Cultural adaptation of Alzheimer’s disease assessment scale–cognitive subscale for use in India and validation of the Tamil version for South Indian population

Objective: Currently no standardized tools are available in the Indian languages to assess changes in cognition. Our objectives are to culturally adapt the Alzheimer’s disease Assessment Scale–Cognitive Subscale (ADAS-Cog) for use in India and to validate the Tamil version in an urban Tamil-speaking older adult population. / Methods: Two panels of key stakeholders and a series of qualitative interviews informed the cultural and linguistic adaptation of the ADAS-Cog-Tamil. Issues related to levels of literacy were considered during the adaptation. Validation of the ADAS-Cog-Tamil was completed with 107 participants − 54 cases with a confirmed diagnosis of mild-moderate dementia, and 53 age, gender and education matched controls. Concurrent validity was examined with the Vellore Screening Instrument for Dementia (VSID) in Tamil. Internal consistency using Cronbach’s alpha, sensitivity and specificity data using the Area under the Receiver Operating Characteristics (AUROC) curve values were computed. Inter-rater reliability was established in a subsample. / Results: The ADAS-Cog-Tamil shows good internal consistency (α = 0.91), inter-rater reliability and concurrent validity (with VSID-Patient version: r = –0.84 and with VSID-Caregiver version: r = –0.79). A cut-off score of 13, has a specificity of 89% and sensitivity of 90% for the diagnosis of dementia. / Conclusion: ADAS-Cog-Tamil, derived from a rigorous, replicable linguistic and cultural adaptation process involving service users and experts, shows good psychometric properties despite the limitations of the study. It shows potential for use in clinical settings with urban Tamil speaking populations. The English version of the tool derived from the cultural adaptation process could be used for further linguistic adaptation across South Asia

Validation of the cognitive stimulation therapy (CST) program for people with dementia in Portugal

BACKGROUND: Cognitive Stimulation Therapy (CST) is considered a gold-standard, evidence-based and cost-effective approach to improve cognitive function and quality of life of people with mild to moderate dementia. AIMS: To validate CST for the Portuguese population and test its effectiveness. METHODS: A single-blind, multi-center, randomized controlled trial recruited 112 older people with dementia. The primary outcome measure was cognition and secondary measures were quality of life, communication, autonomy, anxiety, depression, and global functioning. We also explored whether CST benefits people differently according to context, gender and level of cognitive reserve. RESULTS: Fifty-five people were randomized to the intervention and 57 to the control group. In the post-test, the intervention group significantly improved relative to controls in cognition (ADAS-Cog, p = 0.013), communication (HCS, p = 0.045), behaviour (CAPE-BRS, p = 0.017) and in global dementia rating (CDR, p = 0.008). Quality of life, depression and anxiety had no significant differences. The estimated number needed to treat was four for one to benefit a cognitive improvement (ADAS-Cog). CONCLUSIONS: Group CST is valid for the Portuguese population with benefits for people with mild to moderate dementia

Towards the development of evidence-based preventive treatments against cognitive decline : about the effects of learning golf in elderly people

Die Thesis sollte einen Beitrag zur Entwicklung evidenzbasierter Bewegungstherapien für den Erhalt der kognitiven Leistungsfähigkeit bei älteren Menschen im Rahmen der Prävention der Demenz vom Alzheimer-Typ leisten. Die Evidenzsynthese konnte zeigen, dass die Intensität von Bewegungsinterventionen nicht die einzige Bedingung für eine Beeinflussung der kognitiven Leistungsfähigkeit ist. Körperliche Aktivität sollte daher nicht allein als metabolisch beanspruchendes Traininginterpretiert werden, sondern auch weitere motorische Beanspruchungsformenberücksichtigen. Basierend auf diesen Erkenntnissen wurde eine 22-wöchige randomisierte Studie entwickelt, in der ältere Menschen das Golfspielen erlernt haben.Die Intervention wurde hinsichtlich der Machbarkeit und ihrer Effekte auf die kognitive Leistungsfähigkeit unter Einbezug (neuro-) biologischer Marker (Elektroenzephalographie und Kynureninpfad) evaluiert. Neben der Machbarkeit und Sicherheit der Intervention konnten positive Effekte auf die Aufmerksamkeit, die funktionelle Integrität des Default-Mode-Netzwerks sowie vermutlich auf die Regulation des Kynureninpfads gefunden werden. Die Ergebnisse wurden allerdings durch die kleine und heterogene Stichprobe (n = 45) eingeschränkt und sollten daher repliziert werden. Ein differenziertes Verständnis von Bewegung und ihrer Kombination mitanderen Domänen (z. B. Kognition) ist für die weitere Entwicklung präventiver evidenzbasierter Therapien notwendig.This thesis should contribute to the development of evidence-based exercise treatments for maintaining cognitive performance in elderly people in the context of prevention of Alzheimers disease. The evidence synthesis showed that intensity of the intervention is not the sole factor for improving cognitive performance. Physical activity should therefore account for different exercise modes and should not only be interpreted as metabolically demanding training. Based on these findings, a 22-week randomized trial was developed, in which elderly people learned to play golf. The intervention was evaluated regarding the feasibility and its effects on cognitive performance by including (neuro-) biological markers (electroencephalography and kynurenine pathway). Besides feasibility and safety of the intervention, positive effects were found for attention performance, the functional integrity of the default mode network and presumably also for regulation of the kynurenine pathway. However, findings should be considered under the limitation of the small and heterogeneous sample (n = 45) and should therefore be replicated in a larger cohort. A differentiated understanding of exercise and its combination with other domains (e.g. cognition) is necessary to move further towards the development of preventive evidence-based interventions.by Julia Kristin Ströhlein ; [Principal supervisor: Prof. Dr. Dr. Claus Reinsberger]Tag der Verteidigung: 30.08.2021Universität Paderborn, Dissertation, 202

Étude de la validité de la Mattis Dementia Rating Scale-2 par l'intermédiaire du diagnostic différentiel des états pré-cliniques des démences d'origine corticale et sous-corticale

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2011-2012Dans les dernières années, les recherches scientifiques portant sur le vieillissement neuropsychologique ont mis en évidence la présence de déficits cognitifs bien avant que le diagnostic clinique de la démence ne puisse être porté. La condition des Troubles Cognitifs Légers (TCL) constituerait ainsi une phase intermédiaire entre le vieillissement normal et le vieillissement pathologique. L'intérêt de la reconnaissance précoce des TCL réside en grande partie dans la possibilité d'offrir différents types de traitement potentiellement susceptibles de ralentir l'évolution vers la démence. Considérant le nombre croissant de personnes atteintes de dysfonctions cognitives variées, jumelé au peu de ressources disponibles pour les évaluer, avoir accès à un outil de dépistage cognitif efficace, capable de contribuer également au diagnostic différentiel à un stade débutant de la maladie, constituerait un atout de taille. La présente thèse doctorale s'inscrit dans cette volonté de plus en plus pressante de détecter précocement les désordres cognitifs associés au vieillissement, et plus spécifiquement par le biais de la Mattis Dementia Rating Scale (MDRS-2). Elle se divise en cinq chapitres, chacun tentant de répondre à un objectif particulier. Le chapitre I introduit brièvement les notions cliniques pertinentes et certains tests de dépistages cognitifs déjà répandus pour le diagnostic de la démence. Ensuite, le chapitre II fait état d'une revue systématique de l'utilité clinique de ces derniers en lien avec la détection des TCL comme phase pré-clinique de la maladie d'Alzheimer (MA). Des données rétrospectives portant sur la MDRS-2 y sont également présentées. Le chapitre III présente, sous forme d'article scientifique, les résultats obtenus quant à la validité clinique de la MDRS-2 pour la détection des TCL et de la démence associée à la maladie de Parkinson (D-MP). Quant au chapitre IV, il réfère à un autre article scientifique rapportant les résultats sur la capacité de la MDRS-2 à contribuer au diagnostic différentiel des phases pré-cliniques de la MA et de la D-MP. Finalement, le cinquième et dernier chapitre du présent ouvrage se veut une discussion générale et critique de l'ensemble des résultats et connaissances acquises au cours de la réalisation de cette thèse doctorale, tout en proposant des perspectives de recherches futures

The cognitive subscale of the Alzheimer's Disease Assessment Scale in a Brazilian sample

The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) is widely used for the evaluation of dementia and is very popular in dementia drug trials because of the characteristics of the scale. The objective of the present study was to adapt the ADAS-Cog for use for the Brazilian population. A major problem is that education is variable, a fact that may influence performance in cognitive evaluation. This study was conducted on a control group (CG) of 96 subjects (25 males and 71 females aged 68 ± 8.6 years) and on 44 Alzheimer's disease (AD) patients (19 males and 25 females aged 72 ± 6.4 years) with mild dementia (Clinical Dementia Rating score 1). For statistical analysis groups were divided into three educational levels: I, 0-4 years of schooling (65 CG/20 AD); II, 5-11 years of schooling (19 CG/7 AD), and III, 12 or more years of schooling (12 CG/17 AD). The battery was applied according to original instructions. Total mean score for CG and AD was 10.9 and 22.9 for level I, 7.8 and 22.4 for level II, and 6.2 and 15.4 for level III, respectively. These results indicate that our version of the ADAS-Cog is useful to identify mild dementia, though there may be an overlapping when comparing high education demented with low education non-demented subjects.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaSciEL

AI and Non AI Assessments for Dementia

Current progress in the artificial intelligence domain has led to the development of various types of AI-powered dementia assessments, which can be employed to identify patients at the early stage of dementia. It can revolutionize the dementia care settings. It is essential that the medical community be aware of various AI assessments and choose them considering their degrees of validity, efficiency, practicality, reliability, and accuracy concerning the early identification of patients with dementia (PwD). On the other hand, AI developers should be informed about various non-AI assessments as well as recently developed AI assessments. Thus, this paper, which can be readable by both clinicians and AI engineers, fills the gap in the literature in explaining the existing solutions for the recognition of dementia to clinicians, as well as the techniques used and the most widespread dementia datasets to AI engineers. It follows a review of papers on AI and non-AI assessments for dementia to provide valuable information about various dementia assessments for both the AI and medical communities. The discussion and conclusion highlight the most prominent research directions and the maturity of existing solutions.Comment: 49 page

Demographic and ethnicity effects on neuropsychological test performance : implications for dementia assessment in Caribbean populations

Prevalence rates of dementia are increasing worldwide and more so in developing countries. Early and accurate diagnosis of dementia then assumes critical importance. Cross-cultural neuropsychological assessment of dementia depends on the use of instruments that have been appropriately normed and validated for target populations. While culture and ethnicity have been acknowledged as variables which significantly impact cognitive performance, they are not usually included in normative and validation studies. The main aim of this dissertation was to standardise and identify the role played by ethnicity in performance on a number of instruments used in the assessment of dementia and identify the role and interaction of ethnicity with other common demographic variables on performance for Caribbean populations. Performance on the Mini Mental State Exam (MMSE) was influenced by age, education and ethnicity and a validation of corrected scores yielded a cut-off that resulted in a 35% reduction in false positive rates among non-AD persons. The Alzheimer’s Disease Assessment Scale-cognitive section (ADAS-cog) was influenced by education and was resistant to effects of ethnicity. Cut-off scores were lower than traditionally suggested, perhaps due to higher educational levels, but resulted in very high sensitivity (89%) and specificity (89%) rates. Education influenced scores on most measures: digit span, digit cancellation, logical memory, semantic and phonemic fluency and Raven’s Coloured Progressive Matrices. Ethnicity also influenced scores on digit span backwards, digit cancellation, semantic fluency and Raven’ Matrices. Ethnic differences in performance may be attributed to differences in attention, working memory and also to differences in cognitive styles. Differences in educational attainment across cultures and generations renders earlier norms invalid and highlight the needs for norms to be periodically revised in order to be considered representative of current populations. The provision of culturally relevant and contemporary norms yielded in this study can be regarded as invaluable tools in the assessment and diagnosis of dementia in diverse populations

Neuropsychological contribution to the study of white matter changes : a 10-year longitudinal study

Tese de doutoramento, Ciências e Tecnologias da Saúde (Desenvolvimento Social e Humano), Universidade de Lisboa, Faculdade de Medicina, 2017This thesis, conceived as a longitudinal, descriptive and analytic observational investigation, aims to identify clear profiles of cognitive functioning in patients with white matter changes (WMC). The first part, presents the contribution to the multinational collaborative research known under the acronym of LADIS (Leukoaraiosis and Disability Study) which attempted to investigate the clinical significance of white matter changes as an independent predictor of the transition to disability in initially non-disabled elderly, to this end selecting and applying an appropriate test battery to assess specific domains in cognitive functions. The second part introduces the long-term follow-up of the Lisbon Centre group of participants in the LADIS study, and identifies the impact of functional and cognitive decline on caregivers who accompanied patients up to the state of full dependency. The constructed neuropsychological battery proved to be effective in identifying cognitive impairment appearing in early stages when comparing different evolutionary profiles, as well as in detecting predictors of good cognitive functioning in lengthy follow-up research, thus opening space for a renewed project to establish intervention programs. Though WMC are exclusively detected by imaging, the clinical expression of those changes, particularly as related to cognitive function, should become identified through sensitive adapted batteries. Neuropsychological assessment allows the definition of the extent of the cognitive impairment, as well as the determination of its impact on daily life and adaptation of intervention programmes either in early stages, or in later stages of the disease, allowing the introduction of non-pharmacologic complementary therapies. The identification of changes in cognitive functioning and the corresponding impact on patients and on their environment, mostly in the family, allows the adoption of broader intervention strategies when introducing future informal caregivers to more appropriate coping strategies as mediators of psychological and emotional wellbeing.Esta tese foi concebida como investigação observacional e longitudinal, descritiva e analítica, e pretende identificar perfis de funcionamento cognitivo em pacientes idosos com alterações da substância branca cerebral. A primeira parte, constitui um contributo para a investigação colaborativa multinacional conhecida sob a sigla de LADIS (Leukoaraiosis and Disability Study), que analisou o significado clínico das alterações de substância branca cerebral (ASBC) como preditor da transição para a perda de autonomia em idosos inicialmente sem défice funcional. Para o efeito foi aplicada uma bateria neuropsicológica de modo a avaliar domínios específicos do funcionamento cognitivo, repetida anualmente ao longo de três anos. A segunda parte apresenta o seguimento a longo prazo do grupo português de participantes no LADIS e identifica o impacto do declínio funcional e cognitivo sobre cuidadores que acompanham os pacientes até o estado de dependência total. Quando comparados os diferentes perfis evolutivos, a bateria neuropsicológica construída provou ser eficaz na identificação de alterações cognitivas nas fases iniciais e permitiu prever níveis de funcionamento cognitivo no longo prazo. Assim abriu espaço para um renovado projeto de intervenção. Embora as ASBC sejam detetadas exclusivamente por exames de imagem, a sua expressão clínica poderá tornar-se identificável através de baterias neuropsicológicas mais sensíveis. A avaliação neuropsicológica permite a definição de um padrão, bem como a determinação do impacto na vida diária para adaptação de programas de intervenção nos estágios iniciais ou em fases mais tardias da doença, assim como introduzir terapias complementares não farmacológicos, tendo em vista promover a autonomia funcional num maior período de tempo possível. A identificação de alterações no funcionamento cognitivo e o correspondente impacto sobre os pacientes e o seu ambiente, principalmente na família, permite a adoção de estratégias mais amplas de intervenção a transmitir aos cuidadores informais para uso no enfrentamento da carga emocional e física que os atinge.LADIS study, Vth European Framework Program ‘Quality of life and management of living resources’ (1998– 2002), contract No. QLRT-2000-0044

What outcomes are important to patients with mild cognitive impairment or Alzheimer's disease, their caregivers, and health-care professionals? A systematic review

Introduction: Clinical trials involving patients with Alzheimer’s disease (AD) continue to try to identify disease-modifying treatments. Although trials are designed to meet regulatory and registration requirements, many do not measure outcomes of the disease most relevant to key stakeholders. Methods: A systematic review sought research that elicited information from people with AD, their caregivers, and health-care professionals on which outcomes of the disease were important. Studies published in any language between 2008 and 2017 were included. Results: Participants in 34 studies described 32 outcomes of AD. These included clinical (memory, mental health), practical (ability to undertake activities of daily living, access to health information), and personal (desire for patient autonomy, maintenance of identity) outcomes of the disease. Discussion: Evidence elicited directly from the people most affected by AD reveals a range of disease outcomes that are relevant to them but are not commonly captured in clinical trials of new treatments.</br