Montreal Cognitive Assessment for the detection of dementia

Background: Dementia is a progressive syndrome of global cognitive impairment with significant health and social care costs. Global prevalence is projected to increase, particularly in resource‐limited settings. Recent policy changes in Western countries to increase detection mandates a careful examination of the diagnostic accuracy of neuropsychological tests for dementia. Objectives: To determine the accuracy of the Montreal Cognitive Assessment (MoCA) for the detection of dementia. Search methods: We searched MEDLINE, EMBASE, BIOSIS Previews, Science Citation Index, PsycINFO and LILACS databases to August 2012. In addition, we searched specialised sources containing diagnostic studies and reviews, including MEDION (Meta‐analyses van Diagnostisch Onderzoek), DARE (Database of Abstracts of Reviews of Effects), HTA (Health Technology Assessment Database), ARIF (Aggressive Research Intelligence Facility) and C‐EBLM (International Federation of Clinical Chemistry and Laboratory Medicine Committee for Evidence‐based Laboratory Medicine) databases. We also searched ALOIS (Cochrane Dementia and Cognitive Improvement Group specialized register of diagnostic and intervention studies). We identified further relevant studies from the PubMed ‘related articles’ feature and by tracking key studies in Science Citation Index and Scopus. We also searched for relevant grey literature from the Web of Science Core Collection, including Science Citation Index and Conference Proceedings Citation Index (Thomson Reuters Web of Science), PhD theses and contacted researchers with potential relevant data. // Selection criteria: Cross‐sectional designs where all participants were recruited from the same sample were sought; case‐control studies were excluded due to high chance of bias. We searched for studies from memory clinics, hospital clinics, primary care and community populations. We excluded studies of early onset dementia, dementia from a secondary cause, or studies where participants were selected on the basis of a specific disease type such as Parkinson’s disease or specific settings such as nursing homes. // Data collection and analysis: We extracted dementia study prevalence and dichotomised test positive/test negative results with thresholds used to diagnose dementia. This allowed calculation of sensitivity and specificity if not already reported in the study. Study authors were contacted where there was insufficient information to complete the 2x2 tables. We performed quality assessment according to the QUADAS‐2 criteria. Methodological variation in selected studies precluded quantitative meta‐analysis, therefore results from individual studies were presented with a narrative synthesis. // Main results: Seven studies were selected: three in memory clinics, two in hospital clinics, none in primary care and two in population‐derived samples. There were 9422 participants in total, but most of studies recruited only small samples, with only one having more than 350 participants. The prevalence of dementia was 22% to 54% in the clinic‐based studies, and 5% to 10% in population samples. In the four studies that used the recommended threshold score of 26 or over indicating normal cognition, the MoCA had high sensitivity of 0.94 or more but low specificity of 0.60 or less. // Authors' conclusions: The overall quality and quantity of information is insufficient to make recommendations on the clinical utility of MoCA for detecting dementia in different settings. Further studies that do not recruit participants based on diagnoses already present (case‐control design) but apply diagnostic tests and reference standards prospectively are required. Methodological clarity could be improved in subsequent DTA studies of MoCA by reporting findings using recommended guidelines (e.g. STARDdem). Thresholds lower than 26 are likely to be more useful for optimal diagnostic accuracy of MoCA in dementia, but this requires confirmation in further studies

Cochrane Centralised Search Service showed high sensitivity identifying randomized controlled trials: A retrospective analysis

BACKGROUND: The Cochrane Central Register of Controlled Trials (CENTRAL) is compiled from a number of sources, including PubMed and Embase. Since 2017, we have increased the number of sources feeding into CENTRAL and improved the efficiency of our processes through the use of APIs, machine learning and crowdsourcing. OBJECTIVES: Our objectives were twofold: (1) Assess the effectiveness of Cochrane's centralised search and screening processes to correctly identify references to published reports which are eligible for inclusion in Cochrane systematic reviews of randomised controlled trials (RCTs). (2) Identify opportunities to improve the performance of Cochrane's centralised search and screening processes to identify references to eligible trials. METHODS: We identified all references to RCTs (either published journal articles or trial registration records) with a publication or registration date between 1st January 2017 and 31st December 2018 that had been included in a Cochrane intervention review. We then viewed an audit trail for each included reference to determine if it had been identified by our centralised search process and subsequently added to CENTRAL. RESULTS: We identified 650 references to included studies with a publication year of 2017 or 2018. Of those, 634 (97.5%) had been captured by Cochrane's Centralised Search Service (CSS). Sixteen references had been missed by the CSS: six had PubMed-not-MEDLINE status, four were missed by the centralised Embase search, three had been misclassified by Cochrane Crowd, one was from a journal not indexed in MEDLINE or Embase, one had only been added to Embase in 2019, and one reference had been rejected by the automated RCT machine learning classifier. Of the sixteen missed references, eight were the main or only publication to the trial in the review in which it had been included. CONCLUSIONS: This analysis has shown that Cochrane's centralised search and screening processes are highly sensitive. It has also helped us to understand better why some references to eligible RCTs have been missed. The CSS is playing a critical role in helping to populate CENTRAL and is moving us towards making CENTRAL a comprehensive repository of RCTs

Plasma and Cerebrospinal fluid (CSF) Abeta42 for the differential diagnosis of Alzheimer's disease dementia in participants diagnosed with any dementia subtype in a specialist care setting

© 2014 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the diagnostic accuracy of the plasma and CSF Abeta42 index tests for distinguishing Alzheimer's disease dementia from each of the other forms of dementia in people who meet the general criteria for a dementia syndrome. To investigate the heterogeneity of test accuracy in the included studies. We expect that heterogeneity will be likely and that it will be an important component of the review. The potential sources of heterogeneity, which will be used as a framework for the investigation of heterogeneity, include target population, index test, target disorder and study quality and are detailed in the analysis section

Big data and data repurposing – using existing data to answer new questions in vascular dementia research

Introduction: Traditional approaches to clinical research have, as yet, failed to provide effective treatments for vascular dementia (VaD). Novel approaches to collation and synthesis of data may allow for time and cost efficient hypothesis generating and testing. These approaches may have particular utility in helping us understand and treat a complex condition such as VaD. Methods: We present an overview of new uses for existing data to progress VaD research. The overview is the result of consultation with various stakeholders, focused literature review and learning from the group’s experience of successful approaches to data repurposing. In particular, we benefitted from the expert discussion and input of delegates at the 9th International Congress on Vascular Dementia (Ljubljana, 16-18th October 2015). Results: We agreed on key areas that could be of relevance to VaD research: systematic review of existing studies; individual patient level analyses of existing trials and cohorts and linking electronic health record data to other datasets. We illustrated each theme with a case-study of an existing project that has utilised this approach. Conclusions: There are many opportunities for the VaD research community to make better use of existing data. The volume of potentially available data is increasing and the opportunities for using these resources to progress the VaD research agenda are exciting. Of course, these approaches come with inherent limitations and biases, as bigger datasets are not necessarily better datasets and maintaining rigour and critical analysis will be key to optimising data use

Monitoring the early signs of cognitive decline in elderly by computer games: an MRI study

BACKGROUND: It is anticipated that current and future preventive therapies will likely be more effective in the early stages of dementia, when everyday functioning is not affected. Accordingly the early identification of people at risk is particularly important. In most cases, when subjects visit an expert and are examined using neuropsychological tests, the disease has already been developed. Contrary to this cognitive games are played by healthy, well functioning elderly people, subjects who should be monitored for early signs. Further advantages of cognitive games are their accessibility and their cost-effectiveness. PURPOSE: The aim of the investigation was to show that computer games can help to identify those who are at risk. In order to validate games analysis was completed which measured the correlations between results of the 'Find the Pairs' memory game and the volumes of the temporal brain regions previously found to be good predictors of later cognitive decline. PARTICIPANTS AND METHODS: 34 healthy elderly subjects were enrolled in the study. The volume of the cerebral structures was measured by MRI. Cortical reconstruction and volumetric segmentation were performed by Freesurfer. RESULTS: There was a correlation between the number of attempts and the time required to complete the memory game and the volume of the entorhinal cortex, the temporal pole, and the hippocampus. There was also a correlation between the results of the Paired Associates Learning (PAL) test and the memory game. CONCLUSIONS: The results gathered support the initial hypothesis that healthy elderly subjects achieving lower scores in the memory game have increased level of atrophy in the temporal brain structures and showed a decreased performance in the PAL test. Based on these results it can be concluded that memory games may be useful in early screening for cognitive decline

Advances in the therapy of Alzheimer's disease: Targeting amyloid beta and tau and perspectives for the future

Worldwide multidisciplinary translational research has led to a growing knowledge of the genetics and molecular pathogenesis of Alzheimer's disease (AD) indicating that pathophysiological brain alterations occur decades before clinical signs and symptoms of cognitive decline can be diagnosed. Consequently, therapeutic concepts and targets have been increasingly focused on early-stage illness before the onset of dementia; and distinct classes of compounds are now being tested in clinical trials. At present, there is a growing consensus that therapeutic progress in AD delaying disease progression would significantly decrease the expanding global burden. The evolving hypothesis- and evidence-based generation of new diagnostic research criteria for early-stage AD has positively impacted the development of clinical trial designs and the characterization of earlier and more specific target populations for trials in prodromal as well as in pre- and asymptomatic at-risk stages of AD

Vastuullisuudesta valttia : Ruoan lakisääteisestä kuluttajaviestinnästä kohti vastuullisuusviestintää

Vastuullisuudesta on tullut keskeinen teema ruoka-alan markkinointiviestinnässä. Näkyvimmin vastuullisuutta tuovat esille suuret ruokatalot monin eri tavoin aina eettisesti korkealaatuisesti tuotetuista raaka-aineista kuluttajan hyvinvointivaikutuksiin. Suuret yritykset ovat näyttävän medianäkyvyyden lisäksi joutuneet panostamaan myös tuotantojärjestelmiensä kehittämiseen, jotta ruokaketju olisi kuluttajille riittävän läpinäkyvä ja viesti vastuullisuudesta uskottava. Monet pienet yritykset eivät tuo esille vastuullisia toimintatapojaan, vaikka vastuullisen toiminnan elementit ovat niille jokapäiväisiä ja sosiaalisen median kanavat ovat avanneet uusia mahdollisuuksia tehokkaaseen markkinointiviestintään. Tämän oppaan tarkoituksena on tiedottaa pienten ruoka-alan yritysten yrittäjille ja markkinointivastaaville keskeisistä yritysvastuun periaatteista sekä menetelmistä niiden hyödyntämiseksi markkinoinnissa. Ensimmäisessä artikkeliosiossa tuodaan esille keskeisin elintarvikelainsäädännöllinen perusta, jonka on ehdottomasti oltava kunnossa ennen kuin ryhdytään suunnittelemaan sen ylittäviä vastuullisuusviestejä kuluttajalle. Tarkastelussa ovat myös itse vastuullisuuden käsite elintarvikealalla, sen sisältö ja ulottuvuudet sekä hyödyntämistavat yrityksen strategisessa suunnittelussa. Toisessa artikkeliosiossa käsitellään pienyrityksenkin ulottuvilla olevia markkinoinnillisia keinoja: asiakkaan tuntemista, vastuullisuudesta viestimistä kilpailuedun saamiseksi, sisällön tuottamista ja sosiaalisen median viestintäkanavia

Outcomes measures in a decade of dementia and mild cognitive impairment trials

Background In a research study, to give a comprehensive evaluation of the impact of interventions, the outcome measures should reflect the lived experience of the condition. In dementia studies, this necessitates the use of outcome measures which capture the range of disease effects, not limited to cognitive functioning. In particular, assessing the functional impact of cognitive impairment is recommended by regulatory authorities, but there is no consensus on the optimal approach for outcome assessment in dementia research. Our aim was to describe the outcome measures used in dementia and mild cognitive impairment (MCI) intervention studies, with particular interest in those evaluating patient-centred outcomes of functional performance and quality of life. Methods We performed a focused review of the literature with multiple embedded checks of internal and external validity. We used the Cochrane Dementia and Cognitive Improvement Group’s register of dementia studies, ALOIS. ALOIS was searched to obtain records of all registered dementia and MCI intervention studies over a 10-year period (2004–2014). We included both published and unpublished materials. Outcomes were categorised as cognitive, functional, quality of life, mood, behaviour, global/disease severity and institutionalisation. Results From an initial return of 3271 records, we included a total of 805 records, including 676 dementia trial records and 129 MCI trial records. Of these, 78 % (630) originated from peer-reviewed publications and 60 % (487) reported results of pharmacological interventions. Cognitive outcomes were reported in 70 % (563), in contrast with 29 % (237) reporting measures of functional performance and only 13 % (102) reporting quality of life measures. We identified significant heterogeneity in the tools used to capture these outcomes, with frequent use of non-standardised tests. Conclusions This focus on cognitive performance questions the extent to which intervention studies for dementia are evaluating outcome measures which are relevant to individual patients and their carers. The heterogeneity in measures, use of bespoke tools and poor descriptions of test strategy all support the need for a more standardised approach to the conduct and reporting of outcomes assessments.</p

Cochrane Centralised Search Service showed high sensitivity identifying randomised controlled trials: A retrospective analysis

Background The Cochrane Central Register of Controlled Trials (CENTRAL) is compiled from a number of sources, including PubMed and Embase. Since 2017, we have increased the number of sources feeding into CENTRAL and improved the efficiency of our processes through the use of APIs, machine learning and crowdsourcing. Objectives Our objectives were twofold: (1) Assess the effectiveness of Cochrane’s centralised search and screening processes to correctly identify references to published reports which are eligible for inclusion in Cochrane systematic reviews of randomised controlled trials (RCTs). (2) Identify opportunities to improve the performance of Cochrane's centralised search and screening processes to identify references to eligible trials. Methods We identified all references to RCTs (either published journal articles or trial registration records) with a publication or registration date between 1st January 2017 and 31st December 2018 that had been included in a Cochrane intervention review. We then viewed an audit trail for each included reference to determine if it had been identified by our centralised search process and subsequently added to CENTRAL. Results We identified 650 references to included studies with a publication year of 2017 or 2018. Of those, 634 (97.5%) had been captured by Cochrane’s Centralised Search Service (CSS). Sixteen references had been missed by the CSS: six had PubMed-not-MEDLINE status, four were missed by the centralised Embase search, three had been misclassified by Cochrane Crowd, one was from a journal not indexed in MEDLINE or Embase, one had only been added to Embase in 2019, and one reference had been rejected by the automated RCT machine learning classifier. Of the sixteen missed references, eight were the main or only publication to the trial in the review in which it had been included. Conclusions This analysis has shown that Cochrane’s centralised search and screening processes are highly sensitive. It has also helped us to understand better why some references to eligible RCTs have been missed. The CSS is playing a critical role in helping to populate CENTRAL and is moving us towards making CENTRAL a comprehensive repository of RCTs