Accuracy of Patient and Care Partner Identification of Cognitive Impairments in Parkinson's Disease-Mild Cognitive Impairment.

BACKGROUND: Criteria for Parkinson's disease-mild cognitive impairment require a caregiver or patient complaint or clinician observation of cognitive decline and objective evidence of cognitive deficit in at least 1 of 5 cognitive domains. This study examines the accuracy of Parkinson's disease-mild cognitive impairment patient and care partner reports of specific cognitive difficulties. METHODS: A total of 42 Parkinson's disease-mild cognitive impairment patients and their care partners reported the absence or presence of deficits in each cognitive domain during an interview. A deficit in each domain was defined by scores ≤ 1.5 standard deviations below the mean on corresponding cognitive tests. RESULTS: Sensitivity, specificity, and positive and negative predictive values were modest for patient and care partner reports across all domains. Patients' and care partners' accuracy in observing objectively identified deficits was poor across all domains (≤ 60% agreement; κ ≤ .07). Patient and care partner reports showed moderate agreement in all domains except attention (≥ 74% agreement; κ ≥ .43). CONCLUSIONS: Parkinson's disease-mild cognitive impairment patients and their care partners may not be accurate in identifying specific cognitive deficits. Thus, even patients (and care partners) who correctly report having a cognitive deficit may misidentify the specific deficit. The finding supports the value of International Parkinson and Movement Disorder Society Parkinson's disease-Mild Cognitive Impairment Level II assessment and cautions against relying on subjective report or screening in research in which the nature of cognitive deficit identification or treatment is paramount. Overreliance on patient and care partner reports of specific impairments may distort epidemiologic estimates of mild cognitive impairment subtypes and misdirect cognitive rehabilitation at incorrect domains. © 2016 International Parkinson and Movement Disorder Society.

MRI volume of the medial frontal cortex predicts financial capacity in patients with mild Alzheimer's disease.

Persons with mild Alzheimer's disease (AD) have significant deficits in financial abilities. This study examined the relationship between brain structure volumes, cognition, and financial capacity in patients with mild AD. Sixteen mild AD patients and 16 older adult comparisons completed the Financial Capacity Instrument (FCI), a psychometric measure of financial abilities, and also underwent magnetic resonance imaging (MRI) to obtain volumes of the bilateral hippocampi, angular gyri, precunei, and medial and dorsolateral frontal cortices. Mild AD patients performed significantly below comparisons on the FCI and had significantly smaller hippocampi. Among mild AD patients, FCI performance was moderately correlated with frontal (medial and dorsolateral frontal cortex) and posterior (angular gyri and precunei) cortical volumes. Stepwise regression demonstrated that medial frontal cortex volume predicted FCI score. The relationship between medial frontal cortex volume and overall FCI score was partially mediated by two measures of simple attention (DRS Attention, DRS Construction). The findings suggest that medial frontal cortex atrophy and associated declines in simple attention play an increasingly important role in declining financial skills in patients with mild AD.

Magnetic resonance imaging volume of the angular gyri predicts financial skill deficits in people with amnestic mild cognitive impairment.

OBJECTIVES: To better understand how brain atrophy in amnestic mild cognitive impairment (MCI) as measured using magnetic resonance imaging (MRI) volumetrics could affect instrumental activities of daily living (IADLs) such as financial abilities. DESIGN: Controlled, matched-sample, cross-sectional analysis regressing MRI volumetrics with financial performance measures. SETTING: University medical and research center. PARTICIPANTS: Thirty-eight people with MCI and 28 older adult controls. MEASUREMENTS: MRI volumetric measurement of the hippocampi, angular gyri, precunei, and medial frontal lobes. Participants also completed neuropsychological tests and the Financial Capacity Instrument (FCI). RESULTS: Correlations were performed between FCI scores and MRI volumes in the group with MCI. People with MCI performed significantly below controls on the FCI and had significantly smaller hippocampi. Among people with MCI, performance on the FCI was moderately correlated with angular gyri and precunei volumes. Regression models demonstrated that angular gyrus volumes were predictive of FCI scores. Tests of mediation showed that measures of arithmetic and possibly attention partially mediated the relationship between angular gyrus volume and FCI score. CONCLUSION: Impaired financial abilities in amnestic MCI correspond with volume of the angular gyri as mediated by arithmetic knowledge. The findings suggest that early neuropathology within the lateral parietal region in MCI leads to a breakdown of cognitive abilities that affect everyday financial skills. The findings have implications for diagnosis and clinical care of people with MCI and AD.