Abstract
Background
Cognitive complaints are common in patients recovering from Coronavirus Disease 2019 (COVID-19), yet their etiology is often unclear. We assess factors that contribute to ...cognitive impairment in ambulatory versus hospitalized patients during the sub-acute stage of recovery.
Methods
In this cross-sectional study, participants were prospectively recruited from a hospital-wide registry. All patients tested positive for SARS-CoV-2 infection using a real-time reverse transcriptase polymerase-chain-reaction assay. Patients ≤ 18 years-of-age and those with a pre-existing major neurocognitive disorder were excluded. Participants completed an extensive neuropsychological questionnaire and a computerized cognitive screen via remote telemedicine platform. Rates of subjective and objective neuropsychological impairment were compared between the ambulatory and hospitalized groups. Factors associated with impairment were explored separately within each group.
Results
A total of 102 patients (76 ambulatory, 26 hospitalized) completed the symptom inventory and neurocognitive tests 24 ± 22 days following laboratory confirmation of SARS-CoV-2 infection. Hospitalized and ambulatory patients self-reported high rates of cognitive impairment (27–40%), without differences between the groups. However, hospitalized patients showed higher rates of objective impairment in visual memory (30% vs. 4%;
p
= 0.001) and psychomotor speed (41% vs. 15%;
p
= 0.008). Objective cognitive test performance was associated with anxiety, depression, fatigue, and pain in the ambulatory but not the hospitalized group.
Conclusions
Focal cognitive deficits are more common in hospitalized than ambulatory patients. Cognitive performance is associated with neuropsychiatric symptoms in ambulatory but not hospitalized patients. Objective neurocognitive measures can provide essential information to inform neurologic triage and should be included as endpoints in clinical trials.
Multiple studies have explored the relationship between MRI-based volumetric measurements of the hippocampus and amygdala, the degree of volumetric asymmetry of these structures, and symptom ...manifestation. However, considerable variability exists with regard to the reported volumetric values of these structures. The present study employed meta-analytic procedures to provide a systematic analysis of the normal population parameters of hippocampal and amygdala volumetric asymmetry as well as the absolute intrahemispheric volumes of these structures in normal adults. A literature review of studies published between 1990 and 2002 resulted in a representative sample of 82 studies (N = 3,564 participants) providing volumetric information of the hippocampus and 51 studies (N = 2,000 participants) providing volumetric information of the amygdala. Results revealed that both the hippocampus and the amygdala are reliably asymmetrical structures in normal adults, with larger right hippocampal (D = 0.21, p.001) and right amygdala (D = 0.09, p.01) volumes. Additional analyses indicated that differences in MRI magnet field strength and slice thickness values might differentially contribute to volumetric asymmetry estimates. These results expand on previous volumetric normative studies and may be relevant to investigators studying the clinical correlates of hippocampal and amygdala volumes.
Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure Exposed Children ...(EC). In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children Unexposed Children (UC). We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.
Subjective cognitive decline (SCD) is prevalent in the general population, particularly among Hispanic adults. SCD increases the risk of mild cognitive impairment (MCI) and dementia. While ...non-pharmacologic interventions are recommended to mitigate cognitive decline and preserve daily function in SCD and MCI, such interventions are not readily available for Spanish-speaking Hispanic adults with SCD. This pilot study, preregistered at clinicialtrials.gov, aimed to develop a linguistically and culturally appropriate adaptation of an existing memory compensation intervention, the Memory Support System (MSS), from English to Spanish, and to gather data to assess its impact in this population. Twenty Spanish-speaking Hispanic adults with SCD and 16 support partners were recruited. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and 8-week follow-up. By treatment end, participants with SCD improved their general functional status, daily activities requiring organizational skills, and depression and anxiety symptoms. Partners reported improvement in anxiety by treatment end and in caregiver burden at follow-up. The MSS was successfully translated into Spanish and readily learned by participants with SCD and their partners. The MSS in Spanish may help with daily functioning and aspects of patient and family well-being.
A proteomic signature for dementia with Lewy bodies O'Bryant, Sid E.; Ferman, Tanis J.; Zhang, Fan ...
Alzheimer's & dementia : diagnosis, assessment & disease monitoring,
December 2019, Volume:
11, Issue:
1
Journal Article
Peer reviewed
Open access
We sought to determine if a proteomic profile approach developed to detect Alzheimer's disease would distinguish patients with Lewy body disease from normal controls, and if it would distinguish ...dementia with Lewy bodies (DLB) from Parkinson's disease (PD).
Stored plasma samples were obtained from 145 patients (DLB n = 57, PD without dementia n = 32, normal controls n = 56) enrolled from patients seen in the Behavioral Neurology or Movement Disorders clinics at the Mayo Clinic, Florida. Proteomic assays were conducted and analyzed as per our previously published protocols.
In the first step, the proteomic profile distinguished the DLB-PD group from controls with a diagnostic accuracy of 0.97, sensitivity of 0.91, and specificity of 0.86. In the second step, the proteomic profile distinguished the DLB from PD groups with a diagnostic accuracy of 0.92, sensitivity of 0.94, and specificity of 0.88.
These data provide evidence of the potential utility of a multitiered blood-based proteomic screening method for detecting DLB and distinguishing DLB from PD.
Objectives
To investigate whether demographic (age and education) adjustments for the Mini‐Mental State Examination (MMSE) attenuate mean score discrepancies between African‐American and Caucasian ...adults and whether demographically adjusted MMSE scores improve the diagnostic classification accuracy of dementia in African‐American adults over unadjusted MMSE scores.
Design
Cross‐sectional study.
Setting
Community‐dwelling adults participating in the Mayo Clinic Alzheimer's Disease Patient Registry and Alzheimer's Disease Research Center.
Participants
Three thousand two hundred fifty‐four adults (2,819 Caucasian, 435 African American) aged 60 and older.
Measurements
MMSE score at study entry.
Results
African‐American adults had significantly lower unadjusted MMSE scores (23.0 ± 7.4) than Caucasian adults (25.3 ± 5.4). This discrepancy persisted despite adjustment of MMSE scores for age and years of education using established regression weights or newly derived weights. Controlling for dementia severity at baseline and adjusting MMSE scores for age and quality of education attenuated this discrepancy. In African‐American adults, an age‐ and education‐adjusted MMSE cut score of 23/24 provided optimal dementia classification accuracy, but this represented only a modest improvement over an unadjusted MMSE cut score of 22/23. The posterior probability of dementia in African‐American adults is presented for various unadjusted MMSE cut scores and prevalence rates of dementia.
Conclusion
Age, dementia severity at study entry, and quality of educational experience are important explanatory factors in understanding the existing discrepancies in MMSE performance between Caucasian and African‐American adults. These findings support the use of unadjusted MMSE scores when screening older African Americans for dementia, with an unadjusted MMSE cut score of 22/23 yielding optimal classification accuracy.
The measurement of cognitive abilities across diverse cultural, racial, and ethnic groups has a contentious history, with broad political, legal, economic, and ethical repercussions. Advances in ...psychometric methods and converging scientific ideas about genetic variation afford new tools and theoretical contexts to move beyond the reflective analysis of between-group test score discrepancies. Neuropsychology is poised to benefit from these advances to cultivate a richer understanding of the factors that underlie cognitive test score disparities. To this end, the present article considers several topics relevant to the measurement of cognitive abilities across groups from diverse ancestral origins, including fairness and bias, equivalence, diagnostic validity, item response theory, and differential item functioning.
Identifying individuals at risk for mild cognitive impairment (MCI) is of urgent clinical need.
This study aimed to determine whether machine learning approaches could harness longitudinal ...neuropsychology measures, medical data, and APOEɛ4 genotype to identify individuals at risk of MCI 1 to 2 years prior to diagnosis.
Data from 676 individuals who participated in the 'APOE in the Predisposition to, Protection from and Prevention of Alzheimer's Disease' longitudinal study (N = 66 who converted to MCI) were utilized in supervised machine learning algorithms to predict conversion to MCI.
A random forest algorithm predicted conversion 1-2 years prior to diagnosis with 97% accuracy (p = 0.0026). The global minima (each individual's lowest score) of memory measures from the 'Rey Auditory Verbal Learning Test' and the 'Selective Reminding Test' were the strongest predictors.
This study demonstrates the feasibility of using machine learning to identify individuals likely to convert from normal cognition to MCI.
Abstract
Background
Subjective cognitive decline (SCD) affects 1 in 9 Hispanics aged ≥45 in the U.S., including 1 in 3 who report that SCD interferes with instrumental activities of daily living ...(IADLs) and 1 in 2 who give up IADLs or need help performing household tasks. A curriculum and calendar/note‐taking system Memory Support System (MSS) has proven effective to sustain independence in IADLs in patients with mild cognitive impairment, and protect mood among program partners compared to controls. Until recently, the MSS had only been utilized among English‐speaking, predominately Caucasian, samples.
Method
This study investigated the use of a translated and culturally‐adapted MSS in 20 Spanish‐speaking participants with SCD 80% female, age M = 66.8 (SD = 10.3), education M = 14.8 (SD = 3.6) and their program partners. A within‐subject multiple baseline design in a 10‐session, 2 to 6‐week MSS training schedule was utilized. Outcome measures included treatment adherence and self‐ and informant‐report questionnaires of IADLs, anxiety, depression, self‐efficacy, caregiver burden, and quality of life.
Result
MSS training significantly improved adherence to the MSS calendar by treatment completion (d = ‐3.75). Participants with SCD also showed significant improvement in overall functional status (d = 0.72), and in daily activities requiring organizational skills (d = 0.66). Symptoms of depression (d = 0.99) and anxiety (d = 0.84) also improved by treatment end, and program partners reported significant improvement in their own anxiety (d = 0.84). There was a significant association between MSS adherence and anxiety in participants with SCD (r = ‐.51).
Conclusion
Overall, preliminary findings suggest that with appropriate training, Spanish‐speaking participants with SCD can and will use a memory notebook system to help compensate in daily life for their SCD and decrease emotional distress. Future research should investigate the Spanish MSS efficacy over time in a randomized controlled trial.
Background
Subjective cognitive decline (SCD) affects 1 in 9 Hispanics aged ≥45 in the U.S., including 1 in 3 who report that SCD interferes with instrumental activities of daily living (IADLs) and 1 ...in 2 who give up IADLs or need help performing household tasks. A curriculum and calendar/note‐taking system Memory Support System (MSS) has proven effective to sustain independence in IADLs in patients with mild cognitive impairment, and protect mood among program partners compared to controls. Until recently, the MSS had only been utilized among English‐speaking, predominately Caucasian, samples.
Method
This study investigated the use of a translated and culturally‐adapted MSS in 20 Spanish‐speaking participants with SCD 80% female, age M = 66.8 (SD = 10.3), education M = 14.8 (SD = 3.6) and their program partners. A within‐subject multiple baseline design in a 10‐session, 2 to 6‐week MSS training schedule was utilized. Outcome measures included treatment adherence and self‐ and informant‐report questionnaires of IADLs, anxiety, depression, self‐efficacy, caregiver burden, and quality of life.
Result
MSS training significantly improved adherence to the MSS calendar by treatment completion (d = ‐3.75). Participants with SCD also showed significant improvement in overall functional status (d = 0.72), and in daily activities requiring organizational skills (d = 0.66). Symptoms of depression (d = 0.99) and anxiety (d = 0.84) also improved by treatment end, and program partners reported significant improvement in their own anxiety (d = 0.84). There was a significant association between MSS adherence and anxiety in participants with SCD (r = ‐.51).
Conclusion
Overall, preliminary findings suggest that with appropriate training, Spanish‐speaking participants with SCD can and will use a memory notebook system to help compensate in daily life for their SCD and decrease emotional distress. Future research should investigate the Spanish MSS efficacy over time in a randomized controlled trial.
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