Megumi Nakai

Apathy is more severe in vascular than amnestic mild cognitive impairment in a community: the Kurihara Project.

The aim of this study was to estimate the prevalence of apathy, and to compare vascular mild cognitive impairment (vMCI), amnestic MCI (amMCI), and other type using Clinical Assessment for Spontaneity (CAS).

A randomized controlled trial of psychosocial interventions for old-old people with mild cognitive impairment (MCI): Patient-reported outcomes—The Kurihara project

Background: Cognitive training is beneficial for patients with Mild Cognitive Impairment (MCI). However, more studies are needed to evaluate the longitudinal benefit yielded from the cognitive training. Patients with amnesic and multiple domains Mild Cognitive Impairment (aMCImd) were followed up after long-term participation in cognitive training. Methods: Participants were 87 aMCImd patients, classified in experimental and control groups, matched in age, gender, education, cognitive and functional performance. Results: At the follow up, there were significant differences in between-groups performance, with the experimental group performing higher in verbal (p€ı,£ .009) and visual memory (p1⁄4 .018), visual constructive abilities (p1⁄4 .018), language (p1⁄4 .026), executive function (p€ı,£ .014), global cognitive function (p1⁄4 .004), executive function in ADL (p1⁄4 .014) and ADL (p1⁄4 .003). Within-group analysis for the experimental group indicated improvement of attention, (p .009), verbal memory (p .010), visual memory (p1⁄4 .038), language (p1⁄4 .000). In contrast, the control group, showed deterioration in verbal memory (p€ı,£ .021), executive function (p€ı,£ .013), executive function in ADL. Conclusions: Longitudinal cognitive training helped aMCImd patients improve their cognitive performance, generalize the primary cognitive benefit to other cognitive domains and stabilize activities of daily living (ADL).

A randomized controlled trial of psychosocial interventions for old-old people with mild cognitive impairment (MCI): Physical and neuropsychological outcomes—The Kurihara project

Background: Cognitive training is beneficial for patients with Mild Cognitive Impairment (MCI). However, more studies are needed to evaluate the longitudinal benefit yielded from the cognitive training. Patients with amnesic and multiple domains Mild Cognitive Impairment (aMCImd) were followed up after long-term participation in cognitive training. Methods: Participants were 87 aMCImd patients, classified in experimental and control groups, matched in age, gender, education, cognitive and functional performance. Results: At the follow up, there were significant differences in between-groups performance, with the experimental group performing higher in verbal (p€ı,£ .009) and visual memory (p1⁄4 .018), visual constructive abilities (p1⁄4 .018), language (p1⁄4 .026), executive function (p€ı,£ .014), global cognitive function (p1⁄4 .004), executive function in ADL (p1⁄4 .014) and ADL (p1⁄4 .003). Within-group analysis for the experimental group indicated improvement of attention, (p .009), verbal memory (p .010), visual memory (p1⁄4 .038), language (p1⁄4 .000). In contrast, the control group, showed deterioration in verbal memory (p€ı,£ .021), executive function (p€ı,£ .013), executive function in ADL. Conclusions: Longitudinal cognitive training helped aMCImd patients improve their cognitive performance, generalize the primary cognitive benefit to other cognitive domains and stabilize activities of daily living (ADL).

Donepezil can prolong lifespan in Alzheimer's disease: The Tajiri Project 1999-2012

Background: The differential diagnosis of mood disorder with associated dementia-like symptoms (pseudodementia) or Alzheimer disease (AD) may be difficult. Although the Mini Mental State Examination (MMSE) and magnetic resonance imaging (MRI) are used as diagnosis for dementia, they cannot adequately identify pseudodementia or AD. We studied that the effectiveness of VSRAD (Voxel-Based Specific Regional Analysis System for Alzheimer’s Disease) in differentiating between mood disorder and AD. Methods: The subjects consisted of 75 patients with pseudodementia or AD (mean age 73.467.01 years, average Z score 1.81 61.18, average MMSE score 22.73 65.43). They were divided into three groups, that is, the mood disorder group (n1⁄433), the AD group (n1⁄430) and the mood disorder group of later development of AD (n1⁄412). We compared the MMSE and degree of parahippocampal gyrus atrophy as a Z score of the VSRAD to MRI data between the three types of dementia. Moreover, Receiver operating characteristic (ROC) curve analysis was used to calculate the cut-off value of a Z score in differentiating between mood disorder and AD.Results: There are correlations between theMMSE and a Z scores, the Z scorewas highly in the group that had a lowerMMSE score. The mood disorder group had significantly lower Z scores than the AD group (p < 0.001). The mood disorder group had significantly lower Z scores than the mood disorder group of later development of AD (p <0.001). The cut-off value of a Z score between the mood disorder group and the AD group was 1.52(sensitivity of 91.67% and specificity of 84.85%), there is a high possibility of AD when a Z score is higher than 1.52. The cut-off value of a Z score between the mood disorder group and the mood disorder group of later development of AD was 1.32, there is a high possibility of mood disorder of later development AD when a Z score is higher than 1.32. Conclusions: It is suggested that VSRAD is an effective auxiliary diagnosis for differentiating between mood disorder with associated dementia-like symptoms and Alzheimer disease, and make it possible to learn the risk of Alzheimer’s disease onset in mood disorder.

Effectiveness of the Montreal Cognitive Assessment (MoCA) for assessing frontal hypoperfusion in people with vascular dementia: The Osaki-Tajiri Project

Background: The CogState brief battery consists of four card playing tasks, which assesses the cognitive domains of psychomotor function, attention, visual learning, and visual working memory. Previous studies have demonstrated the utility and sensitivity of the CogState brief battery for detection of cognitive impairment in Alzheimer’s disease (AD) and mild cognitive impairment (MCI), and for the measurement of cognitive change in the preclinical stages of AD. Thus, the CogState brief battery may be a useful screening tool to assist the management of cognitive function in clinical settings. This study aimed to determine the clinical utility of the CogState brief battery. Methods: Healthy older adults (n 1⁄4 653), adults with MCI (n 1⁄4 68), and adults with AD (n 1⁄4 44) who completed the CogState brief battery were recruited from the Australian Imaging, Biomarkers, and Lifestyle (AIBL) Study of Ageing, and the AIBL-Rate of Change sub-study (AIBL-ROCS). The four performance measures of the CogState brief battery were reduced to two composites a psychomotor/attention composite and a learning/working memory composite. Sensitivity and specificity analyses were conducted on the two composites to determine their clinical utility. Results: Large impairments inMCI (d1⁄4 1.20) and AD (d1⁄4 2.20) were identified for the learning/working memory composite but not the psychomotor/attention composite (MCI d 1⁄4 0.40; AD d 1⁄4 0.50). Using a cutscore of -1.96, the learning/working memory composite showed 85.71% sensitivity and 96.81% specificity to a clinical classification of AD. Both composite scores showed high test-retest reliability (0.95) over four months. Performance on the memory composite was also related to performance on the MMSE, with worse scores on the MMSE associated with worse performance on the CogState memory composite. Additionally, increasing severity on the CDR, sum of boxes score was also associated with worse performance on the CogState memory composite. Conclusions: The results of this study suggest that the CogState memory composite is a useful tool for the identification of AD related memory impairment, and correlates well with traditional measures of disease classification.

Scope (quantitative) and performance (qualitative) of instrumental ADLs in older adults with mild cognitive impairment: Difference between very mild Alzheimer's disease and very mild subcortical vascular dementia—The Kurihara Project

ing was an early marker of decline, with abnormalities even at the pre-MCI stage. Lower volumes of the hippocampus and the basal forebrain area were associated with an increased likelihood of MCI. Different MCI subtypes showed distinct grey matter atrophy patterns. A suite of novel plasma proteins was a good biomarker. Genome-wide association studies of cognitive performance and decline, white matter lesions and hippocampal volume have shown suggestive results which warrant replication. Conclusions: MCI is a heterogeneous condition, and its risk and protective factor studies should take age, sex and subtype into consideration. Many biomarkers, with modest predictive value, are being developed, using neuroimaging and proteomics, and novel gene discovery and replication studies are being undertaken.

A community-based study of the Montreal Cognitive Assessment (MoCA) in Japan: The Kurihara Project

fected several attention indices, it did not significantly affect the results of frontal executive function tests. In addition, the SAS risk level had greater impact on attention deficits in the MCI group than in the normal control group, whereas it had greater impact on frontal executive functions in the normal control group than in the MCI group. Conclusions: Considering that SAS might act as a deteriorating factor of cognitive functions for MCI patients and normal elderlies, the corresponding evaluation and medical intervention in these subjects might be valuable. Our study has significance for the experimental research on the characteristics of cognitive deficits and SAS risk with MCI patients in Korea.

Very mild subcortical vascular dementia (CDR 0.5) has severer apathy than very mild Alzheimer's disease (CDR 0.5) in a community: The Kurihara project

Background: Previous studies reported that apathy was shown in almost half of sub cortical vascular dementia (SVD) and Alzheimer’s disease (AD) patients, and in 15% of mild cognitive impairment (MCI) subjects. Our aim is to elucidate the differences of clinical features of apathy between very mild SVD (vm SVD) and very mild AD (vm AD) subjects. Methods: We obtained the agreement from 200 community dwellers, aged 75+ years living in Kurihara, Northern Japan. We utilized clinical examination, Clinical Dementia Rating (CDR), MRI, blood tests and neuropsychological tests. Of the 200 subjects, there were 57 with a CDR 0 (healthy), 111 with a CDR 0.5 (MCI), and 32 with a CDR 1+ (dementia). We divided CDR 0.5 subjects into 3 groups, 12 with vm SVD, 38 with vm AD and 61 with other types. All vm SVD subjects met the Erkinjuntti’s criteria; memory deficits, executive function disturbances, neurological signs present and lacunar infarctions in basal ganglia or white matter hyper intensity on MRI. All vm AD subjects met possible AD as per the NINCDS-ADRDA criteria. They showed no cerebral infarctions, no neurological signs, or no abnormalities of blood test causing dementia. The two CDR 0.5 groups diagnosed as vm SVD and vm AD were compared. There were no significant differences between the two groups for age, sex, educational level, MMSE (22.2 v.s. 22.8) and Geriatric Depression Scale (5.3 v.s. 3.8). To assess apathy, we used the Clinical Assessment for Spontaneity part 3 (CAS3) which estimated their apathy through a questionnaire given to each subject’s caregiver. We examined the differences between the two groups for CDR domains; Community Affairs (CA), Home and Hobbies (HH) and Personal Care (PC), and CAS3. Results: There were no significant differences between the vm SVD and vm AD groups in CA, HH and PC. However, the apathy score of the vm SVD group was severer than the vm AD group in CAS3 (3.8 v.s. 2.0, p1⁄40.02). Conclusions: The results suggest that vm SVD subjects have severer apathy compared with vm AD subjects. Earlier therapeutic intervention would be needed for vm SVD patients who showed apathy in a community.