OBJECTIVES: This systematic review aims to provide updated and comprehensive evidence on the validity and feasibility of screening tools for mild cognitive impairment (MCI) and dementia among the elderly at primary healthcare level.
STUDY DESIGN: A review of articles was performed.
METHODS: A search strategy was used by using electronic bibliographic databases including PubMed, Embase and CENTRAL for published studies and reference list of published studies. The articles were exported to a bibliographic database for further screening process. Two reviewers worked independently to screen results and extract data from the included studies. Any discrepancies were resolved and confirmed by the consensus of all authors.
RESULTS: There were three screening approaches for detecting MCI and dementia - screening by a healthcare provider, screening by a self-administered questionnaire and caretaker informant screening. Montreal Cognitive Assessment (MoCA) was the most common and preferable tool for MCI screening (sensitivity [Sn]: 81-97%; specificity [Sp]: 60-86%), whereas Addenbrooke's Cognitive Examination (ACE) was the preferable tool for dementia screening (Sn: 79-100%; Sp: 86%).
CONCLUSION: This systematic review found that there are three screening approaches for detecting early dementia and MCI at primary health care. ACE and MoCA are recommended tools for screening of dementia and MCI, respectively.
There is no report in the English literature on the criteria for neuroablation or neuroaugmentation for the treatment of Parkinson's disease in a developing country like Malaysia. A prospective study of patients with Parkinson's disease from the north-eastern peninsular Malaysia was done to assess their suitability of surgery. Age, race, duration of illness and dementia were considered important factors towards the success of such surgical procedures. A mathematical model is suggested for future cases deemed to be suitable for neuroaugmentative or ablative surgery.
Nicergoline (NIC) is a semisynthetic ergot alkaloid derivative applied for treatment of dementia and other cerebrovascular disorders. The efficacy of sesame oil to slow and reverse the symptoms of neurodegenerative cognitive disorders has been proven. This work aimed to formulate and optimize sesame oil-based NIC-nanostructured lipid carriers (NIC-NLCs) for intranasal (IN) delivery with expected synergistic and augmented neuroprotective properties. The NIC-NLC were prepared using sesame oil as a liquid lipid. A three-level, three-factor Box-Behnken design was applied to statistically optimize the effect of sesame oil (%) of the total lipid, surfactant concentration, and sonication time on particle size, zeta potential, and entrapment efficacy as responses. Solid-state characterization, release profile, and ex vivo nasal permeation in comparison to NIC solution (NIC-SOL) was studied. In vivo bioavailability from optimized NIC-NLC and NIC-SOL following IN and IV administration was evaluated and compared. The optimized NIC-NLC formula showed an average particle size of 111.18 nm, zeta potential of -15.4 mV, 95.11% entrapment efficacy (%), and 4.6% loading capacity. The NIC-NLC formula showed a biphasic, extended-release profile (72% after 48 h). Permeation of the NIC-NLC formula showed a 2.3 enhancement ratio. Bioavailability studies showed a 1.67 and 4.57 fold increase in plasma and brain following IN administration. The results also indicated efficient direct nose-to-brain targeting properties with the brain-targeting efficiency (BTE%) and direct transport percentage (DTP%) of 187.3% and 56.6%, respectively, after IN administration. Thus, sesame oil-based NIC-NLC can be considered as a promising IN delivery system for direct and efficient brain targeting with improved bioavailability and expected augmented neuroprotective action for the treatment of dementia.
Alzheimer's disease (AD) is a progressive neurodegenerative disease, wherein a progressive loss of cholinergic synapses occurs in hippocampus and neocortex. Decreased concentration of the neurotransmitter, acetylcholine (ACh), appears to be critical element in the development of dementia, and the most appropriate therapeutic approach to treat AD and other form of dementia is to restore acetylcholine levels by inhibiting both major form of cholinesterase: Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Consequently, researches have focused their attention towards finding cholinesterase inhibitors from natural products. A large number of such inhibitors have been isolated from medicinal plants. This review presents a comprehensive account of the advances in field of cholinesterase inhibitor phytoconstituents. The structures of some important phytoconstituents (collected through www.Chemspider.com) are also presented and the scope for future research is discussed.
Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.
The early detection of poststroke dementia (PSD) is important for medical practitioners to customize patient treatment programs based on cognitive consequences and disease severity progression. The aim is to diagnose and detect brain degenerative disorders as early as possible to help stroke survivors obtain early treatment benefits before significant mental impairment occurs. Neuropsychological assessments are widely used to assess cognitive decline following a stroke diagnosis. This study reviews the function of the available neuropsychological assessments in the early detection of PSD, particularly vascular dementia (VaD). The review starts from cognitive impairment and dementia prevalence, followed by PSD types and the cognitive spectrum. Finally, the most usable neuropsychological assessments to detect VaD were identified. This study was performed through a PubMed and ScienceDirect database search spanning the last 10 years with the following keywords: "post-stroke"; "dementia"; "neuro-psychological"; and "assessments". This study focuses on assessing VaD patients on the basis of their stroke risk factors and cognitive function within the first 3 months after stroke onset. The search strategy yielded 535 articles. After application of inclusion and exclusion criteria, only five articles were considered. A manual search was performed and yielded 14 articles. Twelve articles were included in the study design and seven articles were associated with early dementia detection. This review may provide a means to identify the role of neuropsychological assessments as early PSD detection tests.
The early detection and classification of dementia are important clinical support tasks for medical practitioners in customizing patient treatment programs to better manage the development and progression of these diseases. Efforts are being made to diagnose these neurodegenerative disorders in the early stages. Indeed, early diagnosis helps patients to obtain the maximum treatment benefit before significant mental decline occurs. The use of electroencephalogram as a tool for the detection of changes in brain activities and clinical diagnosis is becoming increasingly popular for its capabilities in quantifying changes in brain degeneration in dementia. This paper reviews the role of electroencephalogram as a biomarker based on signal processing to detect dementia in early stages and classify its severity. The review starts with a discussion of dementia types and cognitive spectrum followed by the presentation of the effective preprocessing denoising to eliminate possible artifacts. It continues with a description of feature extraction by using linear and nonlinear techniques, and it ends with a brief explanation of vast variety of separation techniques to classify EEG signals. This paper also provides an idea from the most popular studies that may help in diagnosing dementia in early stages and classifying through electroencephalogram signal processing and analysis.
Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors' quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA) scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An optimal therapeutic program that would help stroke patients enjoy additional years with higher quality of life is presented.
Characterizing dementia is a global challenge in supporting personalized health care. The electroencephalogram (EEG) is a promising tool to support the diagnosis and evaluation of abnormalities in the human brain. The EEG sensors record the brain activity directly with excellent time resolution. In this study, EEG sensor with 19 electrodes were used to test the background activities of the brains of five vascular dementia (VaD), 15 stroke-related patients with mild cognitive impairment (MCI), and 15 healthy subjects during a working memory (WM) task. The objective of this study is twofold. First, it aims to enhance the recorded EEG signals using a novel technique that combines automatic independent component analysis (AICA) and wavelet transform (WT), that is, the AICA-WT technique; second, it aims to extract and investigate the spectral features that characterize the post-stroke dementia patients compared to the control subjects. The proposed AICA-WT technique is a four-stage approach. In the first stage, the independent components (ICs) were estimated. In the second stage, three-step artifact identification metrics were applied to detect the artifactual components. The components identified as artifacts were marked as critical and denoised through DWT in the third stage. In the fourth stage, the corrected ICs were reconstructed to obtain artifact-free EEG signals. The performance of the proposed AICA-WT technique was compared with those of two other techniques based on AICA and WT denoising methods using cross-correlation X C o r r and peak signal to noise ratio ( P S N R ) (ANOVA, p ˂ 0.05). The AICA-WT technique exhibited the best artifact removal performance. The assumption that there would be a deceleration of EEG dominant frequencies in VaD and MCI patients compared with control subjects was assessed with AICA-WT (ANOVA, p ˂ 0.05). Therefore, this study may provide information on post-stroke dementia particularly VaD and stroke-related MCI patients through spectral analysis of EEG background activities that can help to provide useful diagnostic indexes by using EEG signal processing.
Stroke survivors are more prone to developing cognitive impairment and dementia. Dementia detection is a challenge for supporting personalized healthcare. This study analyzes the electroencephalogram (EEG) background activity of 5 vascular dementia (VaD) patients, 15 stroke-related patients with mild cognitive impairment (MCI), and 15 control healthy subjects during a working memory (WM) task. The objective of this study is twofold. First, it aims to enhance the discrimination of VaD, stroke-related MCI patients, and control subjects using fuzzy neighborhood preserving analysis with QR-decomposition (FNPAQR); second, it aims to extract and investigate the spectral features that characterize the post-stroke dementia patients compared to the control subjects. Nineteen channels were recorded and analyzed using the independent component analysis and wavelet analysis (ICA-WT) denoising technique. Using ANOVA, linear spectral power including relative powers (RP) and power ratio were calculated to test whether the EEG dominant frequencies were slowed down in VaD and stroke-related MCI patients. Non-linear features including permutation entropy (PerEn) and fractal dimension (FD) were used to test the degree of irregularity and complexity, which was significantly lower in patients with VaD and stroke-related MCI than that in control subjects (ANOVA; p ˂ 0.05). This study is the first to use fuzzy neighborhood preserving analysis with QR-decomposition (FNPAQR) dimensionality reduction technique with EEG background activity of dementia patients. The impairment of post-stroke patients was detected using support vector machine (SVM) and k-nearest neighbors (kNN) classifiers. A comparative study has been performed to check the effectiveness of using FNPAQR dimensionality reduction technique with the SVM and kNN classifiers. FNPAQR with SVM and kNN obtained 91.48 and 89.63% accuracy, respectively, whereas without using the FNPAQR exhibited 70 and 67.78% accuracy for SVM and kNN, respectively, in classifying VaD, stroke-related MCI, and control patients, respectively. Therefore, EEG could be a reliable index for inspecting concise markers that are sensitive to VaD and stroke-related MCI patients compared to control healthy subjects.
This paper presents comprehensive insights into mobile patient monitoring systems (MPMSs) from evaluation and benchmarking aspects on the basis of two critical directions. The current evaluation criteria of MPMSs based on the architectural components of MPMSs and possible solutions are discussed. This review highlights four serious issues, namely, multiple evaluation criteria, criterion importance, unmeasurable criteria and data variation, in MPMS benchmarking. Multicriteria decision-making (MCDM) analysis techniques are proposed as effective solutions to solve these issues from a methodological aspect. This methodological aspect involves a framework for benchmarking MPMSs on the basis of MCDM to rank available MPMSs and select a suitable one. The benchmarking framework is discussed in four steps. Firstly, pre-processing and identification procedures are presented. Secondly, the procedure of weight calculation based on the best-worst method (BWM) is described. Thirdly, the development of a benchmark framework by using the VIKOR method is introduced. Lastly, the proposed framework is validated.
Dementia is a large and growing problem in the ageing population but often not diagnosed in its earlier stages which is Mild Cognitive Impairment (MCI). MCI represents the phase between normal ageing and early dementia. About 12% of patients with MCI develop dementia per year, usually Alzheimer's disease. It is a diagnosis given to individuals who have cognitive impairments beyond that is expected for their age and education. However, this condition does not interfere significantly with daily activities as these individuals retain their critical thinking and reasoning skills. Nevertheless, due to its complexity and vague initial presentation, many cases of MCI can be missed. Therefore, it is imperative for primary care physicians to recognise these symptoms as opposed to normal ageing memory changes, and refer these patients to the memory clinic early to confirm the diagnosis. This paper illustrates a common primary care presentation of a patient with MCI. As there is no proven pharmacological treatment for MCI, the mainstay of management is to provide lifestyle intervention and long term support to these patients in the community. Primary care physicians should work as a team with the geriatrician, allied health personnel, support groups and caregivers in providing this care.
Higher level of education is associated with better cognitive performance and lower risk of developing dementia. However, the effect of education on cognitive performance varies across different cognitive domains and in different populations. The aim of this study was to determine the relationship between education and performance of different cognitive domains among healthy Malay adults. A total of 53 individuals aged 29 to 77 years participated in a battery of neurophysiological tests consisting of Mini-Mental State Examination, Montreal Cognitive Assessment, digit span, visual reproduction and digit symbol speed test (DSST). Blood test was performed for each participant to obtain their biochemical profile. Educational level was divided into level 1 (PMR), level 2 (SPM), level 3 (STPM), level 4 (Diploma) and level 5 (Degree). Simple linear regression indicated that years of education was positively associated with scores of delayed visual reproduction (b=1.348, p=0.002) and DSST (b=3.257, p=0.012). However, scores of all the tests were not significantly different among different levels of education after controlling for age, gender and blood test profile by ANCOVA. Multiple linear regression analysis showed that MMSE score was associated with red cell distribution width (b=-0.628, p=0.005), age (b=-0.119, p<0.001) and there was interaction between high density lipoprotein (HDL) with age (b=0.047, p<001). MoCA score was associated with age (b=-0.121, p<0.001), gender (male compared to female, b=1.870, p=0.020) and HDL (b=1.681, p=0.047). Age was associated with backward digit span (b=-0098, p<0.001) and immediate visual reproduction (b=-0.348, p<0.001), resp. Delayed visual reproduction was associated with age (b=-0.323, p<0.001) and potassium level (b=-4.471, p=0.016). DSST was associated with age (b=-0.911, p<0.001) and alanine aminotransferase (b=-0.754, p=0.002). The lack of association between educational level and cognitive performance after adjusting for confounders in this study maybe due to multiple factors influencing cognitive performance and further studies with a larger sample size are needed to further identify the factors involved.
Keywords: Cognitive performance; education; healthy Malay adults
ABSTRAK
Tahap pendidikan yang tinggi telah dikaitkan dengan prestasi kognitif yang lebih baik dan risiko perkembangan dementia yang lebih rendah. Namun, kesan pendidikan terhadap prestasi kognitif berbeza antara domain kognitif dan populasi yang berlainan. Kajian ini bertujuan untuk menentukan hubungan antara pendidikan dengan prestasi pada domain kognitif yang berlainan pada individu dewasa Melayu yang sihat. Seramai 53 individu yang berumur antara 29 hingga 77 tahun telah menyertai ujian neuropsikologi yang terdiri daripada Pemeriksaan Keadaan Mental Mini, Penilaian Kognitif Montreal, digit span, penghasilan semula visual dan ujian kelajuan simbol digit (DSST). Tahap pendidikan dibahagikan kepada tahap 1 (PMR), tahap 2 (SPM), tahap 3 (STPM), tahap 4 (Diploma) dan tahap 5 (Ijazah Sarjana Muda). Regresi linear mudah menunjukkan bahawa tahap pendidikan berhubung kait secara positif dengan penghasilan semula visual tertunda (b=1.348, p=0.002) dan DSST (b=3.257, p=0.012). Namun, semua skor ujian menjadi tidak berbeza antara tahap pendidikan yang berbeza selepas mengambil kira kesan konpengasas dengan menggunakan ANCOVA. Regresi linear berganda menunjukkan bahawa skor MMSE berhubung kait dengan lebar taburan sel merah (b=-0.628, p=0.005), umur (b=-0.119, p<0.001) dan interaksi antara lipoprotein ketumpatan tinggi (HDL) dan umur (b=0.047, p<001). MoCA didapati berhubung kait dengan umur (b=-0.121, p<0.001), jantina (lelaki berbanding perempuan, b=1.870, p=0.020) dan HDL (b=1.681, p=0.047). Umur juga berhubung kait dengan digit span ke belakang (b=-0098, P<0.001) dan penghasilan semula visual segera (b=-0.348, p<0.001). Penghasilan semula visual tertunda berhubung kait dengan umur (b=-0.323, p<0.001) dan tahap kalium (b=-4.471, p=0.016). DSST berhubung kait dengan umur (b=-0.911, p<0.001) dan alanin aminotransferase (b=-0.754, p=0.002). Hubungan antara tahap pendidikan dan prestasi kognitif tidak dikesan selepas mengambil kira kesan konpengasas yang mencadangkan bahawa prestasi kognitif mungkin dipengaruhi oleh pelbagai faktor dan kajian lanjut dengan bilangan sampel yang lebih besar diperlukan untuk mengenal pasti faktor ini.
The diversity of Singapore's population affords a unique opportunity to study ethnic variability in the dementias. We sought to explore the effects of ethnicity on the frequency of Alzheimer disease and vascular dementia in a large Singaporean sample. A total of 357 patients were studied: 190 with vascular dementia and 167 with Alzheimer disease. Vascular dementia was more common among Chinese and Malays, whereas Alzheimer disease was more common in Indians and Eurasians. Factors that may contribute to the observed ethnic variability in dementia etiologies include differential frequency of the ApoE-e4 allele, frequency of vascular risk factors, lifestyle choices, and cultural attitudes toward health care utilization.
Introduction: Reduced cerebral blood fl ow is associated with neurodegenerative disorders and dementia, in particular. Experimental evidence has demonstrated the initiating role of chronic cerebral hypoperfusion in neuronal damage to the hippocampus, the cerebral cortex, the white matter areas and the visual system. Permanent, bilateral occlusion of the common carotid arteries of rats (two vessel occlusion - 2VO) has been introduced for the reproduction of chronic cerebral hypoperfusion as it occurs in Alzheimer’s disease and human aging. Increased generation of free radicals through lipid peroxidation can damage neuronal cell membrane. Markers of lipid peroxidation have been found to be elevated in brain tissues and body fl uids in neurodegenerative diseases, including Alzheimer’s disease, Parkinson disease and amyotrophic lateral sclerosis. Materials and Methods: Malondialdehyde (MDA), fi nal product of lipid peroxidation, was estimated by thiobarbituric acid-reactive substances (TBARS) assay kit at eight weeks after induction of 2VO in the rats and control group. Results: Our study revealed a highly signifi cant (p
In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities.
Dementia is a neurodegenerative disorder with global impact, with the largest proportion of cases occurring in low- and middle-income countries. It is estimated that there are 46.8 million cases globally with approximately 10 million new cases each year or a new case occurring every 3 sec (Prince et al., 2015). For comparison there are 36.7 million HIV cases with an estimated 2 million new cases each year (WHO, 2017). The rise in dementia prevalence is largely due to population ageing, with the oldest being at highest risk. To date there are no diseases modifying medications for Alzheimer's disease or the other causes of dementia. Academics and research groups are increasingly focused on prevention or delay of dementia (Brayne and Miller, 2017) and a number of organizations now prioritize dementia, indicating a strong and coherent international effort to address this problem. Examples include the World Health Organisation (WHO), which has established a Global Dementia Observatory; the World Dementia Council; the Organisation for Economic Co-operation and Development (OECD); the U.S. National Alzheimer's Project Act (NAPA); and the Global Council on Brain Health.
BACKGROUND: Worldwide, the population is ageing, resulting in an associated increase in dementia prevalence. Forgetfulness in elderly people is often perceived as normal in some local cultures and thus, the early detection of dementia in primary care requires detection of symptoms other than memory complaints.This study was conducted to screen elderly patients for early dementia in primary care using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with a standard assessment tool, the Mini Mental State Examination (MMSE).
METHODS: A cross-sectional study was conducted on a group of elderly patients using convenience sampling of consecutive patients. Elderly depression was excluded using the Geriatric Depression Scale (GDS). Exclusion criteria also included known cases of dementia. Inclusion criteria included a score of 5 or less in GDS and the presence of a reliable informant. A face-to-face interview was done using the EDQ with the patient and informant to elicit symptoms of early dementia. If the informant was not present, a telephone interview was used instead. The patient was then assessed with the Mini Mental State Examination (MMSE) using a cut-off point of 21.
RESULTS: Prevalence of dementia among 155 subjects was 52.3% by EDQ and 15.5% by MMSE. The EDQ demonstrated a sensitivity of 79.2% with specificity of 52.7%. Positive predictive value (PPV) of EDQ was 23.5% with the negative predictive value (NPV) of 93.2%. The strongest predictor of possible early dementia was complaints of memory problems (OR 26.22; 95% CI 2.03-338.14) followed by complaints of concentration problems (OR 14.33; 95% CI 5.53-37.12), emotional problems (OR 4.75; 95% CI 1.64-13.81) and sleep disturbances (OR 3.14; 95% CI 1.15-8.56). Socio-demographic factors, medical problems and smoking status were not associated with possible dementia (p>0.05), despite that 60-70% of the elderly had chronic illnesses.
CONCLUSION: The EDQ is a promising alternative to MMSE for screening of early dementia in primary care.
BACKGROUND: Early Dementia Questionnaire (EDQ) was developed as a screening tool to detect patients with early dementia in primary care. It was developed based on 20 symptoms of dementia. From a preliminary study, EDQ had been shown to be a promising alternative for screening of early dementia. This study was done to further test on EDQ's reliability and validity.
METHODS: Using a systematic random sampling, 200 elderly patients attending primary health care centers in Kuching, Sarawak had consented to participate in the study and were administered the EDQ. Geriatric Depression Scale (GDS) was used to exclude patients with depression. Those who scored >21 MMSE, were retested using the EDQ. Reliability was determined by Cronbach's alpha for internal consistency and construct validity was assessed using confirmatory factor analysis (principle component with varimax rotation). Test retest Intraclass Correlation Coeeficient (ICC) was used to determine the reliability of the scale.
RESULTS: The result showed that the sensitivity and specificity for EDQ was 71.2% and 59.5%. The overall Cronbach's alpha coefficient was good which was 0.874. Confirmatory factor analysis on 4 factors indicated that the Cronbach's alpha for each domain were acceptable with memory (0.741), concentration (0.764), emotional and physical symptoms (0.754) and lastly sleep and environment (0.720). The Intraclass Correlation Coefficient between the first EDQ score and the retest EDQ score among those with MMSE of >21 showed a very strong overall agreement, ICC = 0.764, N = 160, P <0.001.
CONCLUSIONS: The results of the validation study showed that Early Dementia Questionnaire (EDQ) is a valid and reliable tool to be used as a screening tool to detect early dementia in primary care.