Browsing by Subject "Dementia"
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Item Abbreviated and Expanded Forms of the Montreal Cognitive Assessment for Dementia Screening(2015-07-15) Horton, Daniel Kevin; Cullum, C. Munro; Hynan, Linda S.; Lacritz, Laura H.; Rossetti, Heidi; Weiner, Myron F.Cognitive screening is becoming increasingly important as the general population ages and the prevalence of dementia rises. However, popular cognitive screening tools have been criticized for their insensitivity to subtle cognitive impairment, poor specificity, excessive administration time, and/or questionable methods of test development. The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity which has demonstrated increased sensitivity to mild cognitive impairment (MCI), but takes roughly 10-15 minutes to administer and was developed without an empirically-driven item selection process. We devised two studies to address common limitations of cognitive screening tools using the MoCA. The aim of Study 1 was to create a short form of the MoCA (SF-MoCA) including only the items found to be most sensitive to MCI and Alzheimer disease (AD) and compare the diagnostic classification accuracy of the SF-MoCA to the Mini-Mental State Examination (MMSE) and standard MoCA. Results revealed delayed recall, orientation, and serial subtraction items to be most useful in differentiating the diagnostic groups. Overall, diagnostic accuracy of the SF-MoCA was superior to the MMSE and comparable to the standard MoCA, suggesting that some MoCA items do not add to the sensitivity of the instrument in these populations. Given the brevity and sensitivity of the SF-MoCA, we suggested this measure may be useful for early detection of cognitive impairment in primary care and other settings where evaluation time is limited. Despite the advantages of the SF-MoCA, this tool only assesses three cognitive domains and may not be appropriate in settings where clinicians may want to efficiently assess additional domains affected in AD and MCI to gain a clearer picture of global functioning and assist in differential diagnosis. Therefore, we conducted a second study to determine if diagnostic accuracy of the SF-MoCA might be enhanced through the addition of several brief and well-validated neuropsychological measures shown to be sensitive to cognitive impairment. Results revealed that the addition of measures of processing speed, category fluency, and verbal recall resulted in an Expanded SF-MoCA with diagnostic classification accuracy superior to both the standard MoCA and SF-MoCA. Findings of these studies have implications for current cognitive screening procedures and techniques used to develop these tools.Item Characterization and Differences Between Possible and Probable Mild Cognitive Impairment in an Alzheimer’s Disease Center(2015-08-31) Weaver, Victoria Allison; Rossetti, Heidi; Lacritz, Laura H.; Silver, Cheryl H.BACKGROUND: Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and dementia. A subjective cognitive complaint (SCC) is a key component in the diagnosis of MCI. However, some individuals with SCCs do not show objective impairment on neuropsychological measures and there has been debate about the role of SCCs for the characterization of MCI. This study aimed to examine the differences in neurocognitive function and other risk factors between MCI subtypes and better understand the role of the SCC when objective cognitive impairment is not present. SUBJECTS: This retrospective study includes 395 participants [age (M, SD) =67.5(7.2), education (M, SD)=15.10(2.7)], from the Alzheimer’s Disease Center (ADC) at the University of Texas Southwestern Medical Center who were English speaking and between the ages of 50-90. Participants received a comprehensive clinical assessment including neuropsychological testing and diagnosis, which was made via multidisciplinary group consensus. This study consisted of participants classified at their baseline ADC visit as individuals with SCC but normal cognitive performance (possible MCI, n=83), individuals with SCC and abnormal cognitive performance (probable MCI, n=121), and normal controls (n=191). METHOD: Differences in performance on neuropsychological measures among possible MCI, probable MCI, and normal control groups were examined using MANOVA. Differences in the frequency of selected cognitive and vascular risk factors, including APOE4, hypertension, high cholesterol, and diabetes mellitus, were examined using chi square test of independence. Demographic differences (age, education, gender, depression, and premorbid intelligence) across groups were compared using either ANOVA or chi square. RESULTS: Normal controls performed significantly better than the probable MCI group on the MMSE, TMT-A, TMT-B, Block Design, WCST, FAS, Animal Fluency, and BNT (p<.05). On the CVLT, normal controls demonstrated fewer intrusion errors, higher total learning scores, and better long delay free recall than both the possible and probable MCI groups, and similarly, the possible MCI group performed significantly better than the probable MCI group. The frequency of APOE4 did not differ significantly among groups (p>.05). The probable MCI and possible MCI group had significantly higher rates of hypertension (58%, 59%) compared to the normal control group (46%). The probable MCI group had significantly higher rates of high cholesterol (66%) than the possible MCI group (18%). The probable MCI group had significantly more males, lower education, and higher GDS scores compared to NC groups (p<.05). DISCUSSION: This study demonstrated that the probable MCI group differed from normal controls on measures of memory, executive function, and language, and had higher rates of hypertension and high cholesterol. Although statistically significant differences among all three groups on measures other than complex verbal memory were not seen; closer examination of the neurocognitive test scores showed that the possible MCI group performances were qualitatively more similar to that of the probable MCI group rather than the NC group. This may support the notion that individuals with a SCC but without overt impairment on testing do share commonalities with those with clear MCI, indicating that SCC do carry clinical significance and warrant evaluation and monitoring over time in older individuals.Item The Effects of Acculturation on the Mexican-American Dementia Caregiver Experience(2005-12-19) Dominguez, Gabriel Angel; Silver, Cheryl H.There is a paucity of research to understand the experience of the Mexican-American caregiver of family members with dementia. The proposed study will investigate how acculturation affects the caregiver experience in the Mexican-American culture. Correlations between caregiver burden, problem behaviors, and positive aspects of caregiving will be computed and compared between participants at two acculturation levels. More caregiver burden and more positive aspects of caregiving are hypothesized to exist in the group with low acculturation, although the correlations between these two variables are expected to be similar in the acculturation groups. These results would imply that acculturation affects Mexican-American caregivers in both positive and negative ways.Item Feeding tube use in advanced dementia: current considerations(2014-12-12) Rhodes, RamonaItem Identifying Predictors of Reversion from Mild Cognitive Impairment to Normal Cognition(2015-07-15) Pandya, Seema Yogendra; Woon, Fu Lye; Lacritz, Laura H.; Weiner, Myron F.; Deschner, Martin; Jeon-Slaughter, HaekyungStudies on mild cognitive impairment (MCI) have focused on identifying predictors of progression to dementia, yet relatively few studies have examined predictors of reversion from MCI to normal cognition. This retrospective study incorporated data from the National Alzheimer's Coordinating Center Uniform Data Set to examine baseline predictors of MCI reversion. A total of 1,208 participants meeting MCI criteria were evaluated at baseline visit and three subsequent annual visits. Of these, 175 (14%) reverted to normal cognition, 612 (51%) remained MCI, and 421 (35%) progressed to dementia at two-years, with sustained diagnoses at three-years. This study only examined MCI participants who reverted to normal cognition (175) and progressed to dementia (421) for a final total of 596 participants. Baseline predictors of MCI reversion were categorized into the clusters of demographic/genetic data, global functioning, neuropsychological functioning, medical health/dementia risk score, and neuropsychiatric symptoms. Binary stepwise logistic regression models were used to identify significant predictors of MCI reversion compared to MCI progression for each cluster, which were then entered into a final comprehensive model to find the overall significant predictor(s). Receiver operating characteristic (ROC) curves were then used to determine cut-off scores for the continuous predictors most significant for MCI reversion. The variables most significantly associated with MCI reversion were younger age, being unmarried, having zero copies of the APOE ε4 allele, lower Clinical Dementia Rating Sum of Boxes scores, and higher test scores on Logical Memory Delayed Recall, Vegetable Fluency, and Boston Naming Test at baseline. ROC curve results revealed a standard z-score of -1.16 or better on Logical Memory Delayed Recall as an accurate classification of the MCI reversion group from the MCI progression group, with 89% sensitivity and 73% specificity. Results suggest that demographic, global functioning, and neuropsychological factors are significantly associated with MCI reversion. Future longitudinal studies on MCI reversion, with a multifactorial approach, are necessary to increase understanding of MCI reversion. Findings could help educate patients and families on clinical outcomes of MCI, better inform healthcare providers on treatment management and clinical prognosis, and increase precision of findings in early intervention studies of dementia.Item Losing it Part II: when is dementia not Alzheimer's(2001-06-07) Vicioso, Belinda A.Item Neuropsychological Functioning in Aging National Football League Retirees(2020-08-01T05:00:00.000Z) Schaffert, Jeffrey Michael; Cullum, C. Munro; Didehbani, Nyaz; LoBue, Christian; Motes, Michael A.; Hart, John, Jr.Concussive and sub-concussive head impacts sustained over a National Football League (NFL) career have been proposed to increase risk for later cognitive impairment. However, research is generally limited on the neuropsychological functioning among NFL retirees, and no studies to date have investigated the cognitive performance of NFL retirees over time. Study One was a critical review of research on neuropsychological functioning among NFL retirees. Findings were mixed, but studies suggested some NFL retirees have lower verbal memory, confrontation naming, and executive functioning abilities compared to control groups. Investigations of dose-response relationships between cognition and head-injury exposure also generated mixed findings which may be related to small samples, sampling bias, small effect sizes, and the measurement of different head-injury exposure variables. Study Two was a prospective cohort design investigating neuropsychological functioning and head-injury exposure in NFL retirees aged 50 and up. Retirees underwent baseline (N = 53) and follow-up (N = 29) comprehensive neuropsychological evaluations. Cognitively normal retirees (n = 26) were age, education, and IQ-matched to healthy controls (n = 26). Retirees diagnosed with MCI or dementia (n = 27) were matched as closely as possible to a clinical sample of patients with MCI and dementia by age, education, and diagnosis (n = 22). Independent samples t-tests and repeated measures ANCOVAs were used to evaluate neuropsychological scores between groups. Pearson correlations, partial correlations, and quadratic regressions were used to examine relationships between head-injury exposure and neuropsychological scores. Head-injury exposure variables included concussions, number of concussions with loss of consciousness, years playing professionally, games played, games started, and age beginning tackle football. Overall, NFL retirees did not significantly differ on the majority of measures at baseline or on any measures over time compared to their respective control groups. Furthermore, the vast majority of neuropsychological scores were not significantly related to head-injury exposure, regardless of cognitive diagnosis. In totality, findings suggest that NFL retirees do not have lower cognitive functioning compare to non-athlete controls later in life, and that head-injury exposure obtained over an NFL career is not related to cognitive functioning later-in-life.Item [Southwestern News](2004-05-05) Horton, RachelItem Utility of the Clinical Dementia Rating Scale in Detecting Autopsy-Proven Dementia in Patients with Low Education(2018-01-23) Li, Chengxi; LoBue, Christian; Schaffert, Jeff; Cullum, C. MunroBACKGROUND AND OBJECTIVE: The Clinical Dementia Rating scale (CDR) assesses impairment in 6 cognitive and functional domains to stage cognitive decline and dementia. Each domain is scored from 0 (no impairment) to 3 (severe impairment), and these scores are summed to a sum-of-boxes (CDR-SB) score ranging from 0 to 18. The CDR-SB score has shown high reliability in staging dementia. However, no studies have determined whether the CDR remains effective when applied to less-educated individuals. This study investigated the sensitivity and specificity of the CDR-SB score in detecting dementia associated with autopsy-proven AD in patients with less than 12 years of education. HYPOTHESIS: Using the validated CDR-SB cut score for mild dementia (4.5) to detect autopsy-proven AD in this population was hypothesized to yield low sensitivity and/or specificity (i.e. <70%). A higher cut score was expected to be required for optimal sensitivity/specificity. METHODS: Participants from the National Alzheimerメs Coordinating Center Uniform Data Set with less than 12 years of education were divided into two cohorts (autopsy-proven AD and normal age-related brain changes), matched for age and sex, and excluded if other major neurological diseases were present (n = 34; 17 per cohort). Receiver Operating Characteristic (ROC) analysis was performed to determine the sensitivity and specificity of CDR-SB scores in discriminating between subjects with autopsy-proven AD and those with normal age-related brain changes. RESULTS: The validated CDR-SB cut score for mild dementia (4.5) correctly classified 10 of 17 patients with normal age-related brain changes and 16 of 17 with autopsy-proven AD (sensitivity = .941, specificity = .588). These data reflect the unexpected presence of 7 patients with clinically-diagnosed dementia in the normal cohort and 1 patient without clinically-diagnosed dementia in the autopsy-proven AD cohort. The optimal cut score was found to be 9.5, correctly classifying 15 of 17 patients with normal age-related brain changes and 14 of 17 with autopsy-proven AD (sensitivity = .824, specificity = .882). DISCUSSION: In patients with <12 years of education, the optimal CDR-SB cut score to detect AD-related dementia (9.5) is in a range associated with moderate dementia, which may be too high for clinical utility. Although numerous neurological syndromes were excluded, factors other than education may have contributed to high CDR-SB scores in the comparison group. Further research in larger samples is needed to validate the results of this preliminary investigation.