Journal of Geriatric Psychiatry and Neurology recent issues

Depressive Symptoms and Metabolic Syndrome: Selective Association in Older Women

Laudisio, A., Marzetti, E., Pagano, F., Pozzi, G., Bernabei, R., Zuccala, G. — Tue, 17 Nov 2009 15:18:52 PST

The metabolic syndrome (MetS) is being increasingly found in older populations. Depressive symptoms are prevalent in elderly populations, and they are associated with adverse outcomes, chiefly cardiovascular. The aim of this study was to evaluate the association of the 30-item geriatric depression scale (GDS) score with MetS, as defined according to the National Cholesterol Education Program’s Adult Treatment Panel III (ATP-III) criteria, in all 353 participants aged 75+ years living in Tuscania (Italy). Metabolic syndrome was associated with the GDS score in a multivariable linear regression analysis in women (β s= 2.14, 95% CI = 0.14 to 4.14; P = .036), but not in men (β = —.84, 95% CI = —3.17 to 1.49; P = .476), after adjusting. Analysis of the interaction term confirmed (P = .022) that such an association differed according to sex. Metabolic syndrome is independently associated with depressive symptoms in community-dwelling older women. Older women with depression should be prompted to undergo screening for MetS. Conversely, elderly women with MetS should be assessed for affective disorders.

Depressive Symptoms in Parkinson Disease Correlate With Impaired Global and Specific Cognitive Performance

Tue, 17 Nov 2009 15:18:52 PST

Consecutive patients in a Movement Disorders Center with Parkinson disease (PD) were offered to undergo complete neuropsychological testing and to complete the Beck Depression Inventory (BDI), regardless of their cognitive and behavioral status. A total of 82 patients were included in this cross-sectional study and had a mean age of 67.7 years, formal education of 14.8 years, PD duration of 101 months, Unified Parkinson Disease Rating Scale—Motor ‘‘off’’ score of 36.96, Mini-Mental State Examination (MMSE) score of 27.8 (range 19-30), and BDI score of 10.23 (SD 8.65). Beck Depression Inventory scores did not correlate with disease duration or motor scores but inversely correlated with the MMSE scores (r = —0.40; P < .001) and total Dementia Rating Scale (DRS) scores (r = —0.33; P < .01). Using a univariate regression analysis controlling for age, gender, education, and total Unified Parkinson Disease Rating Scales (UPDRS) score, the BDI scores had a significant and unique relationship with MMSE scores. However, when the BDI scores were correlated with specific cognitive domains, only the Boston Naming Test and the Hopkins Verbal Learning Test (HVLT) delayed recall remained significant after Bonferroni correction. Similarly, when comparing the cognitive performance of patients with PD who scored >14 on the BDI versus those who scored <14, only the mean score of the Boston Naming Test was different between the 2 groups. Our study shows that while depressive symptoms correlated with global cognitive performance, naming, verbal memory, and language are the most susceptible cognitive domains affected with depressive symptoms.

Assessing Cognition in Parkinson Disease: Use of the Cognitive Linguistic Quick Test

Parashos, S. A., Johnson, M. L., Erickson-Davis, C., Wielinski, C. L. — Tue, 17 Nov 2009 15:18:52 PST

Objective: To evaluate the Cognitive Linguistic Quick Test (CLQT) as a cognitive screening tool in Parkinson disease (PD). Methods: A total of 93 patients with PD were evaluated with the Mini-Mental State Examination (MMSE) and the CLQT. The CLQT provides separate ratings for 5 cognitive domains. Descriptive statistics, correlations between the tests, and diagnostic value for dementia were analyzed. Results: Cognitive Linguistic Quick Test correlated well with MMSE. Diagnostic values for dementia were similar for the 2 instruments. Unlike the MMSE, the CLQT also provided domain-specific information on cognitive deficits. Cognitive domains were differentially affected between and within the demented and nondemented patient groups with PD: memory was the weakest domain in the demented group and attention in the nondemented. Conclusions: The CLQT is a valuable instrument in assessing cognitive dysfunction in PD. The CLQT is superior to the MMSE as it also provides cognitive domain-specific information.

Clock Test Deficits Are Associated With Semantic Memory Impairment in Alzheimer Disease

Leyhe, T., Saur, R., Eschweiler, Gerhard. W., Milian, M. — Tue, 17 Nov 2009 15:18:52 PST

Based on previous findings, we hypothesized that Clock Test deficits in patients with Alzheimer disease (AD) are associated primarily with the impairment of semantic memory regarding the appearance and functionality of a clock. To scrutinize this hypothesis, we developed a Clock Questionnaire that examined the semantic knowledge of the concept of a ‘‘Clock’’ and correlated scores from the questionnaire with performance in Clock Drawing, Clock Setting, and Clock Reading by healthy control participants and patients with mild cognitive impairment, early AD, and progressed AD. The Rey-Osterrieth-Complex-Figure is known to measure both visuospatial abilities and executive functions, and was chosen as a control variable. We found that deteriorated semantic memory best predicted Clock Test performance. In progressed AD, degraded knowledge regarding the appearance of a clock can explain the reduced ability to draw a clock face, while in early AD, impaired access to semantic knowledge about the minute hand might explain observed difficulties in drawing, setting, and reading the minute hand.

Consistency of Clinical Diagnosis of Dementia in NEDICES: A Population-Based Longitudinal Study in Spain

Tue, 17 Nov 2009 15:18:52 PST

Background: Few longitudinal studies have verified the clinical diagnosis of dementia based on clinical examinations. We evaluated the consistency of the clinical diagnosis of dementia over a period of 3 years of follow-up in a population-based, cohort study of older people in central Spain. Methods: Individuals (N = 5278) were evaluated at baseline (1994-1995) and at follow-up (1997-1998). The evaluation included a screening questionnaire for dementia and a neurological assessment. Results: Dementia screening consisted of a 37-item version of the Mini-Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (FAQ). Study neurologists investigated those participants who screened positively (N = 713) as well as 843 who had screened negatively to test the sensitivity of the screening instruments or because they had a positive screening for other chronic neurological diseases. We detected 295 patients among those who screened positive and 13 among those who screened negatively. Three years follow-up evaluation demonstrated 14 diagnostic errors at baseline (4.5%) leading to a final number of 306 patients with dementia. The corrected prevalence of dementia was 5.8% (95% confidence interval [CI] 5.2-6.5). Conclusions: The diagnosis of dementia was highly accurate in this population-based, Spanish cohort study, and our prevalence figures agree with other European surveys. Given the high cost and difficulties of population rescreening and its relatively low yield, we conclude that a single 2-phase investigation (screening followed by clinical examination) provides accurate information for most population-based prevalence studies of dementia.

Cognitive Impairment in Older Adults Without Dementia: Clinical and Pathologic Outcomes in a Community-Based Sample

Tue, 17 Nov 2009 15:18:52 PST

This study examines clinical and neuropathologic characteristics of 37 participants in a community-based dementia series who had cognitive complaints at enrollment but did not meet dementia criteria. Participants had neuropsychological testing, were followed until death, and underwent autopsy. Twenty-four participants progressed to dementia, and their baseline characteristics were analyzed. Of the 24, 13 met criteria for neuropathologic Alzheimer disease (AD). The 13 participants who progressed to neuropathologic AD (mean intake age 78.5 ± 7.7, mean enrollment 6.4 ± 2.1 years) performed worse than the 11 who progressed to neuropathologic non-AD dementias (mean intake age 79.0 ± 6.0, mean enrollment 6.0 ± 3.2 years) on baseline Wechsler Memory Scale (WMS) delayed logical memory (3.4 ± 2.9 vs 6.3 ± 3.9, P = .05) and delayed visual reproduction (1.4 ± 2.1 vs 3.1 ± 2.7, P = .02). These observations are consistent with the view that nondemented patients with underlying AD may be more likely to present with memory than nonmemory cognitive impairment.

Functional Consequences of Subcortical White Matter Lesions and MRI-Defined Brain Infarct in an Elderly General Population

Baune, B. T., Schmidt, W. P., Roesler, A., Berger, K. — Tue, 17 Nov 2009 15:18:52 PST

The impact of single and combined effects of subcortical white matter lesions (WMLs) and magnetic resonance imaging (MRI)—defined brain infarct on activities of daily living (ADL), depression, and health status perception was analyzed in community-dwelling elderly individuals. The study included 268 participants from the Memory and Morbidity in Augsburg Elderly (MEMO) project, a population-based study on individuals aged 65 to 83 years, conducted in Augsburg, Germany. Cerebral MRI was performed, and 2 geriatric performance tests, scales to assess ADL, depressive symptoms, and self-perceived health status were assessed. The prevalence of large (>10 mm) subcortical WML was 37.7% and of MRI-defined infarct-like lesions was 15.3%. Both vascular lesion types combined were found in 9% of the participants. Large WMLs were associated with significantly more impairments in basic ADL, inferior results in the performance tests, and a worse self-perceived health status compared to those without large WML. Magnetic resonance imaging—defined brain infarct was associated with impairments in performance tests. Participants with both lesion types were limited in all domains and were 2 to 3 times more likely to have impairments in all examined functions. Their risk of impairment in a specific function was considerably higher than the sum of the single risks associated with each lesion type alone. This study suggests that the single and especially the combined occurrence of common vascular brain lesions are associated with functional impairment. Identifying individuals with severe WML combined with MRI-defined brain infarct can help better understand the development of marked impairments in old age.

The Reasons for Nursing Home Entry in an Adult Day Care Population: Caregiver Reports Versus Regression Results

Cohen-Mansfield, J., Wirtz, P. W. — Tue, 17 Nov 2009 15:18:52 PST

This article aims to compare reasons for nursing home entry determined through a regression of baseline predictors to relatives’ perceptions of reasons for entry. Participants included 201 community-residing members of 5 senior day care centers in Maryland. Through a prospective design, statistical predictors using Cox regressions were compared to the relatives’ reports of reasons for nursing home entry. These reports identified the most common reasons for nursing home entry as deterioration of independence and confusion. Behavior problems were also reported for almost half of the participants. In contrast, strong baseline statistical predictors of institutionalization were depressed affect, number of psychiatric diagnoses, a diagnosis of dementia, and age. Because of its strong significance within the baseline predictors, the meaning of depressed affect and why it was such a potent predictor of nursing home entry, yet still not reported by caregivers, should be studied further.

Measuring Cognition in a Geriatric Outpatient Clinic: Rasch Analysis of the Montreal Cognitive Assessment

Koski, L., Xie, H., Finch, L. — Fri, 21 Aug 2009 16:34:37 PDT

Objective: To evaluate the psychometric properties of the Montreal Cognitive Assessment as a quantitative measure of cognitive ability. Data analyzed: A total of 222 cases extracted from a clinical database (57-91 years) of patients screened for cognitive impairment in outpatient geriatric assessment clinics. Data collected: Demographic information and individual item responses to Montreal Cognitive Assessment. Results: Comparison of the data with a unidimensional Rasch model indicated that the total score obtained by summing across all items yields a reliable (0.75) quantitative estimate of global cognitive ability. All items fit the model and together spanned a range of difficulty from -3.75 to +2.88 logits. Items were assessed for differential item functioning across such patient characteristics as age, education, and language spoken. We provide a table for converting Montreal Cognitive Assessment total scores onto a linearly scaled score, with guidelines for interpreting changes in Montreal Cognitive Assessment score in terms of their statistical significance. Conclusions: The Montreal Cognitive Assessment can provide a reliable and valid quantitative estimate of cognitive ability in a geriatric cognitive disorders clinic setting.

Outcomes of Oregon's Law Mandating Physician Reporting of Impaired Drivers

Snyder, K. M., Ganzini, L. — Fri, 21 Aug 2009 16:34:37 PDT

Oregon enacted a law in 2002 that requires some health care practitioners to report cognitively impaired drivers to the Department of Motor Vehicles. We examined reports submitted between 2003 and 2006 on 1664 potential impaired drivers. Of reported drivers, 48% were older than 80 years of age. Reports of cognitive impairment were 7 times more common than functional impairments. The most common cognitive impairments were judgment and problem solving (65%), memory (53%), and reaction time (52%). Only 10% of suspended drivers regained their driving privileges. Drivers older than 80 years of age were 6 times less likely to regain privileges compared to drivers 59 years or younger. In summary, Oregon’s law resulted in loss of driving privileges in a small number of licensed drivers. Over half were aged 80 years or older, with chronic or progressive cognitive impairments. Further study is needed to determine whether this law reduces crashes and crash-related fatalities.

APOE Alleles in Parkinson Disease and Their Relationship to Cognitive Decline: A Population-based, Longitudinal Study

Kurz, M. W., Dekomien, G., Nilsen, O. B., Larsen, J. P., Aarsland, D., Alves, G. — Fri, 21 Aug 2009 16:34:37 PDT

Apolipoprotein E gene alleles have been linked to various cardiovascular and neurodegenerative disorders. There have been conflicting reports of associations between Apolipoprotein E alleles and Parkinson disease and Parkinson disease dementia. To investigate the role of Apolipoprotein E alleles in Parkinson disease and Parkinson disease dementia, we have determined Apolipoprotein E genotypes in a group of patients with Parkinson disease (n = 95) and compared them with those of healthy control participants (n = 73). Additionally, in 64 longitudinally followed patients with Parkinson disease, the allele types were correlated to development and progression of dementia and to time from onset of Parkinson disease to dementia using multivariate and survival analyses. The Apolipoprotein E e4e4 genotype was more common in patients with Parkinson disease (7.4%) than in healthy controls (1.4%; P = .03). No significant associations between the Apolipoprotein E genotype and development and progression of dementia or time to dementia were found. More studies with larger Parkinson disease samples are warranted.

The Clock Drawing Test--Modified and Integrated Approach (CDT-MIA) as an Instrument for Detecting Mild Cognitive Impairment in a Specialized Outpatient Setting

Heinik, J., Shaikewitz, D. — Fri, 21 Aug 2009 16:34:37 PDT

This study examined the accuracy of the Clock Drawing Test—Modified and Integrated Approach (CDT-MIA) alone and combined with the Mini-Mental State Examination (MMSE) to detect Mild Cognitive Impairment (MCI) in patients with suspected MCI. For comparison, the accuracy of the Cambridge Cognitive Examination—Revised (CAMCOG-R) was tested. A total of 65 elderly outpatients with suspected MCI underwent a comprehensive evaluation. Following assessment, the entire sample was classified into: dementia (mild)—24 participants, MCI—22 participants, no cognitive impairment (NCI)—19 participants. CDT-MIA and the MMSE alone failed to appropriately discriminate demented from nondemented (MCI and NCI) and MCI from NCI. The best acceptable diagnostic accuracy to discriminate between demented and nondemented was obtained with CDT-MIA/MMSE combined and with CAMCOG-R. CDT-MIA/MMSE combined failed to appropriately discriminate MCI from NCI. The best diagnostic accuracy in this regard was obtained with CAMCOG-R.

Incidence of Mild Cognitive Impairment and Alzheimer Disease in Southern Brazil

Lorena Chaves, M., Luiza Camozzato, A., Godinho, C., Piazenski, I., Kaye, J. — Fri, 21 Aug 2009 16:34:37 PDT

The objective of the study was to evaluate incident cases of Alzheimer disease (AD) and mild cognitive impairment (MCI) in an elderly community cohort in a major city of southern Brazil and to determine the variables associated with the development of cognitive dysfunction. Data were drawn from a cohort to investigate healthy aging among community elderly (N = 345) and were derived from the follow-up for a maximum of 8 years. Sociodemographic, psychiatric and medical information, the Mini-Mental State Examination (MMSE), and the Clinical Dementia Rating scale were obtained in each assessment. The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV), NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and related Disorders Association), and the Mayo Clinic criteria were applied to ascertain diagnoses of AD and MCI. The incidence rate per 1000 persons-year for MCI was 13.2 (95% confidence interval [CI] 7.79-20.91) and for AD was 14.8 (95% CI 9.04-22.94). Cognitive dysfunction was associated with education (odds ratio [OR] = 0.86; confidence limit [CL] 0.76-0.97 95%) and baseline MMSE (OR = 0.81; CL 0.70-0.94 95%). The AD incidence in this sample was higher than those reported in a previous Brazilian study. The study filled the epidemiological gap in the evaluation of MCI in Brazil.

Serum 25-Hydroxyvitamin D Concentration and Cognitive Impairment

Llewellyn, D. J., Langa, K. M., Lang, I. A. — Fri, 21 Aug 2009 16:34:37 PDT

Vitamin D may be of interest in the prevention of cognitive impairment, though previous findings are inconclusive. Participants were 1766 adults aged 65 years and older from the Health Survey for England 2000, a nationally representative population-based study. Cognitive impairment was assessed using the Abbreviated Mental Test Score. The cross-sectional relation of serum 25-hydroxyvitamin D quartiles to cognitive impairment was modeled using logistic regression. In all, 212 participants (12%) were cognitively impaired. Odds ratios (95% confidence intervals) for cognitive impairment in the first (8-30 nmol/L), second (31-44 nmol/L), and third (45-65 nmol/L) quartiles of serum 25-hydroxyvitamin D compared with the fourth (66-170 nmol/L) were 2.3 (1.4-3.8), 1.4 (0.8-2.4), and 1.1 (0.6-1.9), after adjustment for age, sex, education, ethnicity, season of testing, and additional risk factors for cognitive impairment (P for linear trend = .001). Our data suggest low serum 25-hydroxyvitamin D is associated with increased odds of cognitive impairment.

Vascular Risk Factors and Cognitive Functions in Nondemented Elderly Individuals

Wiederkehr, S., Laurin, D., Simard, M., Verreault, R., Lindsay, J. — Fri, 21 Aug 2009 16:34:37 PDT

Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment continuum and includes individuals with vascular risk factors (VRF). However, there is still no clear definition of this concept. The aim of the study is to characterize the neuropsychological profile of elderly individuals by 3 levels of VRF. Methods: This is a cross-sectional analysis of the Canadian Study of Health and Aging baseline data; 577 nondemented elderly individuals ≥65 years old were divided into 3 groups: reference group (0 VRF; n = 82); intermediate brain-at-risk group (1-2 VRF; n = 360); high brain-at-risk group (≥3 VRF; n = 135). A principal component analysis (PCA) and univariate/multivariate analyses of variance were performed to examine the relationships between the groups and various cognitive measures. Main findings: The PCA produced a 2-component solution (1) executive/psychomotor functions including measures of abstraction and (2) verbal memory. The high brain-at-risk group performed significantly worse than the reference group on the first component. Conclusions: Elderly individuals presenting with ≥3 VRF are more impaired on measures of executive functions/ processing speed than participants without any VRF.

White Matter Hyperintensities and Cognitive Dysfunction in Alzheimer Disease

Heo, J.-H., Lee, S.-T., Kon Chu, , Park, H.-J., Shim, J.-Y., Kim, M. — Fri, 21 Aug 2009 16:34:37 PDT

The effect of white matter lesions in magnetic resonance imaging or vascular atherosclerosis on cognitive function is not fully understood in Alzheimer disease (AD). In this investigation, we examined the influence of white matter lesions on cognitive decline in AD. A total of 142 patients with AD (44 men, mean age 65.7 + 7.6 years; mean education period 7.8 + 5.0 years) were included. Patients were divided into 4 groups based on the severities of white matter hyperintensities (WMH) in brain magnetic resonance images (MRI) using Fazekas scale. Cognitive functions were determined using the Korean version of the Mini-Mental State Examination (K-MMSE) and the Clinical Dementia Rating (CDR) scale before acetylcholinesterase inhibitors were administered. Of the 142 patients, 30% (43/142) had no white matter signal abnormality (grade 0). Fourteen percentage (20/142) were grade 1, 42% (59/142) grade 2, and 14% (20/142) were grade 3. Mean K-MMSE scores declined as MRI grades increased to grade 2 and 3 compared to grade 0 (P < .01). Clinical Dementia Ratings were also aggravated by MRI grade. These results remained significant after adjusting for compounding factors affecting cognitive functions; sex, age, number of years in full-time education, hypertension, diabetes, hypercholesterolemia, smoking, and atrial fibrillation. The presence of WMHs were associated with score of MMSE and CDR impairment in patients with AD. These features could be a correctable factor hastening cognitive decline in AD.

Mild Cognitive Impairment and Everyday Function: An Investigation of Driving Performance

Tue, 05 May 2009 15:15:43 PDT

Mild Cognitive Impairment (MCI) involves subtle functional losses that may include decrements in driving skills. We compared 46 participants with MCI to 59 cognitively normal controls on a driving evaluation conducted by a driving rehabilitation specialist who was blinded to participants' MCI classification. Participants with MCI demonstrated significantly lower performance than controls on ratings of global and discrete driving maneuvers, but these differences were not at the level of frank impairments. Rather, performance was simply less than optimal, which to a lesser degree was also characteristic of a subset of the cognitively normal control group. The finding of significantly lower global driving ratings, coupled with the increased incidence of dementia among people with MCI and the known impact of dementia on driving safety, suggests the need for increased vigilance among clinicians, family members, and individuals with MCI for initially benign changes in driving that may become increasingly problematic over time.

Quality of Life in Relation to Mood, Coping Strategies, and Dyskinesia in Parkinson's Disease

Montel, S., Bonnet, A.-M., Bungener, C. — Tue, 05 May 2009 15:15:43 PDT

Given the variability of the results found in the literature, the current study is a step toward better clarifying the influence of motor and nonmotor factors on quality of life in Parkinson's disease. A total of 135 participants with Parkinson's disease were selected. Semistructured interviews were carried out, after which their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA). Finally, all participants completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP) and 1, quality of life (Parkinson's disease questionnaire-39). It appears that the presence of dyskinesia, depression, and anxiety were linked to a poor quality of life. Interestingly, some different coping strategies, namely diversion as well as emotional strategies, were associated with a poor quality of life. These results encourage us to develop interventions focused on coping strategies and tailored to the emotional and clinical characteristics of each patient.

The Use of the Modified Telephone Interview for Cognitive Status (TICS-M) in the Detection of Amnestic Mild Cognitive Impairment

Cook, S. E., Marsiske, M., McCoy, K. J. M. — Tue, 05 May 2009 15:15:43 PDT

Many screening tools for detecting cognitive decline require in-person assessment, which is often not cost-effective or feasible for those with physical limitations. The Modified Telephone Interview for Cognitive Status has been used for screening dementia, but little is known about its usefulness in detecting amnestic mild cognitive impairment. Community-dwelling participants (mean age = 74.9, mean education = 16.1 years) were administered the Modified Telephone Interview for Cognitive Status during initial screening and subsequently given a multidomain neuropsychological battery. Participants were classified by consensus panel as cognitively normal older adult (noMCI, N = 54) or amnestic mild cognitive impairment (N = 17) based on neuropsychological performance and Clinical Dementia Rating Scale interview, but independent of Modified Telephone Interview for Cognitive Status score. There was a significant difference between groups in Modified Telephone Interview for Cognitive Status score (t = 8.04, P < .01, noMCI range 32-43, mean [SD] = 37.4 [2.5], amnestic mild cognitive impairment range 25-37, mean [SD] = 31.2 [3.5]). Discriminant function analysis revealed that TICS-M alone correctly classified 85.9% of participants into their respective diagnostic classification (sensitivity = 82.4%, specificity = 87.0%). Receiver operating characteristics analysis resulted in cutoff score of 34 that optimized sensitivity and specificity of amnestic mild cognitive impairment classification. The Modified Telephone Interview for Cognitive Status is a brief, cost-effective screening measure for identifying those with and without amnestic mild cognitive impairment.

Leisure Activities and Risk of Vascular Cognitive Impairment in Older Adults

Verghese, J., Cuiling Wang, , Katz, M. J., Sanders, A., Lipton, R. B. — Tue, 05 May 2009 15:15:43 PDT

``Vascular cognitive impairment'' refers to cognitive impairment caused or associated with vascular risk factors, and encompasses a cognitive spectrum ranging from mild cognitive impairment to dementia. We examined the association of leisure activity participation to risk of developing VCI in the Bronx aging study. Over 21 years, 71 of the 401 participants who were free of dementia or VCI at entry developed VCI (49 participants with VCI without dementia). We derived Cognitive and Physical Activity Scales based on frequency of leisure activity participation. A 1-point increase on the Cognitive, but not Physical Activity Scale, was associated with lower risk of VCI (hazard ratio 0.931, 95% confidence interval [CI] 0.895-0.970) in Cox analysis. Participation in cognitive but not physical leisure activities is associated with lower risk of VCI with or without dementia. Prospective studies and clinical trials are needed to define the causal role of cognitive leisure activities in influencing vascular risk for cognitive decline.

The Minute Hand Phenomenon in the Clock Test of Patients With Early Alzheimer Disease

Leyhe, T., Milian, M., Muller, S., Eschweiler, G. W., Saur, R. — Tue, 05 May 2009 15:15:43 PDT

Common scoring systems for the Clock Test do not sufficiently emphasize the correct time representation by the clock hands. We compared Clock Drawing, Clock Setting, and Clock Reading in healthy control persons, patients with mild cognitive impairment, early Alzheimer disease and progressed Alzheimer disease particularly analyzing clock time representation. We found that healthy control persons and participants with mild cognitive impairment did not show any impairment in Clock Test performance. Patients with early Alzheimer disease could be discriminated from healthy control persons and participants with mild cognitive impairment solely by misplacement of the minute hand in Clock Drawing and Clock Setting. The progressed Alzheimer disease group showed significantly more impairments in all Clock Test variants. It is assumed that early stage Alzheimer disease patient deficits in Clock Tests are mainly determined by a reduced access to semantic memory about the appearance and functionality of a clock.

Impaired Social Cognition in Mild Alzheimer Disease

Tue, 05 May 2009 15:15:43 PDT

Abnormal decoding of social information has been associated with the conversion from prodromal Alzheimer's disease (AD) to dementia. Since the distributed neural networks involved in face processing are differentially affected in prodromal and dementia states of AD and in Fronto-Temporal Dementia (FTD), we hypothezed a differential impairment in face processing in these populations. Facial expression, gender and gaze direction decoding abilities were examined in patients with probable amnesic Mild Cognitive Impairment (aMCI, N = 10) fulfilling criteria for prodromal AD, in patients with mild and moderate AD (N = 10) as well as in FTD patients (N = 10) and in a group of age- and sex-matched healthy comparison subjects (N = 10). Gender recognition was preserved in all groups. Compared to controls, patients with mild or moderate AD were impaired in expression recognition and FTD patients were impaired in expression and gaze direction determination, whereas MCI patients were not impaired at all.

Death Ideas, Suicidal Thoughts, and Plans Among Nursing Home Residents

Scocco, P., Fantoni, G., Rapattoni, M., de Girolamo, G., Pavan, L. — Tue, 05 May 2009 15:15:43 PDT

Recent studies have shown that suicides are at least as frequent among Nursing Home (NH) residents as they are among older people in the general population. The objective of the present study was to evaluate the prevalence of death- and/or suicidal feelings, thoughts, and plans and any attempted suicides in a random, unselected sample (N = 288) of individuals aged 65-years-and-over, living in NHs located in the Veneto Region (the Italian North-East). One hundred seventy-two participants were surveyed with a response rate of 59.7%. Five sample questions were asked to investigate the presence of death- and suicidal thoughts, plans and behaviors in different time periods. Among the NH residents, 30.8% admitted having had death or suicidal thoughts or plans during the month prior to the interview. The oldest-old residents (85 + y) more frequently reported death-suicide ideation. This high frequency of death and/or suicidal feelings and thoughts among older NH residents should be carefully considered when planning and implementing health care programs in these facilities.

CSF APPs{alpha} and Phosphorylated Tau Protein Levels in Mild Cognitive Impairment and Dementia of Alzheimer's Type

Wed, 18 Feb 2009 15:53:40 PST

We exploratively measured APPs, a secreted fragment of the non-amyloidogenic cleavage of amyloid precursor protein via a-secretase, and tau protein phosphorylated at threonine 181 (ptau) in the cerebrospinal fluid of 10 patients with mild cognitive impairment, 20 patients with dementia of Alzheimer's type, and 10 controls. Cerebrospinal fluid APPs and ptau levels were correlated with cognitive performance. Ptau levels were significantly elevated in mild cognitive impairment and in patients with dementia of Alzheimer's type, APPs levels were significantly reduced in patients with dementia of Alzheimer's type compared to the controls. APPs levels were associated with Mini Mental State Examination total scores but not with Delayed Verbal Recall Test performance. Vice versa, ptau levels correlated only with Delayed Verbal Recall Test in patients with dementia of Alzheimer's type or mild cognitive impairment. Both, an increase in ptau levels and a decrease in cerebrospinal fluid APPs, seem to refer to relevant but functionally different processes in the development of mild cognitive impairment and dementia of Alzheimer's type.

Association of ACE I/D Gene Polymorphism With Vascular Dementia: A Meta-Analysis

Wed, 18 Feb 2009 15:53:40 PST

Background: Vascular dementia is the second common cause of dementia, only second to Alzheimer's disease in later life, and has a greater mortality risk than Alzheimer's disease among the elderly population group. The angiotensin-converting enzyme insertion/deletion polymorphism as a risk factor in vascular dementia has been suggested, but direct evidence from genetic association studies remain inconclusive. We performed a meta-analysis pooling data from all relevant studies in order to determine the effect of the insertion/deletion polymorphism on the vascular dementia.

Methods: We applied a random-effects model or fixed-effects model to combine odds ratio and 95% confidence intervals. Q statistic was used to evaluate the homogeneity, and Egger's test and Funnel plot were used to assess publication bias.

Results: A total of 10 studies were included worldwide. Publication bias was not observed. There was no evidence of the association of angiotensin-converting enzyme insertion/deletion polymorphism with the vascular dementia in general or in the Asian populations or in the Caucasian populations. Conclusions: The angiotensin-converting enzyme insertion/deletion polymorphism might be neutral to vascular dementia.

Association Between Cytokines and Cerebral MRI Changes in the Aging Brain

Baune, B. T., Ponath, G., Rothermundt, M., Roesler, A., Berger, K. — Wed, 18 Feb 2009 15:53:40 PST

The association between cytokines (IL-1β, sIL-4R, IL-6, IL-8, IL-10, IL-12, TNF-) and subcortical white matter lesions, cortical atrophy and lacunar infarctions of the aging brain was investigated among 268 elderly community participants. Single pro- and anti-inflammatory cytokines were neither associated with WML nor with atrophy and lacunar infarction. An association between atrophy and the chemokine-cytokine factor (containing sIL-4R, IL-6, IL-8) remained significant after adjustment for age, gender, education, depressive symptoms, diabetes mellitus, cardiovascular diseases (stroke, TIA, myocardial infarction, myocardial insufficiency, arrhythmic heart), hypertension, body-mass index, smoking status and aggregation inhibitors as opposed to single cytokines. Atrophy of the parietal, temporal and occipital lobes was associated with the same cytokinechemokine factor for both the whole sample or restricted to those without history of stroke/TIA. The results indicate that a combination of chemokine-cytokines rather than single cytokines may contribute to inflammatory processes associated with cortical atrophy in the aging brain.

Alterations in Regional Brain Volume and Individual MRI-Guided Perfusion in Normal Control, Stable Mild Cognitive Impairment, and MCI-AD Converter

Wed, 18 Feb 2009 15:53:40 PST

Regional differences in tissue volume and perfusion in brains of individuals with mild cognitive impairment (MCI) versus normal healthy age-matched controls (NC), and the differences between MCI-AD converters and stable MCI patients were investigated. MRI and SPECT scans were performed on 13 MCI (74+6 years) and 12 NC (75+4 years). Of the MCI patients, 10 were followed for up to three years and 4 subsequently converted to Alzheimer's disease (AD). Episodic memory function was assessed using tests of delayed recall for word lists and stories. The volume reductions and hypoperfusion were mainly confined to the medial temporal lobe (MTL) of MCI patients and associated with worse scores on memory tests. Perfusion in the corpus callosum and the gray matter of frontal, lateral temporal, parietal or occipital lobe was not significantly affected in MCI. The 4 MCI-AD converters had relatively low MTL structural volume and perfusion compared to their stable peers.

The Association of Transient Ischemic Attack Symptoms With Memory Impairment Among Elderly Participants of the Third US National Health and Nutrition Examination Survey

Wed, 18 Feb 2009 15:53:40 PST

Background and Purpose: Stroke is a well-known risk factor for vascular dementia. However, the association of transient ischemic attacks with cognitive impairment is less well-established.

Methods: Records from Third National Health and Nutrition Examination Survey were abstracted for demographic and medical information for participants with an age !60 years who reported being free of stroke. Five self-reported symptoms (weakness, numbness, loss of vision, inability to speak, and severe dizziness) were used as surrogates representing transient ischemic attacks. Information on conventional risk factors for vascular dementia was also obtained. Multivariable logistic regression was used to examine risk factors for memory impairment. Results: 4617 participants were included with a sample-weighted prevalence of memory impairment of 6.6% (1417 participants). The final multivariable analysis revealed a significant association between transient weakness and memory impairment (odds ratio 1.52, 95% CI 1.11-2.07). The other 4 transient ischemic attacks symptoms were not significantly associated with memory impairment in the final model. Systolic blood pressure >140 was most strongly associated with prevalent memory impairment (odds ratio, 9.78, 95% CI 1.49-64.3). Other associated risk factors included non-white race, male gender, age, education ≤12 years, and history of any alcohol use.

Conclusion: Among transient ischemic attacks symptoms, self-reported weakness in the face, arm, or leg was significantly associated with memory impairment. This study indicates that transient ischemic attacks symptoms are, even in the absence of stroke, associated with memory impairment. Aggressive risk factor modification in patients with TIA symptoms may be warranted to prevent potential future memory loss.

Outcomes of Older Cognitively Impaired Individuals With Current and Past Depression in the NCODE Study

Steffens, D. C., McQuoid, D. R., Potter, G. G. — Wed, 18 Feb 2009 15:53:40 PST

We examined the frequency and course of cognitive impairment, no dementia among a group of older patients enrolled in a longitudinal study of depression. Among 230 participants, 29 with baseline dementia diagnosis were excluded from further analyses. Among the remaining 201 participants, 69 were classified with cognitive impairment, no dementia—broadly defined (34.3%) and 28 (13.9%) with cognitive impairment, no dementia—narrowly defined. At 2-year follow-up, individuals with cognitive impairment, no dementia either narrowly or broadly defined had varied outcomes including (1) improvement to normal cognition, (2) continued cognitive impairment, and (3) progression to dementia. Patients with cognitive impairment, no dementia were more likely to be assigned a later diagnosis of dementia. Our results characterize the concept of cognitive impairment, no dementia as a risk factor for dementia among older individuals with current and past depression; however, just as with the general population, the course of this condition is heterogeneous.

Predicting Everyday Functional Abilities of Dementia Patients With the Mini-Mental State Examination

Wed, 18 Feb 2009 15:53:40 PST

The Mini-Mental State Examination is a widely used cognitive screening measure. The purpose of the present study was to assess how 5 specific clusters of Mini-Mental State Examination items (ie, subscores) correlate with and predict specific areas of daily functioning in dementia patients, 61 patients with varied forms of dementia were administered the Mini-Mental State Examination and an observation-based daily functional test (the Direct Assessment of Functional Status). The results revealed that the orientation and attention subscores of the Mini-Mental State Examination correlated most significantly with most functional domains. The Mini-Mental State Examination language items correlated with all but the shopping and time orientation tasks, while the Mini-Mental State Examination recall items correlated with the Direct Assessment of Functional Status time orientation and shopping tasks. Stepwise regression analyses found that among the Mini-Mental State Examination subscores, orientation was the single, best independent predictor of daily functioning.

Parental Education and Late-life Dementia in the United States

Wed, 18 Feb 2009 15:53:40 PST

We investigated the relation between parental education and dementia in the United States. Participants in the Aging, Demographics, and Memory Study were included, with information regarding parental education obtained from the Health and Retirement Study. The odds of dementia in elderly Americans whose mothers had less then 8 years of schooling were twice (95% CI, 1.1-3.8) that of individuals with higher maternal education, when adjusted for paternal education. Of elderly Americans with less educated mothers, 45.4% (95% CI, 37.4-53.4%) were diagnosed with dementia or ``cognitive impairment, no dementia'' compared to 31.2% (95% CI, 25.0-37.4%) of elderly Americans whose mothers had at least an 8th grade education. The population attributable risk of dementia due to low maternal education was 18.8% (95% CI, 9.4-28.2%). The education of girls in a population may be protective of dementia in the next generation.