Timed Up and Go in People with Subjective Cognitive Decline Is Associated with Faster Cognitive Deterioration and Cortical Thickness.

INTRODUCTION: Early markers of neurodegeneration provide an opportunity to detect, monitor, and initiate interventions in individuals who have an increased risk of developing dementia. Here, we investigated whether the Timed Up and Go (TUG) test is associated with early brain neurodegeneration and whether the TUG test could be a marker of cognitive decline in people with subjective cognitive decline (SCD). METHODS: This is a longitudinal analysis of the Dementia Disease Initiation Study, a prospective, community-based, cohort study from Norway, designed to investigate early markers of cognitive impairment and dementia. Participants were classified as SCD and healthy controls (HC). The main studied variables were the TUG test and cognition as measured by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease memory composite score. Additionally, we investigated the cross-sectional association of brain morphology with the TUG using 1.5T-MRI. RESULTS: The sample included 45 participants (SCD = 21, HC = 24) followed during a mean time of 1.50 ± 0.70 years. At baseline, the cognitive performance did not differ between the groups, but TUG was longer in SCD. Slower baseline TUG was associated with a faster cognitive decline in both groups and it was also associated with reduced cortical thickness especially in motor, executive, associative, and somatosensory cortical regions in people with SCD. DISCUSSION/CONCLUSION: TUG predicted cognitive change in individuals with SCD, and there was a negative association between TUG and cortical thickness. TUG is a promising cheap and noninvasive marker of early cognitive decline and may help initiate interventions in individuals who have an increased risk of dementia.

Multispectral MRI segmentation of age related white matter changes using a cascade of support vector machines.

White matter changes (WMC) are the focus of intensive research and have been linked to cognitive impairment and depression in the elderly. Cumbersome manual outlining procedures make research on WMC labor intensive and prone to subjective bias. We present a fast, fully automated method for WMC segmentation using a cascade of reduced support vector machines (SVMs) with active learning. Data of 102 subjects was used in this study. Two MRI sequences (T1-weighted and FLAIR) and masks of manually outlined WMC from each subject were used for the image analysis. The segmentation framework comprises pre-processing, classification (training and core segmentation) and post-processing. After pre-processing, the model was trained on two subjects and tested on the remaining 100 subjects. The effectiveness and robustness of the classification was assessed using the receiver operating curve technique. The cascade of SVMs segmentation framework outputted accurate results with high sensitivity (90%) and specificity (99.5%) values, with the manually outlined WMC as reference. An algorithm for the segmentation of WMC is proposed. This is a completely competitive and fast automatic segmentation framework, capable of using different input sequences, without changes or restrictions of the image analysis algorithm.

Depression in mild dementia: associations with diagnosis, APOE genotype and clinical features.

BACKGROUND: Depression is common in dementia, with important clinical implications. Few studies of depression in dementia with Lewy bodies are available, and the results are inconsistent. OBJECTIVE: To examine the frequency of depression and its characteristics and correlates, in people with mild dementia. METHODS: All referrals for patients with a first time diagnosis of dementia to geriatric and older psychiatry outpatient clinics in the counties of Rogaland and Hordaland in Western Norway from March 2005 to March 2007 were screened for the study. Participants and their caregivers underwent a comprehensive and standardised diagnostic and assessment procedure. The depression subitem of the neuropsychiatric inventory (NPId) and Montgomery and Åsberg depression rating scale (MADRS) were used to estimate depression. Cut-off scores for any depression were 0/1 (NPId) and 6/7 (MADRS), and for clinically significant depression 3/4 and 14/15, respectively. RESULTS: Two hundered and twenty-three subjects with dementia participated, of whom 59 and 50% showed symptoms of depression assessed by NPI or MADRS, respectively, and 25 and 16% had clinically significant depression as measured by NPI and MADRS, respectively. Depression was more frequent in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD; p < 0.05). APOE genotype was available in 153 patients, and in AD, but not in DLB, a general linear model showed that the presence of APOEε4 allele was significantly associated with depression (F = 4.14; p = 0.045). CONCLUSION: Depression is common even in mild dementia, and more common and severe in DLB compared to AD. Future studies should explore the longitudinal course of depression in DLB, and the neural underpinnings of depression in DLB.

Hypertension is a potential risk factor for vascular dementia: systematic review.

OBJECTIVE: The aim of the study was to conduct a meta-analysis of epidemiological and case control studies to determine whether arterial hypertension is specifically associated with an increased risk of vascular dementia (VaD). DESIGN: Longitudinal and cross-sectional prospective studies using operationalised criteria to define VaD and hypertension, with a normal control comparison group were systematically reviewed. Cochrane Library, Embase, Medline, and PsycInfo data sources were searched along with reference lists of included articles and reviews. Original, prevalence or incidence studies were included if operationalised criteria for hypertension and VaD as well as number of cases with and without hypertension in VaD and non-demented groups were provided. Intervention studies and post-stroke and CADASIL studies were excluded. RESULTS: Eleven studies recruiting either volunteers or clinical patients, or which were population-based, examined a total of 768 people with VaD and 9857 control cases. A meta-analysis of the six longitudinal studies showed that hypertension was significantly associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29-1.95, p < 0.0001). A similar association between hypertension and the risk of prevalent VaD was found in the five cross-sectional studies (OR: 4.84, CI: 3.52-6.67, p < 0.00001). CONCLUSIONS: Hypertension significantly increases the risk of vascular dementia. The current meta-analysis highlights the potential importance of rigorous treatment of hypertension as a key measure to help prevent the development of VaD.

High prevalence of orthostatic hypotension in mild dementia.

BACKGROUND/AIMS: Orthostatic hypotension (OH) and QTc prolongation have potentially important prognostic and therapeutic consequences but have rarely been studied in patients with mild dementia. METHODS: Patients with mild dementia were diagnosed according to consensus criteria after comprehensive standardized assessment. OH and QTc were assessed using standardized criteria. RESULTS: OH was significantly more common in the dementia than in the control group, and systolic drop was higher in those with dementia with Lewy bodies. There were no significant differences in QTc values between dementia and control subjects. CONCLUSION: OH occurs even in patients with mild dementia, in particular in dementia with Lewy bodies. QTc was not prolonged in patients with mild dementia compared with normal controls.

[Cognitive failure in terminal kidney disease]. / Kognitiv svikt ved terminal nyresykdom.

BACKGROUND: Renal failure occurs more frequently among the elderly and elderly patients comprise an increasing proportion of dialysis patients. The objective of this paper is to review the frequency of cognitive impairment among elderly people in dialysis, and discuss causes and consequences of cognitive impairment and dementia in patients with end-stage renal disease. Prevention and treatment of cognitive impairment are discussed. MATERIAL AND METHODS: The review is based on literature retrieved from a search of Medline and other web-sites, review papers and clinical experience. RESULTS AND INTERPRETATION: Cognitive impairment occurs in 20-87% of patients in haemodialysis, and the frequency is significantly more increased than that for control groups. The etiology is multifactorial, including the primary renal disease, comorbidity, the effect of uraemia and treatment-related factors. Potentially reversible factors such as anaemia and treatment complications may contribute to cognitive impairment in these patients. Cognitive impairment has major clinical consequences for compliance, resource use and the prognosis for patients with renal failure, and is often not detected by the clinicians. The authors propose that cognitive assessment should be included in the routine evaluation of elderly patients with renal failure, with potential implications for the treatment and quality of treatment for these patients.