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Fulltext Role of EEG as biomarker in the early detection and classification of dementia

Al-Qazzaz NK, Ali SH, Ahmad SA, Chellappan K, Islam MS, Escudero J

ScientificWorldJournal, 2014;2014:906038.
PMID: 25093211 DOI: 10.1155/2014/906038

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.

Matched MeSH terms: Dementia/diagnosis*
Schizophrenia or frontotemporal dementia in a young Chinese female: a purview of possible diagnoses

Grewal GS, Kanagasundram S, Jambunathan S

Turk Psikiyatri Derg, 2011;22(4):266-8.
PMID: 22143952

Frontotemporal dementia (FTD) is now increasingly being recognized as one of the causes of young onset dementia (YOD). The presentation of FTD can be subtle with a broad range of symptoms. This frequently causes misdiagnosis and a delay in initiating the correct treatment. While subtle personality changes, disinhibition and problems in executive functioning are frequently encountered in FTD, frank psychotic symptoms resembling schizophrenia are unusual. This is a case of a 38 year old Chinese female that highlights how obsessive compulsive symptoms which progressed to florid psychosis and disorganized speech and behavior can be a presenting picture in FTD. For seven years, this patient was treated as a case of schizophrenia and was thought to have poor response to electroconvulsive therapy (ECT) as well as antipsychotic medication. Her blood work and electroencephalogram (EEG) were normal. Magnetic resonance imaging (MRI) showed progressive cerebral atrophy. This case report suggests that psychosis should be investigated in detail especially when the clinical presentation is not typical of a functional disorder and more so when the patient is not responsive to conventional treatment. This report also highlights the importance of eliciting symptoms suggestive of an "organic" etiology, such as incontinence and disorientation. In addition, the usefulness of repeated imaging to show the rapidly progressive course of FTD has been illustrated. Other possible differential diagnoses of this patient are also discussed.

Matched MeSH terms: Frontotemporal Dementia/diagnosis*
Validation study of the Mini-Mental State Examination in a Malay-speaking elderly population in Malaysia

Ibrahim NM, Shohaimi S, Chong HT, Rahman AH, Razali R, Esther E, et al.

Dement Geriatr Cogn Disord, 2009;27(3):247-53.
PMID: 19246909 DOI: 10.1159/000203888

BACKGROUND/AIMS: In view of the differing sensitivity and specificity of the Mini-Mental State Examination (MMSE) in the non-English-speaking populations, we conducted the first validation study of the Malay version (M-MMSE) in Malaysia among 300 subjects (from the community and outpatient clinics).
METHODS: Three versions were used: M-MMSE-7 (serial 7), M-MMSE-3 (serial 3) and M-MMSE-S (spell 'dunia' backwards). Dementia was assessed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV. The optimal cutoff scores were obtained from the receiver operating characteristics curves.
RESULTS: Seventy-three patients (24.3%) had dementia and 227 (75.7%) were controls. Three hundred patients completed the M-MMSE-7, 160 the M-MMSE-3 and 145 the M-MMSE-S. All 3 versions were valid and reliable in the diagnosis of dementia. The optimal cutoff scores varied with each version and gender. In the control group, significant gender differences were observed in the patients with the lowest educational status. Increasing educational levels significantly improved the M-MMSE performance in both genders.
CONCLUSION: All 3 versions of the M-MMSE are valid and reliable as a screening tool for dementia in the Malaysian population, but at different cutoff scores. In those with the lowest educational background, gender-adjusted cutoff scores should be applied.
Study site: Community, neurology and dementia outpatient clinics, Perubatan Universiti Kebangsaan Malaysia (PPUKM), University Malaya Medical Centre (UMMC)

Matched MeSH terms: Dementia/diagnosis
Prevalence of dementia among elderly Chinese and Malay residents of Singapore

Kua EH, Ko SM

Int Psychogeriatr, 1995;7(3):439-46.
PMID: 8821351

This is a comparative study of the prevalence of dementia among elderly Chinese and Malay persons living in the community in Singapore. The subjects, aged 65 years and over, were all living in public housing estates. Two hundred elderly Chinese and 149 elderly Malay persons were interviewed. They were first screened for any cognitive deficit with the Elderly Cognitive Assessment Questionnaire (ECAQ). All those who scored 5 or fewer points on the ECAQ were then assessed with the Geriatric Mental State schedule. The results showed an overall dementia prevalence of 4.0% among the Malay elderly and 2.5% among the Chinese elderly. The rate of dementia of the Alzheimer's type was 1.8% for Chinese women and 1.5% for Malay women; for multi-infarct dementia the rate for Malay women was 4.4% and for Chinese women 0.9%. For Chinese and Malay men, the prevalence of Alzheimer's disease and multi-infarct dementia was quite similar (1.1% and 1.2%).

Matched MeSH terms: Dementia/diagnosis
Fulltext Psychiatric aspects of the acquired immunodeficiency syndrome. A case report

Maniam T, Abu Bakar AK

Med J Malaysia, 1988 Jun;43(2):166-9.
PMID: 3237133
Matched MeSH terms: Dementia/diagnosis
A case of TREM2 mutation presenting with features of progressive non-fluent aphasia and without bone involvement

Chee KY, Gaillard F, Velakoulis D, Ang CL, Chin LK, Ariffin R

Aust N Z J Psychiatry, 2017 Nov;51(11):1157-1158.
PMID: 28462591 DOI: 10.1177/0004867417707821
Matched MeSH terms: Dementia/diagnosis*
Validity of screening tools for dementia and mild cognitive impairment among the elderly in primary health care: a systematic review

Abd Razak MA, Ahmad NA, Chan YY, Mohamad Kasim N, Yusof M, Abdul Ghani MKA, et al.

Public Health, 2019 Apr;169:84-92.
PMID: 30826688 DOI: 10.1016/j.puhe.2019.01.001

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.

Matched MeSH terms: Dementia/diagnosis*
Fulltext Reliability and construct validity of the Early Dementia Questionnaire (EDQ)

Arabi Z, Syed Abdul Rahman SA, Hazmi H, Hamdin N

BMC Geriatr, 2016 11 30;16(1):202.
PMID: 27903242 DOI: 10.1186/s12877-016-0384-1

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.

Matched MeSH terms: Dementia/diagnosis*
Treatment of dementia with herbs: a short review

Tang CT, Belani LK, Das S, Jaafar MZ

Clin Ter, 2013;164(1):43-6.
PMID: 23455743 DOI: 10.7417/T.2013.1511

Dementia is a common symptom observed in many psychiatric and neurodegenerative diseases. Alzheimer's disease is the most common form of senile dementia seen in the general population. Multiple factors like oxidative stress, apoptosis, mitochondrial dysfunction and inflammation may be related to the neurodegenerative states. Many drugs like cholinesterase have been used for treatment but the progression of the disease still poses a challenge to the clinician. During recent times, herbs have gained much popularity as supplements because of the cost effectiveness, easy availability and fewer side effects. Early diagnosis and proper treatment may help in the prevention of mortality and morbidity concerned with any neurodegenerative disease. Understanding the cellular and molecular biology of the mode of the action of herbal products may be beneficial for researchers and clinicians. The present review article attempts to look into the potential herbal extracts which may act as an antioxidant in combating dementia.

Matched MeSH terms: Dementia/diagnosis
Fulltext Early Dementia Questionnaire (EDQ): a new screening instrument for early dementia in primary care practice

Arabi Z, Aziz NA, Abdul Aziz AF, Razali R, Wan Puteh SE

BMC Fam Pract, 2013;14:49.
PMID: 23586732 DOI: 10.1186/1471-2296-14-49

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.

Matched MeSH terms: Dementia/diagnosis*
Cognitive assessment tools in Asia: a systematic review

Rosli R, Tan MP, Gray WK, Subramanian P, Chin AV

Int Psychogeriatr, 2016 Feb;28(2):189-210.
PMID: 26450414 DOI: 10.1017/S1041610215001635

The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia.

Matched MeSH terms: Dementia/diagnosis*
Fulltext Protocol of a feasibility study for cognitive assessment of an ageing cohort within the Southeast Asia Community Observatory (SEACO), Malaysia

Mohan D, Stephan BC, Allotey P, Jagger C, Pearce M, Siervo M, et al.

BMJ Open, 2017 01 19;7(1):e013635.
PMID: 28104710 DOI: 10.1136/bmjopen-2016-013635

INTRODUCTION: There is a growing proportion of population aged 65 years and older in low-income and middle-income countries. In Malaysia, this proportion is predicted to increase from 5.1% in 2010 to more than 15.4% by 2050. Cognitive ageing and dementia are global health priorities. However, risk factors and disease associations in a multiethnic, middle-income country like Malaysia may not be consistent with those reported in other world regions. Knowing the burden of cognitive impairment and its risk factors in Malaysia is necessary for the development of management strategies and would provide valuable information for other transitional economies.
METHODS AND ANALYSIS: This is a community-based feasibility study focused on the assessment of cognition, embedded in the longitudinal study of health and demographic surveillance site of the South East Asia Community Observatory (SEACO), in Malaysia. In total, 200 adults aged ≥50 years are selected for an in-depth health and cognitive assessment including the Mini Mental State Examination, the Montreal Cognitive Assessment, blood pressure, anthropometry, gait speed, hand grip strength, Depression Anxiety Stress Score and dried blood spots.
DISCUSSION AND CONCLUSIONS: The results will inform the feasibility, response rates and operational challenges for establishing an ageing study focused on cognitive function in similar middle-income country settings. Knowing the burden of cognitive impairment and dementia and risk factors for disease will inform local health priorities and management, and place these within the context of increasing life expectancy.
ETHICS AND DISSEMINATION: The study protocol is approved by the Monash University Human Research Ethics Committee. Informed consent is obtained from all the participants. The project's analysed data and findings will be made available through publications and conference presentations and a data sharing archive. Reports on key findings will be made available as community briefs on the SEACO website.

Matched MeSH terms: Dementia/diagnosis
How Can We Best Screen for Cognitive Impairment in Malaysia? A Pilot of the IDEA Cognitive Screen and Picture-Based Memory Impairment Scale and Comparison of Criterion Validity with the Mini Mental State Examination

Rosli R, Tan MP, Gray WK, Subramanian P, Mohd Hairi NN, Chin AV

Clin Gerontol, 2017 03 29;40(4):249-257.
PMID: 28459304 DOI: 10.1080/07317115.2017.1311978

OBJECTIVES: To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE).

METHODS: The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference.

RESULTS: The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5-83.0) years and 11.0 median years of education (IQR, 9.0-13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased.

CONCLUSION: The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties.

CLINICAL IMPLICATIONS: Study provides alternative screening tools for dementia for both non-specialists and specialists.

Matched MeSH terms: Dementia/diagnosis*
Intellectual and physical activities, but not social activities, are associated with better global cognition: a multi-site evaluation of the cognition and lifestyle activity study for seniors in Asia (CLASSA)

Lam LC, Ong PA, Dikot Y, Sofiatin Y, Wang H, Zhao M, et al.

Age Ageing, 2015 Sep;44(5):835-40.
PMID: 26271049 DOI: 10.1093/ageing/afv099

population ageing will lead to a leap in the dementia population in Asia. However, information about potentials for low-cost and low-risk interventions is limited.

Matched MeSH terms: Dementia/diagnosis

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