Browsing by Subject "Mild Cognitive Impairment"
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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 Analysis of Practice Effects Across Cognitive Domains in Mild Cognitive Impairment(2014-09-01) Rao, Shruthi; Lacritz, Laura; Cullum, C. Munro; Martin-Cook, KristinSerial assessments provide clinically useful information about progression of a disease. Since individuals with mild cognitive impairment are less likely to show decline in cognitive areas other than memory, it is important to analyze which domains are more susceptible to practice effects than others. The appearance of practice effects in serial assessments is a common challenge for clinicians interpreting neuropsychological tests. Detecting true change can be altered by factors such as test intervals, standardization procedures, alternate forms, respondent characteristics, and cognitive domains impaired in a clinical population. Some cognitive domains such as learning, memory, and executive functioning are known to be more susceptible to practice effects than others such as processing speed, attention, and language. Normal adults are also shown to have greater practice effects over multiple exposures than disease populations. The review supports the claim that healthy adult individuals are more likely to improve and show greater practice effects during serial assessments than clinical populations. In patients with mild cognitive impairment (MCI), domains that rely on recall and learning test rules like learning, memory, and executive functioning tend to be more susceptible to practice effects than crystallized and skill - based domains such as language, processing speed, and attention. Future research should focus on developing reliable change indices for each cognitive domain and possibly each neuropsychological test to help provide a comparison and detect true change in test scores. Studies should also focus on developing alternate equivalent forms, which would help minimize practice effects across populations.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 Use of Cognitive Screening and the Influence of Psychosocial Variables in Identification of Cognitive Impairment in MS(2013-05-17) Ritter, Ashley Reyes; Lacritz, Laura H.; Hynan, Linda S.; Cullum, C. MunroBACKGROUND: The purpose of this project is to examine the potential of abbreviated cognitive screening to identify patients with clinically significant cognitive dysfunction. A secondary goal is to examine relationships between cognitive functioning and psychosocial factors of disease. SUBJECTS: The study includes 94 subjects with a Demyelinating disease [M age = 45.04 (11.08); M education = 15.40 (2.13)] who were referred to the University of Texas Southwestern Medical Multiple Sclerosis Clinical Center and Multiple Sclerosis Program and signed informed consent for a larger study on cognition in multiple sclerosis and demyelinating disease. METHOD: Subjects completed a screening battery (JoL, 9HPT, PASAT, SDMT-Oral, and T25FW) at visit one and a larger cognitive assessment within 4 weeks of visit one, which was used to divide subjects into impaired and non-impaired groups. Linear regression was used to assess which tests on the screening battery predicted impairment on the longer battery. Associations between psychosocial factors of depression, fatigue, and sleepiness were examined in relation to cognitive performance. The relationship between depression and objective versus subjective cognitive performance was also examined. RESULTS: The PASAT (p = .001) was the only measure in the screening battery that predicted group membership, with correct classification of 76% of subjects using a cut score of T ² 38. Depression (QIDS-SR) was significantly correlated with self-reported cognitive dysfunction (MSNQ) (r = .57; p = <.001) but only modestly associated with the four measures on the screening battery (r = -.17 to .25). Those who endorsed depressive symptoms performed lower on JoL(p = .003), PASAT (p = .015) and SDMT (p = .023). Level of fatigue was associated with cognitive performance, as significant mean differences were found on all screening battery measures in high versus low fatigue groups. There was no impact of sleepiness on cognition. DISCUSSION: Complex attention was the most sensitive measure for predicting cognitive impairment on a more comprehensive battery and may be a good screening tool in identifying who might benefit from more detailed testing. Higher levels of depression and fatigue significantly impacted test performance and highlight important areas for screening and treatment, while daytime sleepiness had no effect.