Tzvi Dwolatzky

Validity of a novel computerized cognitive battery for mild cognitive impairment.

BackgroundThe NeuroTrax Mindstreams computerized cognitive assessment system was designed for widespread clinical and research use in detecting mild cognitive impairment (MCI). However, the capability of Mindstreams tests to discriminate elderly with MCI from those who are cognitively healthy has yet to be evaluated. Moreover, the comparability between these tests and traditional neuropsychological tests in detecting MCI has not been examined.MethodsA 2-center study was designed to assess discriminant validity of tests in the Mindstreams Mild Impairment Battery. Participants were 30 individuals diagnosed with MCI, 29 with mild Alzheimers disease (AD), and 39 healthy elderly. Testing was with the Mindstreams battery and traditional neuropsychological tests. Receiver operating characteristic (ROC) analysis was used to examine the ability of Mindstreams and traditional measures to discriminate those with MCI from cognitively healthy elderly. Between-group comparisons were made (Mann-Whitney U test) between MCI and healthy elderly and between MCI and mild AD groups.ResultsMindstreams outcome parameters across multiple cognitive domains significantly discriminated among MCI and healthy elderly with considerable effect sizes (p < 0.05). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best, and discriminability was at least comparable to that of traditional neuropsychological tests in these domains.ConclusionsMindstreams tests are effective in detecting MCI, providing a comprehensive profile of cognitive function. Further, the enhanced precision and ease of use of these computerized tests make the NeuroTrax system a valuable clinical tool in the identification of elderly at high risk for dementia.

Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n = 72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n = 88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly with depression.

Validity of the Mindstreams Computerized Cognitive Battery for Mild Cognitive Impairment

This article, published as an invited review in the special ISOA issue of the journal, was first published as an original article in BMC Geriatrics: Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, Chertkow H. Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatrics, 3, 4–16, 2003. J Mol Neurosci (2008) 35:251 DOI 10.1007/s12031-007-9031-9

Elevated serum homocysteine levels in male patients with PTSD

It has been suggested that an elevated serum or plasma homocysteine level may be a risk factor for neuropsychiatric conditions such as Alzheimers disease, schizophrenia, and depression. Because depression is closely related to anxiety disorders, and because it has been suggested that stress may be associated with an elevated homocysteine level, we studied whether serum homocysteine levels are elevated in patients with posttraumatic stress disorder (PTSD). Total serum homocysteine levels in 28 male patients with PTSD were compared to those of 223 healthy controls. The effect of PTSD on the serum homocysteine level was significant (F=42.96, P<.0001). In a regression model for the PTSD patients, the duration of PTSD was found to predict serum homocysteine levels (t=2.228, P=.035). Our results suggest that elevated levels of homocysteine in male patients with PTSD may be related to pathophysiological aspects associated with the chronicity of this disorder. Depression and Anxiety, 2008.

The detection of neurocognitive decline in schizophrenia using the Mindstreams Computerized Cognitive Test Battery

BACKGROUND The Mindstreams Computerized Cognitive Test Battery (Mindstreams) is a standardized computer-based battery that was designed for widespread clinical and research use. The capability of Mindstreams to test cognitive impairment in schizophrenia has yet to be evaluated. The aim of the present study was to determine the ability of Mindstreams in detecting cognitive dysfunction in schizophrenia patients and to compare it to the Cambridge Neuropsychological Test Automated Battery (CANTAB). METHOD Fifty-five schizophrenia patients and 63 healthy subjects were enrolled in the study. The Positive and Negative Syndrome Scale (PANSS) was used to quantify symptom severity. Neurocognitive functions were assessed using Mindstreams and CANTAB. RESULTS The schizophrenia patients scored significantly more poorly than healthy subjects on all tests comprising the Mindstreams battery. Comparable tasks of the Mindstreams and CANTAB batteries significantly correlated on raw scores and the standardized cognitive indices. The Mindstreams executive function tasks had significant correlations with the PANSS negative, autistic preoccupation and activation cluster scores, and with global functioning. Two-week test-retest reliability correlations were all significant (N=17, p<0.05-p<0.001). CONCLUSIONS This study indicates that Mindstreams is reliable in assessing the cognitive function of patients with schizophrenia and may play a role in standardizing the cognitive assessment of these patients in clinical and research settings.

Aerobic fitness and multidomain cognitive function in advanced age.

BACKGROUND Studies generally describe the relationship between physical fitness and cognitive function by measuring only one or two specific cognitive tasks. In addition, in spite of the significant increase in life expectancy, the age of participants in these studies does not extend beyond a mean age of 70 years. This study was thus designed to examine the relationship between physical fitness and function in multiple cognitive domains in subjects older than those previously reported. METHODS Thirty-eight individuals, aged 65.3 to 85.3 years, performed a graded, progressive, maximal exercise test. Based on a median score of peak VO2, participants were divided into low-fitness and moderately-fit groups. Cognitive function was assessed by means of a computerized neuropsychological battery. RESULTS The moderately-fit group achieved significantly better scores on the global cognitive score (U = 97, p = 0.04), and a significant correlation was found between peak VO2 and attention, executive function, and global cognitive score (rs = .37, .39, .38 respectively). The trend for superior cognitive scores in the moderate-fitness compared to the low-fitness groups was unequivocal, both in terms of accuracy and reaction time. CONCLUSION Maintenance of higher levels of cardiovascular fitness may help protect against cognitive deterioration, even at an advanced age. An adequately powered randomized controlled trial should be performed to further evaluate this hypothesis.

Vitamin B6 versus mianserin and placebo in acute neuroleptic-induced akathisia: a randomized, double-blind, controlled study.

Abstract: Treatment strategies against acute neuroleptic-induced akathisia (NIA) include anticholinergic (antimuscarinic) agents, dopamine agonists, GABAergic agents, &bgr;-blockers, benzodiazepines, and serotonin antagonists. However, many patients who have acute akathisia fail to respond. In previous studies, mianserin and vitamin B6 were found to be effective in the treatment of acute akathisia. The purpose of this study was to compare the efficacy of B6, mianserin and placebo in the treatment of acute NIA. Sixty schizophrenia and schizoaffective inpatients who have NIA were randomly divided to receive vitamin B6 1200 mg/d, mianserin 15 mg/d, or placebo for 5 days, in a double-blind design. The Barnes Akathisia Rating Scale, Brief Psychiatric Rating Scale, and Clinical Global Impression were used to assess the severity of NIA and psychotic symptoms. The assessment was made at baseline and daily for the duration of the study. Compared with the placebo group, the vitamin B6-treated and mianserin-treated patients showed a significant improvement in the subjective (P < 0.0001), subjective distress (P < 0.0001), and global (P < 0.0001) subscales. The objective subscale did not show significant positive results (P = 0.056), but there was a trend toward symptom amelioration in both groups. A reduction of at least 2 points on the Barnes Akathisia Rating Scale global subscale was noted in the vitamin B6 group (13/23, 56%) as well as in the mianserin groups (13/20, 65%), and in only one patient in the placebo group (1/17, 6%; P < 0.0005). Our results indicate that high doses of B6 and a low dose of mianserin may be a useful addition to current treatments of NIA. The efficacy of vitamin B6 and mianserin suggests that the pathophysiology of acute NIA is heterogeneous with the various subtypes of acute NIA responding differently to the various pharmacological approaches.

An estimate of the prevalence of dementia among residents of long-term care geriatric institutions in the Jerusalem area.

BACKGROUND To determine the prevalence of dementia among the residents of geriatric institutions in the greater Jerusalem area. METHODS A population-based, cross-sectional survey of a representative sample, weighted according to the level of care, of 11 of the 88 long-term care (LTC) wards in 34 LTC institutions providing care for the elderly residents in the greater Jerusalem area in 1999. A single physician interviewed 311 residents. The presence of dementia was determined from medical records and by performance on the Modified Mini-mental State Examination (3MS) instrument (with a score less than 78/100 indicating significant cognitive impairment or suspected dementia), and professional care providers were interviewed for their opinion regarding the presence of dementia in each subject. RESULTS The mean age of the patients was 83.9 years and 75% were women. Overall, 180 residents, representing 49.9% of the weighted sample in Jerusalem LTC facilities, were determined to have dementia according to medical records, ranging from 22.9% in independent and frail care units to 97.7% in skilled nursing care wards. However, based on their performance on the 3MS, the prevalence of cognitive impairment with suspected dementia among the subjects was substantially greater, with the staff being unaware of this diagnosis in about one-quarter of the subjects. CONCLUSIONS There is a high prevalence of dementia in geriatric institutions in the Jerusalem area, particularly in those providing greater care. Moreover, significant cognitive impairment is probably under-reported in the medical records.

AN INFLAMMATION METER TO REVEAL THE PRESENCE AND EXTENT OF INFLAMMATION IN OLDER PATIENTS

and no significant difference in muscle area (Table 1) . We found a strong linear correlation between bone and muscle area in both groups of women (Figure 1). Women with osteoporotic fractures had bone areas lower than expected given their muscle areas. In linear regression analyses fitted separately for the two groups (Figure l), we found similar slopes (2.98 vs 2.73) but significantly different intercepts (32.29 vs 113.84; P < .0001). These findings suggest that the reduction in bone mass often observed in women with osteoporotic fractures is attributable to a primary bone-related pathophysiologic process. The bone/muscle ratio may help to identify women with true osteoporosis from those in whom reduction in bone mass is merely the consequence of severe sarcopenia in the context of ageassociated frailty and not a primary disturbance of bone metabolism.

Computerized Testing of Neurocognitive Function in Euthymic Bipolar Patients Compared to Those with Mild Cognitive Impairment and Cognitively Healthy Controls

Objectives: While neuropsychological impairment in bipolar disorder is well documented, the effect size of this impairment is rarely compared directly to that in other clinically familiar cognitive disorders. This study compares neuropsychological functioning of euthymic bipolar patients to those with mild cognitive impairment (MCI) as well as healthy controls. Methods: Following evaluation during regular follow-up in a mood disorders clinic, 58 euthymic adult bipolar subjects were administered a validated and fully computerized cognitive assessment (Mindstreams; NeuroTrax Corp., N.Y., USA). Study data were compared to existing data for MCI and cognitively healthy individuals tested with the same assessment. Results: Final analyses were based on 51 bipolar patients, 162 MCI patients and 495 healthy comparison subjects. Significant (p < 0.001) group effects were found for every parameter. Post hoc analysis revealed that the bipolar and MCI groups showed statistically equivalent functioning in memory, executive function, verbal function, and information processing speed. In the domains of visual-spatial processing, attention, and motor skills, the MCI group outperformed the bipolar group. In every domain, the healthy control group outperformed both the bipolar and the MCI groups. Conclusions: The cognitive function of euthymic bipolar patients and those diagnosed with MCI was found to be similar in most but not all domains. Both groups performed significantly less well than the comparison group of healthy subjects. It may be helpful for clinicians to conceptualize the overall level of cognitive impairment in bipolar patients as similar to that in MCI.