Exploring the role of cognitive factors in a new instrument for elders' financial capacity

Although the general public and mental health professionals seem to disregard incapacity regarding financial issues and relevant decision making in mild cognitive impairment (MCI), and focus only on severe dementia cases, a PhD study in Greece reveals that noticeable deficits do exist in the handling of financial issues in elders suffering from MCI.

14 mar 2018--An extended sample of 719 elders from Northern Greece, including healthy participants and patients with different types of cognitive deficits, such as amnestic mild cognitive impairment (aMCI), mild, moderate, and severe Alzheimer's dementia (AD), mild Parkinson's disease dementia (PDD), mild vascular dementia (VD), moderate frontotemporal dementia (FTD), and moderate mixed dementia (MD), were examined with a new instrument specifically designed in the Greek cultural context, entitled Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) and a battery of classic neuropsychological tests concerning various cognitive functions.
The proposed instrument is based on Marson's theoretical model of financial capacity and consists of seven domains: basic monetary skills, cash transactions, bank statement management, bill payment, financial conceptual knowledge, financial decision making, and knowledge of personal assets. In addition, both participants and their family members/caregivers were examined with a structured interview and a questionnaire that assessed everyday financial experiences/problems and their personal beliefs about the elders' everyday financial capacity. An assessment of capacity was made by mental health experts. The generally accepted psychometric approach for the classification and determination of capacity status (incapable, marginally capable, and capable) was used for LCPLTAS and was established in relation to normal control performance. Cutoff scores for distinguishing capable from marginally capable status, and marginally capable from incapable status was set at 1.5 SDs and 2.5 SDs, respectively, below the control group mean for LCPLTAS
Significantly different profiles in the scores and subscores of LCPLTAS for all the groups of dementia patients were found. Α general incapacity finding holds true not only for all the dementia groups who obtained scores more than 2.5 SDs lower than healthy controls, but also for the MCI patients group who scored around 2.0 SDs lower than healthy participants.
The severity of the deficits in the scores and subscores of LCPLTAS depend on the severity of the cognitive deficits in the classic neuropsychological tests, and more specifically on Mini Mental State Examination (MMSE) total score. Logistic regression showed that specific neuropsychological tests, such as the MMSE, Geriatric Depression Scale (GDS) and Trail Making Part B predicted competence on LCPLTAS for the patients. Persons with MCI and dementia had lower financial knowledge scores than those without cognitive impairment, with MMSE scores below 27, suggestive of an indication of financial incapacity.
Cross-cultural replication studies are needed, as this research serves as a first step in the direction of providing a short form of a reliable and valid tool for use in the Greek elderly population. In addition, it seems necessary to further investigate in detail the biological and brain underpinnings of financial incapacity in MCI patients. Finally, normative data for the child and teenage population, as well as patients with other neurological disorders that may affect judgment for financial issues, is a promising area of future research, as normative data are generally lacking, not only in Greece, but internationally, while there is a plethora of relevant financial cases at courts which rely on other neuropsychological tests and not on relevant tests that aim specifically the financial capacity.

More information: Vaitsa Giannouli et al, Exploring the Role of Cognitive Factors in a New Instrument for Elders' Financial Capacity Assessment, Journal of Alzheimer's Disease (2018). DOI: 10.3233/JAD-170812


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Prediction of conversion to Alzheimer's disease with longitudinal measures and time-to-event data

Predicting the timing of Alzheimer's disease (AD) conversion for individuals with mild cognitive impairment (MCI) can be significantly improved by incorporating longitudinal change information of clinical and neuroimaging markers, in addition to baseline characteristics, according to projections made by investigators from The University of Texas Health Science Center at Houston.

 12 may 2017--In an article published in Journal of Alzheimer's Disease, the research team describes how their novel statistical models found that longitudinal measurements of ADAS-Cog was the strongest predictor for AD progression and the predictive utility was consistently significant with progression of disease.
"The growing public health threat posed by Alzheimer's disease has raised urgency to discover and assess prognostic markers for the early detection of the disease," says Sheng Luo, PhD, senior author of the report. "We assessed the comparative predictive utility of thirty-three longitudinal markers in determining the risk of AD conversion at future time points among individuals with MCI. We found that longitudinal measurements of common cognitive and functional tools can provide more accurate prediction regarding AD conversion than volumetric MRI markers for MCI patients, and markers would show different predictive values at different times in disease progression."
The data used for this study was from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. It was very well suited for the tasks because of its large samples, long follow-up period, breadth of cognitive markers and biomarkers, and prospective nature. "We simultaneously modeled time-to-dementia as well as longitudinal change in the neuropsychological, neuroimaging, and functional/behavioral variables, using joint modelling for longitudinal and survival data. These longitudinal measures may be highly associated with time-to-dementia, and therefore statistical methods that can model both the longitudinal and the time-to-event components jointly are becoming increasingly essential in most observational studies and clinical trials of neurodegenerative disorders such as AD," remarked Dr. Luo.
"The main contribution of the study," according to the lead author Li, "is that it's the first attempt to comprehensively evaluate the comparative predictive ability of longitudinal markers, both clinical and biological, for timing of AD conversion under the joint model framework. We demonstrated that the imaging and other technology-intensive markers are less powerful than cognitive and functional assessments in the prediction of AD conversion. We expect the markers identified as strong predictors in this study along with the joint modeling approach can serve as a useful tool for continuous monitoring of AD progression and treatment effect in the clinical practice."


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Alzheimer's drug prescribed 'off-label' for mild cognitive impairment could pose risk for some

Credit: CC0 Public Domain

Donepezil, a medication that is approved to treat people with Alzheimer's disease, should not be prescribed for people with mild cognitive impairment without a genetic test. UCLA School of Nursing researchers discovered that for people who carry a specific genetic variation—the K-variant of butyrylcholinesterase, or BChE-K—donezpezil could accelerate cognitive decline.

24 feb 2017--Mild cognitive impairment is a transitional state between normal age-related changes in cognition and dementia. Because many people with the condition display symptoms similar to those caused by Alzheimer's disease, some physicians prescribe donepezil, which is marketed under the brand name Aricept and is the most-prescribed medication for Alzheimer's.
Donepezil was tested as a possible treatment for mild cognitive impairment in a large, federally funded study published in 2005, but it was not approved by the FDA. Still, doctors have often prescribed the drug "off-label"—meaning that it is not approved for that specific disorder—for their patients with mild cognitive impairment.
From data collected during the 2005 trial, the researchers looked at the association between BChE-K and changes in cognitive function. Using two tests that measure cognitive impairment, the Mini-Mental State Examination and the Clinical Dementia Rating Sum of Boxes, they found that people with the genetic variation who were treated with donepezil had greater changes in their scores than those who took placebos. They also found that those who took donepezil had a faster cognitive decline than those who took the placebo.
Physicians are increasingly using personalized medicine, including pharmacogenetics—the study of how genetics affect a person's response to a drug—to tailor their patients' care. The findings reinforce the importance of physicians discussing the possible benefits and risks of this treatment with their patients.

More information: Deleterious Effect of Butyrylcholinesterase K-Variant in Donepezil Treatment of Mild Cognitive Impairment. Journal of Alzheimer's Disease. www.j-alz.com/Vol56-1


Provided by University of California, Los Angeles

The diet that feeds your brain

The Mediterranean diet—rich in vegetables, fish and olive oil and featuring moderate alcohol consumption—has been shown to reduce the risk of heart disease, certain cancers and diabetes.

A study by researchers at Rush revealed that this diet is also associated with slower rates of cognitive decline in older adults. The study, which was published in the American Journal of Clinical Nutrition, looked at how well almost 4,000 older adults on the South Side of Chicago adhered to the Mediterranean diet.


23 sept 2016--The result: Those who most closely followed the diet in their eating habits showed slower rates of cognitive decline than those whose food choices were less in line with the diet.

Measuring the benefits

Every three years, study participants underwent a cognitive assessment that tested such things as memory and basic math skills. They also filled out a questionnaire on the frequency with which they ate 139 food items, such as cereal, olive oil, red meat and alcohol.
Out of a maximum score of 55, which would indicate complete adherence to the Mediterranean diet, study participants' average score was 28.
According to lead study author Christy Tangney, PhD, a faculty member in the Department of Clinical Nutrition at Rush, those with the higher scores were also the individuals whose cognitive tests showed a slower rate of decline—even when other factors that might account for the result, such as education level, were considered.
"It's always beneficial to eat healthily," says Tangney. "But we're finding more and more evidence that people who follow the Mediterranean diet have the right idea because they're actually helping to prevent some of the serious health problems that are prevalent among older adults."

A healthy approach to eating

A lot of the rules of thumb for the Mediterranean diet are true of any sensible eating plan, such as replacing whole or 2 percent milk with skim, loading up on lots of fresh fruits and vegetables, and avoiding breads, snacks and cereals made with refined white flour.
Here's a quick rundown of the diet:

• Eat seven to 10 servings a day of fresh fruits and vegetables, including legumes
• Switch to whole grain breads and cereals, and eat more whole-grain rice and pastas
• Keep almonds, cashews, pistachios and walnuts on hand for a quick snack (but because they are high in calories, limit yourself to about a handful a day and avoid candied, honey-roasted or salted nuts)
• Replace butter and margarine with healthy fats such as olive oil or canola oil
• Use herbs and spices instead of salt to flavor foods
• Limit red meat to no more than a few times a month
• Eat fish and poultry at least twice a week
• Limit higher fat dairy products, such as whole or 2 percent milk, cheese and ice cream, and switch to skim milk, fat-free yogurt and low-fat cheese
• Enjoy moderate amounts of red wine, such as a glass with lunch or dinner

The diet isn't just about what you should eat—it's also about what you shouldn't eat. As much as possible, avoid processed foods and choose foods with no trans-fats (trans-fats are responsible for increasing bad cholesterol, or LDL, and reducing good cholesterol, or HDL).


Provided by Rush University Medical Center

New model of Alzheimer's patient emotions can help guide health care

The Socio-Emotional Adaptation Model created by Emory researchers shows combinations of positive and negative contextual domains.  Credit: Emory University

A recent study published in The Gerontologist says understanding the emotional reactions of individuals diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) will provide health care professionals with important information needed to develop suitable treatments.

05 jun 2016--Emory researchers developed a model, the Socio-Emotional Adaptation Theory, based on emotional reactions of individuals diagnosed with MCI and AD, which shows combinations of complex interactions and accompanying emotions. The model consists of four positive and negative contextual domains, including relationship with informal support partner (spouse or loved one), relationship with formal support partner (clinicians), locus of control, and coping mechanisms. By looking at areas of overlap, based on positive or negative contexts, researchers suggest it is possible to better understand the root cause of the emotions.
"If we can look at a person's connection with those around them along with emotions they experience, which are complex and do not present linearly, then clinicians will be better able to provide treatment, particularly for patients in later stages of AD who have difficulty explaining their emotional needs," says Sean N. Halpin, MA, lead author of the study and manager of research projects in geriatrics in the Emory University School of Medicine.
Halpin notes this is an initial effort to develop a cohesive model of the emotional changes experienced by patients with MCI/AD and to encourage health care practitioners to engage these patients as active partners in the process of fully understanding their disease.

More information: Sean N. Halpin et al. Socio-Emotional Adaptation Theory: Charting the Emotional Process of Alzheimer's Disease, The Gerontologist (2016). DOI: 10.1093/geront/gnw046


Provided by Emory University

New study indicates ankle-brachial index associated with mild cognitive impairment

In a large population-based study of randomly selected participants in Germany, researchers found that mild cognitive impairment (MCI) occurred significantly more often in individuals diagnosed with a lower ankle brachial index (ABI), which is a marker of generalized atherosclerosis and thus cumulative exposure to cardiovascular risk factors during lifetime. Interestingly, this strong association was only observed in patients with non-amnestic MCI, but not amnestic MCI. There also was no independent association of MCI and intima media thickness (IMT) or coronary artery calcification (CAC), two other surrogate markers of cardiovascular risk. Examination of differences by gender revealed a stronger association of a decreasing ABI with non-amnestic MCI in women. This study is published in the Journal of Alzheimer's Disease.

23 july 2015--The concept of MCI describes an intermediate state between normal cognitive aging and dementia. Although people with MCI have a higher dementia risk, very few actually develop dementia. In fact, many persons with MCI convert back to a cognitively normal state. This transitional - and therefore possibly modifiable - characteristic makes the concept of MCI a promising approach in the development of prevention strategies.

What criteria determine MCI? The following four criteria must be met for a diagnosis of MCI: First, participants have a subjective impression of a declined cognitive performance over the last two years. Second, this subjective impression is validated by objective measures (cognitive test battery). Third, participants are capable of handling activities of daily living. Fourth, a diagnosis of dementia is ruled out.

The concept of MCI distinguishes between two subtypes depending on the affected cognitive domain: participants with impairment in the memory domain are categorized as amnestic MCI (aMCI) and those with deficits in non-memory domains are categorized as non-amnestic MCI (naMCI).

The Heinz Nixdorf Recall (Risk Factors, Evaluation of Coronary Calcium and Lifestyle) study is an observational, population-based, prospective study that examined 4,814 participants (50% men) between 2000 and 2003 in the metropolitan Ruhr Area. After five years a second examination was conducted with 90% of the participants taking part.

For this analysis, 490 participants diagnosed with MCI were compared with 1,242 cognitively normal participants. Of participants with MCI, 249 had amnestic MCI and 241 had non-amnestic MCI.

"In conclusion, we found an independent association of a lower ABI with a higher prevalence of MCI and particularly with naMCI, whereas no significant association could be found with aMCI in fully adjusted models," commented lead investigator Christian Weimer, MD, Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany. "This underlines the importance of preventing atherosclerosis by treating cardiovascular risk factors and life style modification to prevent cognitive decline."

More information: "Ankle-Brachial Index but Neither Intima Media Thickness Nor Coronary Artery Calcification Is Associated with Mild Cognitive Impairment"Journal of Alzheimer's Disease. DOI: 10.3233/JAD-150218 

Provided by IOS Press

Women descend into alzheimer's at twice the speed of men: study

Investigators find gender differences in progression from mild cognitive impairment.

21 july 2015—Women with mild thinking and memory problems—known as mild cognitive impairment—deteriorate twice as fast mentally as men with the same condition, according to new research.

Mild cognitive impairment isn't severe enough to interfere with daily life, but it is linked to higher odds of developing Alzheimer's disease or another type of dementia, the researchers said.

"Our findings do suggest greater vulnerability in women with mild cognitive impairment stage, which is more severe than normal memory loss and is an intermediary stage between aging and dementia," said lead researcher Katherine Lin, a clinical research scholar at Duke University in Durham, N.C.

Several factors may account for this increased vulnerability among women, Lin added. Women may be genetically predisposed to developing more plaque in the brain, which is a hallmark of Alzheimer's, or perhaps there is an as-yet-unknown genetic cause, she said.

To determine the reasons, gender-specific research into Alzheimer's disease needs to become a priority, Lin said. "Potentially, Alzheimer's prevention trials could test treatment effects separately by gender," she suggested.

The results of her study were scheduled for presentation Tuesday at the Alzheimer's Association International Conference, in Washington, D.C. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

Dr. Luca Giliberto, an Alzheimer's investigator at the Feinstein Institute for Medical Research in Manhasset, N.Y., offered another theory: "Women may have better cognitive reserve than men—that is, more connections between brain cells," Giliberto said.

Because of this greater mental reserve, it's possible that women may start declining later than men, but progress faster once the fall-off begins, he said. In addition, Giliberto said there might be a hormonal component to the speed of decline, perhaps associated with estrogen levels.

For the study, Lin and colleagues collected data on 400 men and women with thinking and memory problems who took part in the Alzheimer's Disease Neuroimaging Initiative. Participants were in their mid-70s at the start of the study.

In up to eight years of follow-up, the thinking and memory of women deteriorated twice as fast as in men, according to a standard test called the Mini Mental State Examination. On that test, the rate of mental slippage in men was 1.05 points a year, in women 2.3 points annually.

For men and women with a specific gene mutation—called the ApoE4 Alzheimer's risk gene—the rate of mental decline was even faster, the researchers said.

Dean Hartley, director of science initiatives at the Alzheimer's Association, agreed that more research is needed to understand gender discrepancies related to Alzheimer's, which is the most common form of dementia.

Hartley said that women make up 75 percent of those who develop Alzheimer's disease. "We also know that 75 percent of the caregivers are women, so women are carrying a big burden," he said.

Women live longer than men. By the time they start having memory and thinking problems, they are at a later stage in life and that might account for the faster decline, Hartley said. It's also possible that biological differences between the sexes are at work, he added.

"The Alzheimer's Association is looking at these differences because it might affect how we need to treat these people," he said.

More information: The U.S. National Institutes of Health outlines the warning signs of Alzheimer's. 

Using smartphones to avoid spatial disorientation of elderly

Researchers from UPM have used new technologies of mobile network operators to locate and send alerts when an elderly person with mild cognitive impairment (MCI) suffers from episodes of spatial disorientation.

23 april 2015--Biomedical Engineering and Telemedicine group of Universidad Politécnica de Madrid (UPM) has developed a location-awareness service using smartphones in order to detect episodes of spatial disorientation that are frequently suffered by elderly people with mild cognitive impairment. The detection of disorientation and loss analyzes information such as proximity to home or place of interest, if the user is with a relative or riding public transportation and accounts for certain time intervals. When disorientation occurs, the service puts the elderly person in touch with his nearest contact (family, a health worker or a friend) to verify if he requires help.

Due to population aging, a big societal challenge is maintaining the quality of life and autonomy of the elderly, as certain cognitive aspects can deteriorate, such as executive functions, verbal attention, visual memory and spatial navigation. This deterioration is known as mild cognitive impairment-MCI, and up to the 60% of cases include episodes of spatial disorientation that appear even in zones where the elderly person carries out daily tasks such as doing the shopping, going to the health centre or visiting someone. The person goes missing and starts to wander, causing not only stress or anxiety, but also dangerous situations (falls, accidents, etc.). Disorientation of elderly also means a source of concern for their caregivers (family, friends).

This study, conducted by GBT group at UPM, establishes safety areas for each user around a series of geographical locations called hotspots. These locations can be their home or other familiar places. These zones distinguish potentially unfamiliar areas where a situation of spatial disorientation could occur. By using the location information service, a lost person is put in contact with his relatives via smartphone.

The location service uses a new technology of intelligent communication networks called IP Multimedia Subsystem (IMS). IMS networks provide basic services that can be reused by any installed application on a smartphone. The basic presence service sends dynamic user information such as location to other users or systems subscribed to the service. The presence service can store static information through the profile of each registered user.

This study is another example of how information and communications technology (ICT) are becoming essential tools for supporting elderly people. Smartphones and their integrated sensors are a rich source of user data and its context.

The location information is an essential part of the user context in order to provide applications based on geographical location. The location service will allow people with MCI to live with more independence, preserving their autonomy and self-esteem. The service will also allow caregivers to manage situations of spatial disorientation and reducing stress and anxiety.

More information: "Design and Technical Evaluation of an Enhanced Location-Awareness Service Enabler for Spatial Disorientation Management of Elderly With Mild Cognitive Impairment". IEEE Journal of Biomedical and Health Informatics 19 (1): 37-43. DOI: 10.1109/JBHI.2014.2327638

Provided by Universidad Politécnica de Madrid

New assessment tool helps predict risk of cognitive decline

22 mar 2015—A new assessment tool may be able to predict risk of mild cognitive impairment (MCI) in older adults, according to a study published online March 18 in Neurology.

V. Shane Pankratz, Ph.D., from the University of New Mexico Health Sciences Center in Albuquerque, and colleagues developed risk scores to predict risk of MCI. Baseline demographic and clinical variables from participants (aged 70 to 89 years at baseline in October 2004) in a longitudinal cohort were used to inform the risk models.

The researchers found that 401 of the 1,449 cognitively normal participants developed MCI (27.7 percent). An augmented model improved the C statistic of the basic model from 0.60 (0.58 for women and 0.62 for men) to 0.70 (0.69 for women and 0.71 for men). In the augmented model, the highest versus lowest sex-specific quartiles had an approximately seven-fold higher risk of developing MCI for both men and women. Inclusion of APOE ε4 carrier status significantly improved the model (P = 0.002).

"These models may be useful in identifying patients who might benefit from more expensive or invasive diagnostic testing, and can inform clinical trial design," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

More information: Abstract
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Diabetes and depression predict dementia risk in people with slowing minds

Credit: George Hodan/Public Domain

23 feb 2015--People with mild cognitive impairment are at higher risk of developing dementia if they have diabetes or psychiatric symptoms such as depression, finds a new review led by UCL researchers.

Mild cognitive impairment (MCI) is a state between normal ageing and dementia, where someone's mind is functioning less well than would be expected for their age. It affects 19% of people aged 65 and over, and around 46% of people with MCI develop dementia within 3 years compared with 3% of the general population.

The latest review paper, published in the American Journal of Psychiatry, analysed data from 62 separate studies, following a total of 15,950 people diagnosed with MCI. The study found that among people with MCI, those with diabetes were 65% more likely to progress to dementia and those with psychiatric symptoms were more than twice as likely to develop the condition.

"There are strong links between mental and physical health, so keeping your body healthy can also help to keep your brain working properly," explains lead author Dr Claudia Cooper (UCL Psychiatry). "Lifestyle changes to improve diet and mood might help people with MCI to avoid dementia, and bring many other health benefits. This doesn't necessarily mean that addressing diabetes, psychiatric symptoms and diet will reduce an individual's risk, but our review provides the best evidence to date about what might help."

The Alzheimer's Society charity recommends that people stay socially and physically active to help prevent dementia. Their guidelines also suggest eating a diet high in fruit and vegetables and low in meat and saturated fats, such as the Mediterranean diet.

"Some damage is already done in those with MCI but these results give a good idea about what it makes sense to target to reduce the chance of dementia," says senior author Professor Gill Livingston (UCL Psychiatry). "Randomised controlled trials are now needed."

Professor Alan Thompson, Dean of the UCL Faculty of Brain Sciences, says: "This impressive Systematic Review and meta-analysis from The Faculty of Brain Science's Division of Psychiatry underlines two important messages. Firstly, the impact of medical and psychiatric co-morbidities in individuals with mild cognitive impairment and secondly, the importance and therapeutic potential of early intervention in the prevention of dementia. Confirming these findings and incorporating appropriate preventative strategies could play an important part in lessening the ever-increasing societal burden of dementia in our ageing population."

More information: Cooper et al., 'Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis', American Journal of Psychiatry: dx.doi.org/10.1176/appi.ajp.2014.14070878

Provided by University College London

A virtual reality brain training game can detect mild cognitive impairment

A virtual reality brain training game can detect mild cognitive impairment (MCI). Credit: Journal of Alzheimer's Disease

13 jan 2015--Greek researchers demonstrated the potential of a virtual supermarket cognitive training game as a screening tool for patients with mild cognitive impairment (MCI) among a sample of older adults. MCI is a condition that often predates Alzheimer's disease (AD) and is characterized by memory loss and inability to execute complex activities such as financial planning.

So far virtual reality game-based applications and especially virtual supermarkets have been used as cognitive training applications and as measures of cognitive functions, although it has been shown that they can detect MCI only when used in combination with standardized neuropsychological tests. However scientists from the Aristotle University of Thessaloniki (AUTH), the Greek Association of Alzheimer's Disease and Related Disorders (GAADRD) and the Centre for Research and Technology Hellas/Information Technologies Institute (CERTH/ITI) have succeeded in making the shift to MCI screening via robust virtual reality game applications that can be used on their own for accurate MCI detection.

In an article published in the Journal of Alzheimer's Disease, the researchers have indicated that the virtual supermarket (VSM) application displayed a correct classification rate (CCR) of 87.30%, achieving a level of diagnostic accuracy similar to standardized neuropsychological tests, which are the gold standard for MCI screening. Patients with MCI can live independently and not all such patients progress to AD. Therefore the global effort against cognitive disorders is focused on early detection at the MCI stage.

A large number of older adults use computerized cognitive training exercises/games as an easy and enjoyable means of exercising their brain. If these games and exercises can also detect cognitive disorders, the whole cognitive screening process could become more pleasurable, thus motivating more people to be evaluated. With the majority of older adults examining their cognitive health regularly through such games, possible cognitive impairment will be detected at the MCI stage thus allowing patients to enjoy a better quality of life and remain independent for a longer time.

Enlarge

A virtual reality brain training game can detect mild cognitive impairment (MCI). This is a VSM payment screen. Credit: Journal of Alzheimer's Disease

The use of the VSM as a robust screening test could have profound implications for the diagnosis and treatment of MCI, the most important of which is the possibility for automated remote MCI screening. The performance of older adults playing such a game at home could be monitored and an algorithm embedded in the game could inform them when their performance suggests possible cognitive impairment due to MCI, prompting them to visit an appropriate health service. Such a system would have the ability to screen the majority of older adults effectively, while at the same time minimizing examination costs. As computer applications increasingly become embedded in our work and social life, they could also become part of our preventive healthcare. Research on the use of the VSM for remote assessment is already underway and the results of that study will be published soon.

The VSM has been developed as part of the "Εν-ΝΟΗΣΗΣ" project for the use of new technologies in the screening, diagnosis, treatment and support of patients with MCI. Its development, testing and research application have been undertaken by research organizations that have been heavily involved in the transfer and dissemination of high-quality research knowledge, advanced solution development and leading-edge technologies. The same organizations are currently involved in the development and trialing of other novel technological instruments that respond to a number of clinical and organizational needs in the effort against cognitive disorders.

More information: "Can a Virtual Reality Cognitive Training Application Fulfill a Dual Role? Using the Virtual Supermarket Cognitive Training Application as a Screening Tool for Mild Cognitive Impairment," by Stelios Zygouris, Dimitrios Giakoumis, Konstantinos Votis, Stefanos Doumpoulakis, Konstantinos Ntovas, Sofia Segkouli, Charalampos Karagiannidis, Dimitrios Tzovaras, and Magda Tsolaki,, DOI: 10.3233/JAD-141260, Journal of Alzheimer's Disease, published online in advance of Volume 44, Issue 4.

Provided by IOS Press

Anxiety can damage brain: Accelerate conversion to Alzheimer's for those with mild cognitive impairment

Credit: George Hodan/Public Domain

People with mild cognitive impairment (MCI) are at increased risk of converting to Alzheimer's disease within a few years, but a new study warns the risk increases significantly if they suffer from anxiety.

11 nov 2014--The findings were reported on Oct. 29 online by The American Journal of Geriatric Psychiatry, ahead of print publication, scheduled for May 2015.

Led by researchers at Baycrest Health Sciences' Rotman Research Institute, the study has shown clearly for the first time that anxiety symptoms in individuals diagnosed with MCI increase the risk of a speedier decline in cognitive functions - independent of depression (another risk marker). For MCI patients with mild, moderate or severe anxiety, Alzheimer's risk increased by 33%, 78% and 135% respectively.

The research team also found that MCI patients who had reported anxiety symptoms at any time over the follow-up period had greater rates of atrophy in the medial temporal lobe regions of the brain, which are essential for creating memories and which are implicated in Alzheimer's.

Until now, anxiety as a potentially significant risk marker for Alzheimer's in people diagnosed with MCI has never been isolated for a longitudinal study to gain a clearer picture of just how damaging anxiety symptoms can be on cognition and brain structure over a period of time. There is a growing body of literature that has identified late-life depression as a significant risk marker for Alzheimer's. Anxiety has historically tended to be subsumed under the rubric of depression in psychiatry. Depression is routinely screened for in assessment and follow-up of memory clinic patients; anxiety is not routinely assessed.

"Our findings suggest that clinicians should routinely screen for anxiety in people who have memory problems because anxiety signals that these people are at greater risk for developing Alzheimer's," said Dr. Linda Mah, principal investigator on the study, clinician-scientist with Baycrest's Rotman Research Institute, and assistant professor in the Department of Psychiatry at the University of Toronto. Dr. Mah is also a co-investigator in a multi-site study lead by the Centre for Addiction and Mental Health, and partially funded by federal dollars (Brain Canada), to prevent Alzheimer's in people with late-life depression or MCI who are at high risk for developing the progressive brain disease.

"While there is no published evidence to demonstrate whether drug treatments used in psychiatry for treating anxiety would be helpful in managing anxiety symptoms in people with mild cognitive impairment or in reducing their risk of conversion to Alzheimer's, we think that at the very least behavioural stress management programs could be recommended. In particular, there has been research on the use of mindfulness-based stress reduction in treating anxiety and other psychiatric symptoms in Alzheimer's —and this is showing promise," said Dr. Mah.

The Baycrest study accessed data from the large population-based Alzheimer's Disease Neuroimaging Initiative to analyze anxiety, depression, cognitive and brain structural changes in 376 adults, aged 55 - 91, over a three-year period. Those changes were monitored every six months. All of the adults had a clinical diagnosis of amnestic MCI and a low score on the depression rating scale, indicating that anxiety symptoms were not part of clinical depression.

MCI is considered a risk marker for converting to Alzheimer's disease within a few years. It is estimated that half-a-million Canadians aged 65-and-older have MCI, although many go undiagnosed. Not all MCI sufferers will convert to Alzheimer's - some will stabilize and others may even improve in their cognitive powers.

The Baycrest study has yielded important evidence that anxiety is a "predictive factor" of whether an individual with MCI will convert to Alzheimer's or not, said Dr. Mah. Studies have shown that anxiety in MCI is associated with abnormal concentrations of plasma amyloid protein levels and T-tau proteins in cerebrospinal fluid, which are biomarkers of Alzheimer's. Depression and chronic stress have also been linked to smaller hippocampal volume and increased risk of dementia.

Provided by Baycrest Centre for Geriatric Care

Dementia risk quadrupled in people with mild cognitive impairment

In a long-term, large-scale population-based study of individuals aged 55 years or older in the general population researchers found that those diagnosed with mild cognitive impairment (MCI) had a four-fold increased risk of developing dementia or Alzheimer's disease (AD) compared to cognitively healthy individuals. Several risk factors including older age, positive APOE-ɛ4 status, low total cholesterol levels, and stroke, as well as specific MRI findings were associated with an increased risk of developing MCI. The results are published in a supplement to the Journal of Alzheimer's Disease.

11 aug 2014--"Mild cognitive impairment has been identified as the transitional stage between normal aging and dementia," comments M. Arfan Ikram, MD, PhD, a neuroepidemiologist at Erasmus MC University Medical Center (Rotterdam). "Identifying persons at a higher risk of dementia could postpone or even prevent dementia by timely targeting modifiable risk factors."

Unlike a clinical trial, the Rotterdam study is an observational cohort study focusing on the general population, instead of persons referred to a memory clinic. The Rotterdam study began in 1990, when almost 8,000 inhabitants of Rotterdam aged 55 years or older agreed to participate in the study. Ten years later, another 3,000 individuals were added. Participants undergo home interviews and examinations every four years.

"This important prospective study adds to the accumulating evidence that strokes, presumably related to so called 'vascular' risk factors, also contribute to the appearance of dementia in Alzheimer's disease. This leads to the conclusion that starting at midlife people should minimize those risk factors. The recent results of the Finish FINGER study corroborate this idea. It should be remembered that delaying the onset of dementia by five years will reduce the prevalence of the disease by half. And of course, since there is no cure for AD, prevention is the best approach at present," explains Professor Emeritus Amos D Korczyn, Tel Aviv University, Ramat Aviv, Israel, and Guest Editor of the Supplement.

To be diagnosed with MCI in the study, individuals were required to meet three criteria: a self-reported awareness of having problems with memory or everyday functioning; deficits detected on a battery of cognitive tests; and no evidence of dementia. They were categorized into those with memory problems (amnestic MCI) and those with normal memory (non-amnestic MCI).

Of 4,198 persons found to be eligible for the study, almost 10% were diagnosed with MCI. Of these, 163 had amnestic MCI and 254 had non-amnestic MCI.

The risk of dementia was especially high for people with amnestic MCI. Similar results were observed regarding the risk for Alzheimer's disease. Those with MCI also faced a somewhat higher risk of death.

The research team investigated possible determinants of MCI, considering factors such as age, APOE-ɛ status, waist circumference, hypertension, diabetes mellitus, total and HDL-cholesterol levels, smoking, and stroke. Only older age, being an APOE-ɛ4 carrier, low total cholesterol levels, and stroke at baseline were associated with developing MCI. Having the APOE-ɛ4 genotype and smoking were related only to amnestic MCI.

When the investigators analysed MRI studies of the brain, they found that participants with MCI, particularly those with non-amnestic MCI, had larger white matter lesion volumes and worse microstructural integrity of normal-appearing white matter compared to controls. They were also three-times more likely than controls to have lacunes (3 to 15 mm cerebrospinal fluid (CSF)-filled cavities in the basal ganglia or white matter, frequently observed when imaging older people). MCI was not associated with total brain volume, hippocampal volume, or cerebral microbleeds.

"Our results suggest that accumulating vascular damage plays a role in both amnestic and non-amnestic MCI," says Dr. Ikram. "We propose that timely targeting of modifiable vascular risk factors might contribute to the prevention of MCI anddementia."

Provided by IOS Press

Cognitive enhancers don't improve cognition, function in people with mild cognitive impairment

Cognitive enhancers—drugs taken to enhance concentration, memory, alertness and moods—do not improve cognition or function in people with mild cognitive impairment in the long term, according to a new study by researchers at St. Michael's Hospital.

21 sept 2013--In fact, patients on these medications experienced significantly more nausea, diarrhea, vomiting and headaches, according to the study published today in the Canadian Medical Association Journal.

"Our findings do not support the use of cognitive enhancers for mild cognitive impairment," wrote Dr. Andrea Tricco and Dr. Sharon Straus, who are both scientists in the hospital's Li Ka Shing Knowledge Institute. Dr. Straus is also a geriatrician at the hospital.

Mild cognitive impairment is a condition characterized by memory complaints without significant limitations in everyday activity. Between 3 and 42 per cent of people are diagnosed with the condition each year, about 4.6 million people worldwide. Each year about 3 to 17 per cent of people with mild cognitive impairment will develop dementia, such as Alzheimer's disease. Given the aging population, it's estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years.

It has been hypothesized that cognitive enhancers may delay the onset of dementia. Families and patients are increasingly requesting these drugs even though their efficacy for patients with mild cognitive impairment has not been established. In Canada, cognitive enhancers can be obtained only with special authorization.

Drs. Tricco and Straus conducted a review of existing evidence to understand the efficacy and safety of cognitive enhancers. They looked at eight randomized trials that compared one of four cognitive enhancers (donepezil,rivastigmine, galantamine or memantine) to a placebo among patients diagnosed with mild cognitive impairment.

While they found short-term benefits to using these drugs on one cognition scale, there were no long-term effects after about a year and a half. No other benefits were observed on the second cognition scale or on function, behaviour, and mortality. As well, patients on these medications experienced significantly more nausea, diarrhea, vomiting and headaches. One study also found a higher risk of a heart condition known as bradycardia (slow heartbeat) among patients who received galantamine.

"Our results do not support the use of cognitive enhancers for patients with mild cognitive impairment," the authors wrote. "These agents were not associated with any benefit and led to an increase in harms. Patients and their families should consider this information when requesting these medications. Similarly, health care decision-makers may not wish to approve the use of these medications for mild cognitive impairment, because these drugs might not be effective and are likely associated with harm."

This study was funded by the Drug Safety and Effectiveness Network/Canadian Institutes of Health Research.

Another St. Michael's study published in the CMAJ in April found no evidence that drugs, herbal products or vitamin supplements help prevent cognitive decline in healthy older adults. That review, led by Dr. Raza Naqvi, a University of Toronto resident, found some evidence that mental exercises, such as computerized memory training programs, might help.

More information: www.cmaj.ca/lookup/doi/10.1503/cmaj.130451

Provided by St. Michael's Hospital

Screening for minor memory changes will wrongly label many with dementia, warn experts

A political drive led by the UK and US to screen older people for minor memory changes (often called mild cognitive impairment or pre-dementia) is leading to unnecessary investigation and potentially harmful treatment for what is arguably an inevitable consequence of ageing, warn University of Sydney experts in in a paper published in the British Medical Journal (BMJ) today.

12sept 2013--A team of specialists in Australia and the UK say that expanding diagnosis of dementia will result in up to 65 percent of people aged over 80 having Alzheimer's disease diagnosed - and up to 23 percent of non-demented older people being labelled with dementia.

They argue this policy is not backed by evidence and ignores the risks, harms and costs to individuals, families and societies. It may also divert resources that are badly needed for the care of people with advanced dementia.

Their views come as the Preventing Overdiagnosis conference opens in New Hampshire next week, partnered by BMJ's Too Much Medicine campaign, where experts from around the world will gather to discuss how to tackle the threat to health and the waste of money caused by unnecessary care.

Paper co-author, Professor David Le Couteur from the University's Charles Perkins Centre, said dementia is an age related condition and with an ageing global population, it is predicted to become an overwhelming and costly problem.

"Although evidence suggests that only five to 10 percent of people with mild cognitive symptoms will develop dementia each year, current policy in many countries is aimed at encouraging more widespread and earlier diagnosis of dementia," he said.

"For example, in the US, the Medicare insurance programme will cover an annual wellness visit to a physician that includes a cognitive impairment test. In England, the government has announced that it will reward general practitioners for assessing brain function in older patients - and has committed to have "a memory clinic in every town and every city" despite no sound evidence of benefit.

"This has led to the development of imaging techniques and tests that are increasingly used in diagnosis, despite uncertainty over their accuracy.

"Furthermore, there are no drugs that prevent the progression of dementia or are effective in patients with mild cognitive impairment, raising concerns that once patients are labelled with disease or pre-disease, they may try untested therapies and run the risk of adverse effects."

The paper co-authors also question whether ageing of the population is becoming a "commercial opportunity" for developing screening, early diagnosis tests and medicines marketed to maintain cognition in old age.

The desire of politicians, dementia organisations, and academics and clinicians in the field to raise the profile of dementia is understandable, write the authors, "but we risk being conscripted into an unwanted war against dementia."

Yet they suggest that the political rhetoric expended on preventing the burden of dementia would be much better served by efforts to reduce smoking and obesity, given current knowledge linking mid-life obesity and cigarettes with the risk of dementia.

"Current policy is rolling out untested and uncontrolled experiments in the frailest people in society without a rigorous evaluation of its benefits and harms to individuals, families, service settings, and professionals," Professor Le Couteur concluded.

More information: www.bmj.com/content/347/bmj.f5125

Provided by University of Sydney

Researchers accurately predict cognitive decline

28 mar 2013—Researchers have shown they can predict impending cognitive decline using a sensitive behavioral task up to three years in advance of clinical evidence. Until now, it has not been possible to reliably differentiate individuals at risk of mild cognitive impairment (MCI) and Alzheimer's disease (AD) from those who are not at risk. The results of this study are in the current (March 2013) issue of the American Journal of Alzheimer's Disease & Other Dementias.

Stuart Zola, PhD, director of the Yerkes National Primate Research Center, and his Emory-based research team administered the Visual Paired Comparison (VPC) task using noninvasive, infrared eyetracking to assess memory function, an important function of the medial temporal lobe region of the brain. The team's findings demonstrate the VPC task performance scores are an early predictor of which individuals diagnosed with amnestic MCI (aMCI) will progress to AD during the subsequent three years and which individuals are not at risk. In addition, the findings also predict which control subjects will develop aMCI and which will not.

"Previous studies have focused on detecting the presence of disease," said Zola. "Our study focused on predicting whether and when the disease will occur. The earlier we can intervene, the more likely we can provide more effective treatment. In addition, a three-year advance notice could give families more time to prepare for the future," Zola continued.

The researchers assessed 92 participants who were either diagnosed with aMCI or were elderly control subjects (CON). Participants viewed images on a computer screen while the researchers recorded the participants' eye movements. Researchers compared the scores of the participants on the VPC task with information from their clinical visits and diagnoses. The scores accurately reflected those participants who were most at risk for cognitive decline and those who were not at risk at all. The researchers believe the VPC task also may be useful in predicting onset and progression of memory dysfunction in other medical conditions in which disruption of the medial temporal lobe memory system could occur, for example, depression, autism spectrum disorder and HIV/AIDS.

"The task used for this study was developed in nonhuman primates in our laboratory and then modified for our studies with patients," Zola said. Our findings not only have the ability to impact countless lives, but this study makes clear the translational connection between research in nonhuman primates and applications to the clinical setting and patient care," he continued.

Provided by Emory University

Gene is marker only for mild cognitive impairment

Credit: Jennifer Infante

Defying the widely held belief that a specific gene is the biggest risk factor for Alzheimer's disease, two Cornell developmental psychologists and their colleagues report that people with that gene are more likely to develop mild cognitive impairment—but not Alzheimer's.

17feb 2013--The study suggests that older adults with healthy brain function can get genetic tests to predict increased risk of future mild cognitive impairment. However, once they are impaired cognitively, the tests won't predict their likelihood of developing Alzheimer's.

"Right now, genetic tests are used in exactly the opposite way. That is, healthy people don't get the tests to predict their risk of mild cognitive impairment, but impaired people get them to predict their risk of Alzheimer's disease," said Charles Brainerd, professor of human development and the study's lead co-author with Valerie Reyna, professor of human development. "So, impaired people think that tests will tell them if they are at increased risk of Alzheimer's, which they won't. And healthy people think that tests won't tell them whether they are at increased risk of cognitive impairment, which they will."

The researchers describe their findings in the January issue of Neuropsychology.

The work builds on previous research by Brainerd and associates that suggested the ε4 allele of the APOE genotype increases the risk of mild cognitive impairment as well as Alzheimer's.

The researchers analyzed data from the only nationally representative dataset of its kind, the National Institute on Aging's Aging, Demographics and Memory Study. They looked at data from 418 people over age 70 to see if those who carried the allele were more likely to develop mild cognitive impairment compared with those who did not have the allele. They also looked at whether ε4 carriers with mild cognitive impairment were more likely to develop Alzheimer's disease compared with non-carriers with mild cognitive impairment.

They found that healthy ε4 carriers were nearly three times—58 percent—more likely to develop mild cognitive impairment compared with non-carriers. However, ε4 carriers with mild cognitive impairment developed Alzheimer's at the same rate as non-carriers.

While previous studies showed that the ε4 allele was more common in people with Alzheimer's disease, this study shows that it does not increase the risk that healthy or impaired people will become demented. Rather, ε4 increases the risk that healthy people will become cognitively impaired, and impaired people are the primary source of new Alzheimer's diagnoses, Brainerd explained. "The reason ε4 is a risk factor for mild cognitive impairment, but not for progression from mild cognitive impairment to Alzheimer's disease, is that this allele is a marker of initial cognitive declines—for example, memory and executive function—that are associated with mild cognitive impairment but not of subsequent declines in cognition or in daily functioning that are associated with forms of Alzheimer's disease."

Brainerd also noted that the effects of ε4 in healthy adults can be detected by the mid-20s. While ε4 is not a risk factor for the severe cognitive declines that signal dementia, it is risk factor for the weaker declines that eventually produce mild cognitive impairment.

Provided by Cornell University

Training can improve memory and increase brain activity in mild cognitive impairment

If someone has trouble remembering where the car keys or the cheese grater are, new research shows that a memory training strategy can help. Memory training can even re-engage the hippocampus, part of the brain critical for memory formation, the results suggest.

11 march 2012--Researchers at Emory University School of Medicine and Atlanta Veterans Affairs Medical Center have been investigating memory-building strategies for people with MCI (mild cognitive impairment). The techniques used in the study were known to be effective for healthy people, but it has been uncertain how they could affect brain function in people with MCI.

The results are published online in the journal Hippocampus.

"Our results suggest that these strategies can help patients remember specific information, such as the locations of objects, " says lead author Benjamin Hampstead, PhD, assistant professor of rehabilitation medicine at Emory University School of Medicine. "This is the first randomized controlled trial to show that these techniques are not only effective in MCI patients, but that they can also re-engage the hippocampus, which is a brain region that is critical for forming new memories."

Hampstead is a clinical neuropsychologist at the Atlanta VA Rehabilitation, Research and Development Center of Excellence. Study co-authors included Krish Sathian, MD, PhD, professor of neurology, rehabilitation medicine, and psychology, and director of the Rehabilitation R&D Center of Excellence at the Atlanta VAMC; and Anthony Stringer, PhD, professor of rehabilitation medicine and psychology.

MCI is a diagnosis meant to identify those at increased risk of eventually converting to Alzheimer's disease. People with MCI have difficulty forming new memories but are still able to handle tasks of daily living. The difficulty learning and remembering new information is because of impaired function in parts of the brain including the hippocampus.

The study focused on how well participants could remember the locations of common household objects. The memory-building strategy involves three steps. First, participants focused on a feature of the room that stood out and was close to the object, then they learned a short explanation for why the object was in that location. Finally, they created a mental picture to tie the information together.

In several sessions, study participants were shown household objects one at a time, each object followed by its location in a computer-simulated room. An hour later, they were asked to identify the location of each object from among three choices.

After the first visit, participants returned to the laboratory for three training sessions. On a fifth visit two weeks later, they were evaluated on how well they could remember the objects' locations. A control group received the same amount of exposure to the objects and their locations, but was not given explicit training.

As expected, at the start of the study MCI patients had more difficulty remembering where objects were and showed less brain activity in the hippocampus (measured through functional magnetic resonance imaging) when compared with healthy people.

Both people with MCI and healthy controls benefitted significantly more from using memory strategies than from mere exposure. In addition, MCI patients in the memory strategy-training group showed increased activity in the hippocampus as they learned and remembered the location of the objects. Participants in the training group showed increases in hippocampal activity, even when trying to remember the locations of new objects.

"This is an initial, albeit encouraging, step in determining methods that can help these patients function better in their everyday lives," says Stringer, who originally developed the strategies on which training in this study was based.

"These techniques may hold particular promise given that they appear to promote neuroplastic changes in key brain regions," Sathian says.

This team has also tested the effectiveness of the memory-building techniques for associating faces and names, in another set of studies. They are continuing the study of the memory-building techniques, with the aim of determining how long the benefits of training last, and whether participants can use the strategies independently outside the laboratory.

More information: B.M. Hampstead, A.Y. Stringer, R.F. Stilla, M. Giddens and K. Sathian. Mnemonic strategy training partially restores hippocampal activity in patients with mild cognitive impairment. Hippocampus, online before print Feb. 27 (2012) http://onlinelibra … 006/abstract

Provided by Emory University

Overeating may double risk of memory loss

New research suggests that consuming between 2,100 and 6,000 calories per day may double the risk of memory loss, or mild cognitive impairment (MCI), among people age 70 and older. The study was released today and will be presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012. MCI is the stage between normal memory loss that comes with aging and early Alzheimer's disease.

14 feb 2012--"We observed a dose-response pattern which simply means; the higher the amount of calories consumed each day, the higher the risk of MCI," said study author Yonas E. Geda, MD, MSc, with the Mayo Clinic in Scottsdale, Arizona and a member of the American Academy of Neurology.

The study involved 1,233 people between the ages of 70 and 89 and free of dementia residing in Olmsted County, Minn. Of those, 163 had MCI. Participants reported the amount of calories they ate or drank in a food questionnaire and were divided into three equal groups based on their daily caloric consumption. One-third of the participants consumed between 600 and 1,526 calories per day, one-third between 1,526 and 2,143 and one-third consumed between 2,143 and 6,000 calories per day.

The odds of having MCI more than doubled for those in the highest calorie-consuming group compared to those in the lowest calorie-consuming group. The results were the same after adjusting for history of stroke, diabetes, amount of education, and other factors that can affect risk of memory loss. There was no significant difference in risk for the middle group.

"Cutting calories and eating foods that make up a healthy diet may be a simpler way to prevent memory loss as we age," said Geda.

Provided by American Academy of Neurology

Mild cognitive impairment is associated with disability and neuropsychiatric symptoms

In low- and middle-income countries, mild cognitive impairment—an intermediate state between normal signs of cognitive aging, such as becoming increasingly forgetful, and dementia, which may or may not progress—is consistently associated with higher disability and with neuropsychiatric symptoms but not with most socio-demographic factors, according to a large study published in this week's PLoS Medicine.

08 feb 2012--The established 10/66 Dementia Research Group interviewed approximately 15 000 people over 65 years of age who did not have dementia in eight low- and middle-incomes countries: Cuba, Dominican Republic, Peru, Mexico, Venezuela, Puerto Rico, China, and India.

Participants also completed standardized assessments of their mental and physical health and cognitive function and the researchers also interviewed relatives and carers for further details about any memory loss or other declines in cognitive function or the presence of any neuropsychiatric symptoms.

Then, using a clinical framework and a statistical model, the authors found that mild cognitive impairment with related memory problems was associated with disability, anxiety, apathy, and irritability but not with depression.

Increasing age or former education level did not seem to be linked but the authors found that men had a slightly higher prevalence of mild cognitive impairment than women. Furthermore, the prevalence of this type of mild cognitive impairment ranged from 0.8% in China to 4.3% in India.

The authors say: "This is one of the first studies, to our knowledge, to investigate the prevalence of [mild cognitive impairment with related memory problems] in [low- and middle-income countries], where the large majority of older people and people with dementia currently live."

They continue: "Differences in prevalence between countries were marked and ranged from 0.8% (China) to 4.3% (India), that is, greater than fivefold variation. After direct standardization for age, gender, and education, using the whole population as the reference, these differences were not markedly attenuated."

The authors conclude: "Further evaluation is needed of the associations with disability and neuropsychiatric symptoms since our findings do suggest higher than expected comorbidity and there are large absolute numbers of older people with [mild cognitive impairment with related memory problems] in these rapidly ageing and populous world regions."

More information: Sosa AL, Albanese E, Stephan BCM, Dewey M, Acosta D, et al. (2012) Prevalence, Distribution, and Impact of Mild Cognitive Impairment in Latin America, China, and India: A 10/66 Population-Based Study. PLoS Med 9(2): e1001170. doi:10.1371/journal.pmed.1001170

Provided by Public Library of Science