Beth Springate

Processing speed in normal aging: Effects of white matter hyperintensities and hippocampal volume loss

ABSTRACT Changes in cognitive functioning are said to be part of normal aging. Quantitative MRI has made it possible to measure structural brain changes during aging which may underlie these decrements which include slowed information processing and memory loss. Much has been written on white matter hyperintensities (WMH), which are associated with cognitive deficits on tasks requiring processing speed and executive functioning, and hippocampal volume loss, which is associated with memory decline. Here we examine volumetric MRI measures of WMH and hippocampal volume loss together in relation to neuropsychological tests considered to be measures of executive functioning and processing speed in 81 non-demented elderly individuals, aged 75–90. Correlational analysis showed that when controlling for age, both greater WMH volume and smaller hippocampal volume were correlated with slower performances on most tests with the exception of a battery of continuous performance tests in which only WMH was correlated with slower reaction time (RT). We then performed a series of hierarchical multiple regression analyses to examine the independent contributions of greater WMH volume and reduced hippocampal volume to executive functioning and processing speed. The results showed that for the four measures requiring executive functioning and speed of processing, WMH volume and hippocampal volume combined predicted between 21.4% and 37% of the explained variance. These results suggest that WM integrity and hippocampal volume influence cognitive decline independently on tasks involving processing speed and executive function independent of age.

Screening for Mild Cognitive Impairment Using the Dementia Rating Scale-2

This study examined the sensitivity and specificity of the Dementia Rating Scale-2 (DRS-2) to distinguish individuals with mild cognitive impairment (MCI) from both patients with Alzheimer’s disease (AD) and healthy controls (HCs). A total of 50 HCs, 98 patients with MCI, and 49 patients with AD completed a neurological examination and battery of neuropsychological tests that included the DRS-2. Across almost all subscales of the DRS-2, patients with AD scored significantly worse than patients with MCI who in turn performed more poorly than the HCs. The only exception was the construction subscale where no significant difference was found between patients with MCI and the HCs. At a cutoff of 136, the sensitivity was 71% and specificity was 86% for distinguishing between patients with MCI and the HCs. Sensitivity was 82% and specificity was 78% for distinguishing between patients with MCI and patients with AD (cutoff score <124). For distinguishing between patients (with MCI and AD) and the HCs, sensitivity was 81% and specificity was 86% at a cutoff of 136. Our findings suggest the DRS-2 is a brief, easily administered cognitive test that appears to be useful in assisting with the detection of MCI.

Caregiver Burden and Depression in Mild Cognitive Impairment

Little is known about contributors to burden and depression in caregivers of patients with mild cognitive impairment (MCI) even though these patients experience cognitive, emotional, and behavioral changes. We examined caregiver burden and depression in 43 caregivers for patients with MCI as well as their associations with patients’ neuropsychological status and behavioral symptoms. Almost 30% of caregivers reported clinically significant burden, whereas <5% reported significant depression. Increased caregiver burden was associated with greater disinhibited behaviors by patients, whereas increased caregiver depressive symptoms were associated with greater disinhibited behaviors as well as instrumental activity of daily living (ADL) impairments. Caregiver burden and depression were not associated with patients’ neuropsychological performance. Results suggest these caregivers would benefit from interventions addressing both practical methods to provide ADL assistance and behavioral methods to address inappropriate behaviors in patients in the predementia stages.

Family Intervention: Telephone Tracking (FITT): A Pilot Stroke Outcome Study

Abstract Objective: The goal of this study was to preliminarily test the efficacy of a telephone intervention, Family Intervention: Telephone Tracking, designed to assist stroke survivors and their primary caregivers during the first 6 months after stroke. Method: Forty-nine stroke survivors and their caregivers were randomly assigned to treatment as usual or treatment as usual plus the telephone intervention. Global outcomes are reported for health care utilization, family functioning, and general functioning. Results: Family and general functioning were positively and significantly changed at 3 and 6 months. Health care utilization was positively and significantly changed at 3 months. Conclusion: Findings suggest that the model has the potential to decrease health care utilization and improve quality of life for stroke survivors and their caregivers. Further study is warranted.

Use of the Telephone-Administered Minnesota Cognitive Acuity Screen to Detect Mild Cognitive Impairment

This study determined the sensitivity and specificity of the telephone-administered Minnesota Cognitive Acuity Screen (MCAS) to distinguish mild cognitive impairment (MCI) from healthy controls (HCs) and from Alzheimer’s disease (AD). A total of 100 individuals with MCI, 50 individuals with possible/probable AD, and 50 HCs were screened to exclude medical and psychiatric conditions affecting cognition. In-office evaluation included neuropsychological testing, neurologic examination, and neurodiagnostic work-up. Participants with AD obtained significantly lower MCAS total scores than participants with MCI, who in turn performed worse than the HC group. Sensitivity was 86% and specificity was 78% for distinguishing between MCI and HC. Sensitivity was 86% and specificity was 77% for discriminating between MCI and AD. Sensitivity was 91% and specificity was 78% for discriminating between impaired groups (MCI and AD) and HCs. Results suggest that the MCAS successfully discriminates MCI from HC and AD and has potential as an effective telephone-administered screening tool for memory disorders.

Self-reported depressive syndromes in mild cognitive impairment and mild Alzheimer's disease

BACKGROUND There is suggestion that self-reported depressive syndromes can independently manifest in the general population as cognitive/affective or somatic/vegetative. The Beck Depression Inventory, 2nd edition (BDI-II), a self-report measure of depressive symptoms, has been shown to support this two-factor structure. However, this finding has not been examined in an older adult sample with cognitive impairment. In order to determine whether older adults with cognitive impairments exhibit similarly independent cognitive/affective and somatic/vegetative depressive syndromes, we explored the factor structure of the BDI-II in this population. METHODS Participants were 228 older adults (mean age = 74, SD = 7.9) diagnosed with mild cognitive impairment (MCI; n = 137) or early Alzheimers disease (n = 85), who completed the BDI-II as part of an outpatient neuropsychological evaluation. Exploratory principal component factor analysis with direct Oblimin rotation was conducted, and a two-factor solution was specified based on our theoretical conceptualization of the cognitive/affective and somatic/vegetative items from the scale. RESULTS The first factor represented cognitive/affective symptoms of depression (e.g. self-dislike, pessimism, worthlessness), and accounted for 36% of the variance. Adding the second factor, reflecting somatic/vegetative items (e.g. sleep and appetite changes, loss of energy), accounted for an additional 6.8% of the variance. CONCLUSION Results supported the presence of two distinct depressive syndromes, cognitive/affective and somatic/vegetative symptoms. Thus, cognitively impaired older adults report mood symptoms relatively similarly to younger and midlife adults. This supports the validity of self-reported mood in this group, and the results may have implications for psychiatric treatment in this population.

Neuropsychologists’ Beliefs About Alcohol and Dementia

Alcohol-related dementia (ARD) is a controversial concept, and the prevailing view of neuropsychologists regarding this disorder is unknown. The purpose of this study was to gain an understanding of neuropsychologists’ beliefs and practices regarding ARD. A total of 140 board-certified neuropsychologists completed an anonymous online survey about alcohol and dementia. Almost all respondents (93%) reported alcohol has direct neurotoxic effects, but most were unsure whether moderate alcohol use can be neuroprotective. The presence and course of cognitive deficits as well as functional impairments were rated as the most important factors to consider when making this diagnosis, and declines in memory, executive functions, and processing speed were most frequently observed cognitive changes. Neuropsychologists were mixed in their opinions about cognitive prognosis, with half the sample endorsing stability of cognitive deficits and about one-third of the group indicating gradual improvement. Although laboratory workup was not a major diagnostic consideration, 68% of respondents recommended treatment with vitamins and nutritional supplements. Findings are consistent with the research literature and suggest that while neuropsychologists generally believe alcohol can have direct neurotoxic effects, they vary in their beliefs about diagnosis, treatment, and prognosis. Future research should focus on providing diagnostic and treatment guidelines for ARD.

Predicting Functional Impairments in Cognitively Impaired Older Adults Using the Minnesota Cognitive Acuity Screen

Despite their growing use, few studies have examined the associations between patients’ performance on brief telephone-based cognitive assessments and their functional status. The purpose of this study was to examine the relationship between the Minnesota Cognitive Acuity Screen (MCAS), a very brief telephone-based dementia screening instrument, and functional impairment as rated by the Clinical Dementia Rating (CDR) scale in a sample of 176 individuals diagnosed with mild cognitive impairment or dementia. Results showed lower MCAS scores were correlated with poorer daily function as measured by CDR global scores and domain scores, and the MCAS orientation subscale was one of the strongest subscales in predicting functional status as it was uniquely predictive of all CDR domains. Findings suggest the MCAS appears to be useful in predicting patients’ level of daily function and may be useful for quickly and easily monitoring patients’ cognitive and functional status over time.

Do statin drugs impair cognition? A systematic review and meta-analysis

Background: Increased cardiorespiratory fitness is associated with reduced whole-brain atrophy and increased white matter volume in persons with Alzheimer’s disease. Maximal oxygen uptake, the gold standard for assessing cardiorespiratory fitness, is costly, time consuming and requires specially trained personnel. In studies on the effect of aerobic exercise in patients with Alzheimer’s disease there is a need for simpler tests to assess cardiorespiratory fitness. The aim of this study was to investigate the association between measured maximal oxygen uptake (VO2max), estimated VO2max using the 6-min Astrand Cycle-Ergometer-Test (Astrand test), and time to complete 400 m walk (400MW). Methods: The ADEX study is a multi-centre, single-blinded, RCT-study including 192 home-dwelling patients with mild to moderate Alzheimer’s disease. In this preliminary baseline sample 33 participants, age 51-83 years, completed VO2max respectively the Astrand test and 400MW on two separate days. Results: Baseline results are presented as mean6SD(range). VO2max ranged from 15.143,7 ml/min/kg, mean 25,166,6 ml/min/kg. A respiratory exchange ratio (RER) >1.10 was achieved in 81% of the participants and an RER of 1.0-1.1 was achieved in 19% of the participants. 27 participants obtained the required target heart rate of 110-160 BPM in the Astrand test and were included in the analysis. The estimated VO2max ranged from 13,0-47,7 ml/ min/kg, with a mean of 25,066,7. Time to complete 400MW ranged from 207-332 sec., with a mean of 267632. The analyses demonstrated a significant correlation between results in the Vo2max and the Astrand test (r1⁄40,619; p1⁄40,001) and 400MW (r1⁄40,551; p1⁄40,001). Thus, approximately 37% and 30% of the variance in VO2max could be accounted for by results in Astrand test and 400MW, respectively. Conclusions: Despite that some participants could not perform the Astrand test and the fact that only 37% of the variance in VO2max could be accounted for by results in Astrand test, this test may be the best surrogate measure for maximal oxygen uptake in patients with Alzheimer’s disease. Further studies are needed to confirm whether the Astrand test should be recommended for assessing cardiorespiratory fitness in patients with Alzheimer’s disease.

Varying the Frequency of Intentional Communication Between Student Affairs Personnel, First-Year Students, and Their Parents

Higher education administrators are increasingly committed to proactive communication with the parents of their students, but little empirical research exists that demonstrates the effectiveness of such communication. This investigation evaluated the effects of varying frequency of communication by randomly assigning first-year college students and their parents to receive 0, 1, or 4 documents that described activities associated with student success in college and urged them to discuss these activities with one another. Students and parents were then mailed a follow-up survey that assessed their recall regarding how many documents they had received, accuracy of recognition about the content of the documents, and extent of communication about these topics. Results indicated that, for parents, significant linear relationships existed between receipt of more documents, recall of receiving a greater number of mailings, and greater accuracy in recognizing content. Recall and recognition among students, however, were not differentially affected by receiving more documents. For both students and parents, receipt of more documents was not associated with increased frequency of conversations about specific content. Across experimental conditions, parents reported having more frequent conversations with their students than students reported having with their parents. These outcomes suggest that parents, but not their children, are attentive to the content of communications from college administrators, especially when they are sent frequently and within a short time frame