Undergraduate GPAs were found to have the most utility in predicting both academic and clinical performance. Scores derived from the simulated tutorial did not predict future performance. The MCAT Verbal Reasoning score and the personal interview were found to be useful in predicting communication skills on the LMCC Part II. CONCLUSIONS: The results have implications for any school that uses the interview as an admissions tool.

Cognition↗

PubMed2004

APOE epsilon4 and cognitive decline in older stroke patients with early cognitive impairment.

BACKGROUND: Dementia is common post stroke, but the potential role of early cognitive impairment and APOE epsilon4 as risk factors is unclear. METHOD: Stroke survivors older than 75 years without dementia at 3 months post stroke received a detailed neuropsychological evaluation at 3 and 15 months post stroke, which included the Cambridge Assessment of Mental Disorders in the Elderly (CAMCOG). Early cognitive impairment was diagnosed using the criteria for cognitive impairment/no dementia (vascular CIND). APOE genotype was determined using a standardized method. RESULTS: One hundred thirty-seven older stroke patients without dementia (mean age 80.6 +/- 4.3, mean CAMCOG score 83.5 +/- 10.4, 68 women) participated in the study, of whom 40 met the criteria for CIND. Stroke patients with one or more APOE epsilon4 alleles were significantly more likely to have CIND (14/40 vs 17/97, odds ratio = 2.5, 95% CI 1.1 to 5.8). Over the 1 year of follow-up, CIND patients with one or more APOE epsilon4 alleles had a mean decline on the total CAMCOG of 2.7 points compared with an improvement of >4 points among patients without APOE epsilon4 (T = 2.9 p = 0.006). CIND patients with an APOE epsilon4 allele also experienced greater decline in memory (T = 2.5, p = 0.015). CONCLUSION: In older stroke patients with early cognitive impairment, the presence of an APOE epsilon4 allele is associated with greater progression of cognitive decline. This has implications for interventions aimed at the secondary prevention of dementia in stroke patients.

Age Factors↗

PubMed1995

Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screening Examination for Cognitive Impairment (SEFCI).

Cognitive impairment affects 40 to 70% of patients with multiple sclerosis (MS), but its occurrence cannot be predicted from knowledge of the individual patient's age, level of physical disability, duration of disease, disease type, or performance on standard mental status examinations. To evaluate the usefulness of a brief screening battery, the Screening Examination for Cognitive Impairment (SEFCI), 103 community-dwelling MS patients and 32 healthy normal controls received the SEFCI and a 2-hour battery of other neuropsychological tests chosen for their sensitivity to the cognitive impairments most often observed in MS. Performance on the SEFCI correctly identified 86% of the patients with impairment on any of the 11 measures from the longer battery, 100% of the patients with impairments in at least three cognitive domains, and 90% of the patients without cognitive impairment. Because the SEFCI is sensitive, specific, and easily administered and scored, it should aid the physician in deciding whether to refer an MS patient for a complete evaluation.

Adult↗

PubMed2004

Moderation of cognition-intention and cognition-behaviour relations: a meta-analysis of properties of variables from the theory of planned behaviour.

Meta-analysis was used to quantify the moderating effects of seven properties of cognitions-accessibility, temporal stability, direct experience, involvement, certainty, ambivalence and affective-cognitive consistency-on cognition-intention and cognition-behaviour relations. Literature searches revealed 44 studies that could be included in the review. Findings showed that all of the properties, except involvement, moderated attitude-behaviour consistency. Similarly, all relevant moderators improved the consistency between intentions and behaviour. Temporal stability moderated PBC-behaviour relations, certainty moderated subjective norm-intention relations, and ambivalence, certainty, and involvement all moderated attitude-intention relations. Overall, temporal stability appeared to be the strongest moderator of cognition-behaviour relations.

Affect↗

PubMed2006

[Cognitive training interventions for normal aging, mild cognitive impairment and Alzheimer's].

BACKGROUND: In the past few years, occupational therapists have been increasingly working with geriatric clients and have used interventions focused on enhancing independance and quality of life. In this area of practice, the cognitive training intervention aimed more specifically at memory disorders, is a promising intervention for the area of aging and occupational therapy. PURPOSE: The aim of this literature review is to present an overview of the fundamentals, objectives and procedures of the cognitive training intervention used with the following populations: aging people presenting a memory disorder associated with normal aging with mild cognitive impairment or with Alzheimer's disease. PRACTICE IMPLICATIONS: A discussion on the cognitive management of memory is presented with respect to the cognitive characteristics of each of these clients.

Aging↗

PubMed1987

The Neurobehavioral Cognitive Status Examination: comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population.

Studies to determine the validity of the Mini-Mental State Examination (MMSE) and the Cognitive Capacity Screening Examination (CCSE) have indicated unacceptably high false-negative rates for these tests. To determine whether a new examination, the Neurobehavioral Cognitive Status Examination (NCSE), is more sensitive in the detection of cognitive dysfunction, we compared the three examinations in 30 patients with documented brain lesions. The CCSE had a false-negative rate of 53%; the MMSE, of 43%; and the NCSE, of 7%. The sensitivity of the NCSE is derived from two features of its design: the use of independent tests to assess skills within five major areas of cognitive functioning, and the use of graded tasks within each of these cognitive domains.

Adult↗

PubMed1999

The cognitive abilities screening instrument (CASI): data from a cohort of 2524 cognitively intact elderly.

OBJECTIVES: To describe the effects of age and education for the Cognitive Abilities Screening Instrument (CASI), a 25-item test of cognitive function. DESIGN: Cross-sectional descriptive study of the initial enrollment in a community-based prospective cohort study. PARTICIPANTS: A total of 2524 cognitively intact older adults over age 65 who were members of a major health maintenance organization, and who consented to participate in a longitudinal study. MEASUREMENTS: Summary scores for the CASI are given in the form of mean, median and percentile distributions specific for age and educational level. RESULTS: Based upon maximum likelihood analyses, age and education were significant (p<0.0001) predictors of total CASI score. Increased age and lower education were associated with a lower CASI score, as well as an increased spread in score distribution. Gender was also significantly related (p<0.01) to total CASI, with women having a slightly higher distribution of scores. Mean total scores ranged from CASI=82.2 (SD=9.0) in subjects aged 90-95 who had less than a high school degree to CASI=94.8 (SD=3. 8) in subjects aged 65-69 with at least a high school education. CONCLUSIONS: Like most cognitive screening instruments, performance on the CASI in non-demented persons is influenced by age and education. The reference values for 5-year age categories described in this article should be useful for clinicians and research investigators when using the CASI as a measure of cognitive function.

Aged↗

PubMed2000

Development and standardization of a new telephonic cognitive screening test: the Minnesota Cognitive Acuity Screen (MCAS).

OBJECTIVE: The aim of this study was to determine the validity and reliability of a telephonically administered cognitive screening battery, consisting of nine brief tests (orientation, attention, delayed word recall, comprehension, repetition, naming, computation, judgment, and verbal fluency), to distinguish between patients with dementia and healthy control subjects. BACKGROUND: Existing telephonic screening instruments do not take full advantage of strategies that might increase precision. METHODS: A total of 228 elderly individuals received a telephone assessment of cognitive function (99 mildly to moderately demented nursing home residents with an established diagnosis of dementia residing in 1 of 12 nursing facilities, and 129 community-dwelling elderly individuals who were independently screened to verify normal cognitive function). RESULTS: Nurses and psychologists experienced in telephonic test administration typically completed the screening with each subject in less than 20 minutes. At the 100% sensitivity level, the test battery had a specificity of 87%. The post hoc optimal cut-score of the discriminant analysis yielded a sensitivity of 97.5% and a specificity of 98.5%. The split-half reliability of the test battery was 0.91. The more powerfully predictive subtests were orientation, delayed word recall, verbal fluency, computation, and judgment. CONCLUSIONS: This telephonic screening instrument appears to have promise to distinguish, with high precision, healthy elderly individuals from those individuals with cognitive impairment. The Minnesota Cognitive Acuity Screen (MCAS) should undergo further study in unselected elderly populations to better understand its value as a screening tool.

Age Distribution↗

PubMed1992

Assessment of basic cognitive abilities in relation to cognitive deficits.

A modal model of information-processing was used to select a battery of nine tasks of basic cognitive ability (learning, relearning, reaction time, probe recall, Sternberg search, self-paced probe, stimulus discrimination, tachistoscopic full report, tachistoscopic partial report). Parameters from these tasks operationalized the model. After extensive pilot testing of the tasks to establish reliability, we tested 40 subjects (20 with mental retardation and 20 college students) on all tasks and the WAIS-R. The parameters from the tasks were generally reliable (.7 through .9) and had low correlations with IQ (average about .37). Nearly all of the major cognitive parameters differentiated significantly between groups. A subset of the basic cognitive parameters predicted IQ with an estimated multiple correlation in the general population of .72. Prediction of IQ using basic cognitive parameters was better for subjects with mental retardation than for college students. A modified version of the modal model was supported. Results show that individual differences in higher mental processes are highly dependent on basic cognitive abilities and can be predicted from them. These findings have substantial implications for the development of models of information-processing.

Adolescent↗

PubMed2006

[Outcome and cognitive changes of mild cognitive impairment in the elderly: a follow-up study of 47 cases].

OBJECTIVE: To examine the cognitive changes and outcome of mild cognitive impairment (MCI) in the elderly and to explore the predictive factors of development from MCI into dementia. METHOD: A cross-sectional and longitudinal parallel cohort study design was conducted among 47 patients with MCI (MCI group), aged 72.4 +/- 7.1, and 50 sex, marital status, and professional structure-matched normal controls (NC group), aged 67.9 +/- 5.3, using the Neuropsychological Battery of Cognitive Assessment Instruments developed by World Health Organization (WHO-BCAI) and the Wechsler Memory Scale (WMS) to assess the cognitive function. Follow-up was conducted for 34.0 +/- 1.8 months. The diagnosis of dementia was based on the criteria in the Diagnostic and Statistical Manual-IV. RESULTS: Dementia was diagnosed in 13 of the 47 MCI patients with a prevalence rate of 27.7%, significantly higher than that in the NC group (2.0%, 1/50, P < 0.01). The mean total score of mini-mental status examination (MMSE) of the MCI group decreased by 2.2 +/- 3.7, significantly more than that of the NC group (1.0 +/- 1.9, P < 0.01). The mean total mental quotient (MQ) of the MCI group decreased by 12.6 +/- 17.3, significantly more than that of the NC group (3.9 +/- 8.4, P < 0.01). The values of MMSE and MQ of the 13 cases in the MCI group who developed into dementia patients decreased by 5.5 +/- 2.8 and 30.0 +/- 18.0 respectively. The WHO-BCAI assessment demonstrated that the scores of performance of verbal learning, verbal fluency, visual reasoning, trail making, sorting and spatial construct tests of the cases in the MCI group who developed into dementia patients were significantly poorer than those of the NC group (P < 0.01). Logistic analysis based on the baseline assessment suggested that the total score of MMSE and its subtest of orientation, score of orientation memory of WMS, and the scores of performance of trail making, attention, and delayed recall tested by WHO-BCAI were all statistically significant predictive factors for MCI converting into dementia (P < 0.01 or 0.05). The predictive accuracy rates of MMSE, WMS, and WHO-BCAI were 70.3%, 78.4% and 90.7% respectively. CONCLUSION: MCI diagnosed based on the criteria of pure MCI modified by the authors is indeed a transitional state from normal aging to dementia, especially Alzheimer's type of dementia. The cognitive change for MCI converting into dementia is characterized in the areas of orientation, attention, speech and executive function. These predictive factors for MCI to develop dementia are valuable in early detection and prevention of dementia in the elderly.

Adult↗

PubMed1980

[Cognitive disturbances in schizophrenia - experimental psychological examination and explanation in the frame of cognitive information processing].

The concern of the paper is, by using the example of schizophrenia, to show in a survey that it is possible and necessary to base the examination of cognitive disturbances and their exaplanation on the methodological concept of information processing. Departing from the stage reached in cognition-psychological schizophrenia research, a survey is given of such studies of cognitive disturbances in schizophrenia that are based on general psychological concepts of cognitive information processing. The approach to an identification of the defect within the frame of a model of the cognitive information processing is explained by two examples (performance of recognition, reproduction deficit).

Cognition Disorders↗