Cognitive medicine - a new approach in health care science.

BACKGROUND: The challenges of today's society call for more knowledge about how to maintain all aspects of cognitive health, such as speed/attention, memory/learning, visuospatial ability, language, executive capacity and social cognition during the life course. MAIN TEXT: Medical advances have improved treatments of numerous diseases, but the cognitive implications have not been sufficiently addressed. Disability induced by cognitive dysfunction is also a major issue in groups of patients not suffering from Alzheimer's disease or related disorders. Recent studies indicate that several negative lifestyle factors can contribute to the development of cognitive impairment, but intervention and prevention strategies have not been implemented. Disability due to cognitive failure among the workforce has become a major challenge. Globally, the changing aging pyramid results in increased prevalence of cognitive disorders, and the diversity of cultures influences the expression, manifestation and consequences of cognitive dysfunction. CONCLUSIONS: Major tasks in the field of cognitive medicine are basic neuroscience research to uncover diverse disease mechanisms, determinations of the prevalence of cognitive dysfunction, health-economical evaluations, and intervention studies. Raising awareness for cognitive medicine as a clinical topic would also highlight the importance of specialized health care units for an integrative approach to the treatment of cognitive dysfunctions.

Prevalence of the apolipoprotein E ε4 allele in amyloid ß positive subjects across the spectrum of Alzheimer's disease.

INTRODUCTION: Apolipoprotein E (APOE) ε4 is the major genetic risk factor for Alzheimer's disease (AD), but its prevalence is unclear because earlier studies did not require biomarker evidence of amyloid ß (Aß) pathology. METHODS: We included 3451 Aß+ subjects (853 AD-type dementia, 1810 mild cognitive impairment, and 788 cognitively normal). Generalized estimating equation models were used to assess APOE ε4 prevalence in relation to age, sex, education, and geographical location. RESULTS: The APOE ε4 prevalence was 66% in AD-type dementia, 64% in mild cognitive impairment, and 51% in cognitively normal, and it decreased with advancing age in Aß+ cognitively normal and Aß+ mild cognitive impairment (P < .05) but not in Aß+ AD dementia (P = .66). The prevalence was highest in Northern Europe but did not vary by sex or education. DISCUSSION: The APOE ε4 prevalence in AD was higher than that in previous studies, which did not require presence of Aß pathology. Furthermore, our results highlight disease heterogeneity related to age and geographical location.

Verbal memory decline from hippocampal depth electrodes in temporal lobe surgery for epilepsy.

OBJECTIVE: To explore whether patients with refractory mesial temporal lobe epilepsy risk aggravated verbal memory loss from intracranial electroencephalography (EEG) recording with longitudinal hippocampal electrodes in the language-dominant hemisphere. METHODS: A long-term neuropsychological follow-up (mean 61.5 months, range 22-111 months) was performed in 40 patients after ictal registration with left hippocampal depth electrodes (study group, n = 16) or no invasive EEG, only extracranial registration (reference group, n = 24). The groups were equal with respect to education, age at seizure onset, epilepsy duration, and prevalence of pharmacoresistant temporal lobe epilepsy (TLE; 75%) versus seizure freedom (25%). Retrospective neuropsychological data from preoperative surgical workup (T1) and prospective follow-up neuropsychological data (T2) were compared. A ≥1 SD intrapatient decline was considered as clinically relevant deterioration of verbal memory. RESULTS: Significant decline in verbal memory was seen in 56% of the patients in the study group compared to 21% in the reference group. At T1, there were no statistical between-group differences in memory performance. At T2, between-group comparison showed significantly greater verbal memory decline for the study group (Claeson Dahl Learning and Retention Test, Verbal Learning: p = 0.05; Rey Auditory Verbal Learning Test, Total Learning: p = 0.04; Claeson Dahl Learning and Retention Test, Verbal Retention: p = 0.04). An odds ratio (OR) of 7.1 (90% confidence interval [CI] 1.3-37.7) for verbal memory decline was seen if right temporal lobe resection (R TLR) had been performed between T1 and T2. The difference between groups remained unchanged when patients who had undergone R TLR were excluded from the analysis, with a remaining aggravated significant decline in verbal memory performance for the study group compared to the reference group. SIGNIFICANCE: Our results suggest a risk of verbal memory deterioration after the use of depth electrodes along the longitudinal axis of the hippocampus. Until this issue is further investigated, caution regarding depth electrodes in the language-dominant hemisphere hippocampus seems advisable.

Prognostic Accuracy of Mild Cognitive Impairment Subtypes at Different Cut-Off Levels.

BACKGROUND/AIMS: The prognostic accuracy of mild cognitive impairment (MCI) in clinical settings is debated, variable across criteria, cut-offs, subtypes, and follow-up time. We aimed to estimate the prognostic accuracy of MCI and the MCI subtypes for dementia using three different cut-off levels. METHODS: Memory clinic patients were followed for 2 (n = 317, age 63.7 ± 7.8) and 4-6 (n = 168, age 62.6 ± 7.4) years. We used 2.0, 1.5, and 1.0 standard deviations (SD) below the mean of normal controls (n = 120, age 64.1 ± 6.6) to categorize MCI and the MCI subtypes. Prognostic accuracy for dementia syndrome at follow-up was estimated. RESULTS: Amnestic multi-domain MCI (aMCI-md) significantly predicted dementia under all conditions, most markedly when speed/attention, language, or executive function was impaired alongside memory. For aMCI-md, sensitivity increased and specificity decreased when the cut-off was lowered from 2.0 to 1.5 and 1.0 SD. Non-subtyped MCI had a high sensitivity and a low specificity. CONCLUSION: Our results suggest that aMCI-md is the only viable subtype for predicting dementia for both follow-up times. Lowering the cut-off decreases the positive predictive value and increases the negative predictive value of aMCI-md. The results are important for understanding the clinical prognostic utility of MCI, and MCI as a non-progressive disorder.

Differences in the use of everyday technology among persons with MCI, SCI and older adults without known cognitive impairment.

BACKGROUND: To use valid subjective reports sensible to cognitive decline is vital to identify very early signs of dementia development. Use of everyday technology (ET) has been shown to be sensitive to differentiate adults with mild cognitive impairment (MCI) from controls, but the group with subjective cognitive impairment (SCI) has not yet been examined. This study aims to investigate and compare self-perceived ability in ET use and number of ETs reported as actually used in a sample of older adults with SCI, MCI, and older adults with no known cognitive impairment, i.e. METHODS: Older adults with MCI (n = 29), SCI ( n = 26), and controls (n = 30) were interviewed with the short version of the Everyday Technology Use Questionnaire (S-ETUQ) to capture self-perceived ability in ET use and number of ETs used. To generate individual measures of ability to use ET, Rasch analysis was used. The measures were then compared group-wise using ANCOVA. The numbers of ETs used were compared group-wise with ANOVA. RESULTS: Controls versus SCI and MCI differed significantly regarding ETs reported as used, but not SCI versus MCI. Similarly, in ability to use ET, controls versus SCI and MCI differed significantly but not SCI versus MCI. CONCLUSIONS: The significantly lower numbers of ETs reported as actually used and the lower ability in SCI and MCI groups compared to controls suggest that ET use is affected already in very minor cognitive decline. This indicates that self-reported ET use based on the S-ETUQ is sensitive to detect changes already in SCI.

Working memory and attention are still impaired after three years in patients with stress-related exhaustion.

Cognitive impairment is one of the most pronounced symptoms reported by patients with stress-related mental health problems. Impairments related to executive function and to some extent speed and attention are therefore common in patients with stress-related burnout/exhaustion. In this paper we present a follow-up of cognitive performance in patients with stress-related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow-up time was three years. Half of the patients still reported mental health problems at follow-up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long-lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress-related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow-up periods longer than three years are needed to explore the persistence of the cognitive impairment.

High Prevalence of Stress and Low Prevalence of Alzheimer Disease CSF Biomarkers in a Clinical Sample with Subjective Cognitive Impairment.

BACKGROUND/AIMS: Subjective cognitive impairment (SCI) is a trigger for seeking health care in a possible preclinical phase of Alzheimer's disease (AD), although the characteristics of SCI need clarification. We investigated the prevalence of psychosocial stress, depressive symptoms and CSF AD biomarkers in SCI and MCI (mild cognitive impairment). METHODS: Memory clinic patients (SCI: n = 90; age: 59.8 ± 7.6 years; MCI: n = 160; age: 63.7 ± 7.0 years) included in the Gothenburg MCI study were examined at baseline. Variables were analyzed using logistic regression with SCI as dependent variable. RESULTS: Stress was more prevalent in SCI (51.1%) than MCI (23.1%); p < 0.0005. SCI patients had more previous depressive symptoms (p = 0.006), but showed no difference compared to MCI patients considering current depressive symptoms. A positive CSF AD profile was present in 14.4% of SCI patients and 35.0% of MCI patients (p = 0.001). Stress (p = 0.002), previous stress/depressive symptoms (p = 0.006) and a negative CSF AD profile (p = 0.036) predicted allocation to the SCI group. CONCLUSION: Psychosocial stress is more prevalent in SCI than previously acknowledged. The high prevalence and long-term occurrence of stress/depressive symptoms in SCI in combination with a low prevalence of altered CSF AD biomarkers strengthens the notion that AD is not the most likely etiology of SCI.

Prevalence and prognosis of Alzheimer's disease at the mild cognitive impairment stage.

Three sets of research criteria are available for diagnosis of Alzheimer's disease in subjects with mild cognitive impairment: the International Working Group-1, International Working Group-2, and National Institute of Aging-Alzheimer Association criteria. We compared the prevalence and prognosis of Alzheimer's disease at the mild cognitive impairment stage according to these criteria. Subjects with mild cognitive impairment (n = 1607), 766 of whom had both amyloid and neuronal injury markers, were recruited from 13 cohorts. We used cognitive test performance and available biomarkers to classify subjects as prodromal Alzheimer's disease according to International Working Group-1 and International Working Group-2 criteria and in the high Alzheimer's disease likelihood group, conflicting biomarker groups (isolated amyloid pathology or suspected non-Alzheimer pathophysiology), and low Alzheimer's disease likelihood group according to the National Institute of Ageing-Alzheimer Association criteria. Outcome measures were the proportion of subjects with Alzheimer's disease at the mild cognitive impairment stage and progression to Alzheimer's disease-type dementia. We performed survival analyses using Cox proportional hazards models. According to the International Working Group-1 criteria, 850 (53%) subjects had prodromal Alzheimer's disease. Their 3-year progression rate to Alzheimer's disease-type dementia was 50% compared to 21% for subjects without prodromal Alzheimer's disease. According to the International Working Group-2 criteria, 308 (40%) subjects had prodromal Alzheimer's disease. Their 3-year progression rate to Alzheimer's disease-type dementia was 61% compared to 22% for subjects without prodromal Alzheimer's disease. According to the National Institute of Ageing-Alzheimer Association criteria, 353 (46%) subjects were in the high Alzheimer's disease likelihood group, 49 (6%) in the isolated amyloid pathology group, 220 (29%) in the suspected non-Alzheimer pathophysiology group, and 144 (19%) in the low Alzheimer's disease likelihood group. The 3-year progression rate to Alzheimer's disease-type dementia was 59% in the high Alzheimer's disease likelihood group, 22% in the isolated amyloid pathology group, 24% in the suspected non-Alzheimer pathophysiology group, and 5% in the low Alzheimer's disease likelihood group. Our findings support the use of the proposed research criteria to identify Alzheimer's disease at the mild cognitive impairment stage. In clinical settings, the use of both amyloid and neuronal injury markers as proposed by the National Institute of Ageing-Alzheimer Association criteria offers the most accurate prognosis. For clinical trials, selection of subjects in the National Institute of Ageing-Alzheimer Association high Alzheimer's disease likelihood group or the International Working Group-2 prodromal Alzheimer's disease group could be considered.

Frequent mild cognitive deficits in several functional domains in elderly patients with heart failure without known cognitive disorders.

BACKGROUND: The objective of the present study was to investigate whether mild cognitive deficits are present in patients with heart failure (HF) despite absence of any known cognitive disorder. METHODS AND RESULTS: A well defined group of patients (n = 40) with heart failure completed a cognitive screening check list, a depression screening questionnaire, and a battery consisting of neuropsychological tests assessing 5 different cognitive domains: speed/attention, episodic memory, visuospatial functions, language, and executive functions. The neuropsychological results were compared with those from a group of healthy control subjects (n = 41). The patients with HF displayed cognitive impairment compared with the control group within the domains speed and attention, episodic memory, visuospatial functions, and language. Among them, 34 HF patients (85%) could be classified with mild cognitive impairment (MCI), the majority as nonamnestic MCI, ie, with no memory impairment. CONCLUSIONS: Considering the high occurrence of mild cognitive deficits among HF patients without known cognitive disorders, closer attention should be paid to their self-care and compliance. Inadequate self-care and compliance could lead to more frequent hospitalizations. Furthermore, the HF patients may be at increased risk of dementia.

An example of exceptional practice effects in the verbal domain.

XY, a 20-year-old mnemonist (current world ranking within the top 50) was tested with standard neuropsychological tests. XY recalled all words on all trials on the Rey Auditory Verbal Learning Test (RAVLT, 15 words) and scored above the 99.9th percentile on the Wechsler Memory Scales R, Logical Memory (WLM, 2 short stories, 25 units per story, 50 units total). XY had not been previously tested with neuropsychological tests, but had trained memory techniques for approximately 8 years. We suggest that training on similar tasks resulted in substantial practice effects in the verbal memory domain, with no measurable transfer effects to the visual domain. In addition to previous findings, we present a practice effect on RAVLT and WLM exceeding previously documented test-retest effects by 2-3 standard deviations.

Living with stable MCI: experiences among 17 individuals evaluated at a memory clinic.

OBJECTIVES: Mild cognitive impairment (MCI) is a state of mildly impaired cognitive functioning but with an intact capability of performing basic daily activities. Few studies have targeted personal narratives from persons living with MCI, the major focus in this study is directed to methods for better predictions of the likelihood for conversion to dementia. This study directly explores experiences among individuals who have lived with MCI over seven years without converting to dementia. METHODS: Seventeen individuals, who had been diagnosed with MCI across four occasions over a seven-year period at a memory clinic, were interviewed at a single occasion about their experiences of living with MCI, life events, stress, coping, psychosocial resources, and lifestyle behaviors. RESULTS: Thematic analysis of the transcripts of the interviews resulted in themes revolving around the life situation and events related to the first visit at the memory clinic, coping with lower cognitive capacity with the aim of enhancing quality of life, and worries about dementia and further cognitive deteriorations. CONCLUSION: The participants' experiences of living with MCI indicate that issues and changes in life situations such as long-term stress, retirement, loss of relatives, perceived heritability of dementia, needs to be understood in the context of the individual's understanding and interpretation of their everyday cognitive functioning. Also, supportive long-term contacts with the specialist care unit were vital for creating a personal understanding of MCI. Addressing the intra-personal dynamics of cognitive functioning in the boundary between normal and pathological cognitive aging can also improve diagnostic accuracy.

Vascular disease, Alzheimer's disease biomarkers and cognition in mild cognitive impairment: additive or synergetic effects?

BACKGROUND/AIMS: To study how vascular disease and Alzheimer-typical biomarkers relate to cognitive performance in mild cognitive impairment (MCI). METHODS: Three groups diagnosed with MCI, one with vascular disease (MCI-vas, n = 61), one with Alzheimer-typical biomarkers (MCI-bio, n = 99) and one with both vascular disease and Alzheimer-typical biomarkers (MCI-vasbio, n = 56), were examined with a comprehensive neuropsychological test battery. RESULTS: The MCI-vas and MCI-bio groups performed quite similarly on the test battery, whereas the MCI-vasbio group tended to perform worse than the other groups. MCI-vasbio patients performed significantly worse on tests within all cognitive domains, with the most clear-cut differences on an executive test. CONCLUSIONS: Considering the small differences between MCI-vas and MCI-bio, vascular disease or biomarkers alone do not seem to be associated with a specific cognitive profile. The combination of vascular disease and Alzheimer-typical biomarkers, on the other hand, seems to be associated with more severe cognitive deficits. The difference in an aspect of executive functioning is interpreted as a synergetic effect.

The Cognitive Assessment Battery (CAB): a rapid test of cognitive domains.

BACKGROUND: The study aimed to evaluate the Cognitive Assessment Battery (CAB) in a specialist clinic setting in order to find out if it if it could be a supplement to the Mini-mental State Examination (MMSE) and distinguish between normal aging, mild cognitive impairment (MCI) and dementia, as well as MCI of different severities. METHODS: CAB consists of six short tests covering the cognitive domains of speed/attention, episodic memory, visuospatial functions, language and executive functions. It takes about 20 minutes to carry out and provides a quick overview of the patient's cognitive profile. Three groups were compared: healthy controls (N = 41), MCI (N = 83) and mild dementia (N = 28). RESULTS: CAB distinguished very clearly between controls and MCI as well as MCI and dementia. On further analysis CAB also distinguished between MCI of different severities. It also showed to have good sensitivity and specificity for identifying more severe MCI. CONCLUSIONS: CAB seems to be a useful supplement to MMSE and a screening instrument for MCI and dementia with good sensitivity and specificity.

Two-year outcome of MCI subtypes and aetiologies in the Göteborg MCI study.

OBJECTIVE: The objective was to study the 2-year outcome of subjects diagnosed as having mild cognitive impairment (MCI). METHODS: Two hundred and nine subjects diagnosed as having MCI were examined with a comprehensive neuropsychological test battery and followed up after 2 years. RESULTS: After 2 years, 34 subjects (16%) were lost for follow-up. Those subjects did not differ significantly in terms of MCI subclassification, MMSE score or age and education. Of the 175 subjects followed up, eight (4.5%) had improved to normal, two with amnestic MCI, one from multiple domains MCI, three with single domain MCI and two without any significant impairment at baseline. Forty-four subjects (25%) had progressed to dementia. Of these, 35 were from the multidomain amnestic group and nine from the multidomain non-amnestic group. The combination of Alzheimer-typical biomarkers (total-tau and amyloid beta) and multidomain amnestic MCI was the strongest predictor of progression to Alzheimer's disease, while vascular disease and multidomain amnestic MCI preceded mixed and vascular dementia. CONCLUSION: The results suggest that memory impairment alone, or impairment in any one cognitive domain alone, is a rather benign condition. Impairment in several cognitive domains is associated with a more severe outcome over 2 years. Also, 20% of the subjects who progressed to dementia, including Alzheimer's disease, did not show memory impairment at baseline, which suggests that memory impairment is not always the first symptom of even the most common dementia disorders.

Thyroid hormones are associated with poorer cognition in mild cognitive impairment.

BACKGROUND: Alterations in interrelated endocrine axes may be related to the pathogenesis of mild cognitive impairment (MCI) and dementia. METHODS: Salivary cortisol before and after a 0.5-mg dexamethasone test, and serum levels of thyroid-stimulating hormone, total thyroxine (T(4)), free T(4), total triiodothyronine (TT(3)), estradiol, testosterone and insulin-like growth factor 1 were measured in 43 MCI cases and 26 healthy controls. All participants underwent a comprehensive neuropsychological test battery covering the cognitive domains of speed/attention, memory, visuospatial functions, language and executive functions. RESULTS: The MCI group did not differ in basal levels of endocrine markers compared to controls. Among those with MCI, TT(3) levels were inversely associated with cognitive performance across all domains. After stratifying MCI cases according to TT(3) levels, those with relatively high TT(3) levels showed impairment in memory as well as in visuospatial and executive functions. Those with TT(3) levels at or below the lower boundary of the normal range performed comparably to healthy controls. Other endocrine markers were not related to cognitive performance. CONCLUSIONS: Among those with MCI, TT(3) was associated with a neuropsychological profile typical of prodromal Alzheimer's disease. While the mechanisms remain unclear, optimal levels of thyroid hormone under a compromising condition such as MCI and related neuropathology need reconsideration.

Cognitive profiles of incipient dementia in the Goteborg MCI study.

OBJECTIVE: To study which cognitive profiles of incipient dementia strongest predict the conversion to Alzheimer's disease (AD) and mixed dementia (MD)/vascular dementia (VaD). METHODS: 260 subjects with mild cognitive impairment (MCI) were included in the study and 209 (79%) were followed up after 2 years. At baseline, the subjects were assessed with a neuropsychological battery covering the cognitive domains speed/attention, memory, visuospatial, language and executive functions. RESULTS: After 2 years, 9 subjects were considered normal, 148 had stationary MCI and 47 (23%) had converted to dementia. Twenty subjects were diagnosed with AD, 15 with MD and 9 with VaD. The others were 2 with unspecified dementias and 1 with primary progressive aphasia. Dementia converters had a high proportion of impairment in all cognitive domains. The profiles of incipient AD and MD/VaD differed, with memory, visuospatial and language symptoms preceding AD, and executive and speed/attention symptoms preceding MD/VaD. CONCLUSIONS: The risk of converting to dementia is increased when domains in addition to memory are impaired. The incipient AD and MD/VaD profiles differed quite clearly. Considering that the vascular group consisted of a majority of patients with MD, the differences are convincing - vascular disease seems to have an essential impact on cognition.

Memory in individuals with mild cognitive impairment in relation to APOE and CSF Abeta42.

BACKGROUND: The epsilon4 allele of the apolipoprotein E (APOE) gene and low levels of cerebrospinal fluid (CSF) amyloid beta-proteins 42 (Abeta) have previously been associated with increased risk of cognitive decline in old age. In this study we examine the interaction of these markers with episodic memory in a sample identified as having mild cognitive impairment (MCI). METHODS: The sample (N = 149) was drawn from the Gothenburg MCI study and measured according to three free recall tests on three occasions spanning over four years. Second-order Latent Curve Models (LCM) were fitted to the data. RESULTS: Analyses accounting for age, gender, education, APOE, Abeta42, and interaction between APOE and Abeta42 revealed that the epsilon4 allele was significantly associated with level of memory performance in the presence of low Abeta42 values (< or = 452 ng/L). Associations between memory performance and Abeta42 were significant among the epsilon4 carriers but not among the non-carriers. The Abeta42 marker was, however, significantly associated with changes in memory over the study time period in the total sample. CONCLUSION: The findings support the hypothesis of an interactive effect of APOE and Abeta42 for memory decline in MCI patients.

Subcortical vascular dementia biomarker pattern in mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) is an etiologically unclear disorder. Cerebrospinal fluid (CSF) biomarkers are potentially useful for the differentiation between various MCI etiologies. AIM: The aim of the study was to assess whether baseline CSF hyperphosphorylated tau (P-tau), total tau (T-tau), amyloid beta 1-42 (Abeta(42)) and neurofilament light (NF-L) in patients with MCI could predict subcortical vascular dementia (SVD) and Alzheimer's disease (AD) at follow-up. METHODS: Biomarker levels were assessed by Luminex xMAP technology and ELISA. RESULTS: Increased baseline concentrations of NF-L significantly separated MCI-SVD from stable MCI. The MCI-SVD patients were inseparable from stable MCI but separable from patients developing AD (MCI-AD) on the basis of Abeta(42,) T-tau and P-tau(181) levels. CONCLUSION: A combination of the biomarkers Abeta(42), T-tau, P-tau(181) and NF-L has the potential to improve the clinical separation of MCI-SVD patients from stable MCI and MCI-AD patients.

Episodic memory and speed/attention deficits are associated with Alzheimer-typical CSF abnormalities in MCI.

UNLABELLED: Mild cognitive impairment (MCI) is regarded as the prodromal stage of dementia disorders, such as Alzheimer's disease (AD). OBJECTIVE: To compare the neuropsychological profiles of MCI subjects with normal concentrations of total tau (T-tau) and Abeta42 in CSF (MCI-norm) to MCI subjects with deviating concentrations of the biomarkers (MCI-dev). MCI-norm (N = 73) and MCI-dev (N = 73) subjects were compared to normal controls (N = 50) on tests of speed/attention, memory, visuospatial function, language and executive function. RESULTS: MCI-norm performed overall better than MCI-dev, specifically on tests of speed and attention and episodic memory. When MCI-dev subjects were subclassified into those with only high T-tau (MCI-tau), only low Abeta42 (MCI-Abeta) and both high T-tau and low Abeta42 (MCI-tauAbeta), MCI-tauAbeta tended to perform slightly worse. MCI-tau and MCI-Abeta performed quite similarly. CONCLUSIONS: Considering the neuropsychological differences, many MCI-norm probably had more benign forms of MCI, or early non-AD forms of neurodegenerative disorders. Although most MCI-dev performed clearly worse than MCI-norm on the neuropsychological battery, some did not show any deficits when compared to age norms. A combination of CSF analyses and neuropsychology could be a step toward a more exact diagnosis of MCI as prodromal AD.

Assessment of cognitive function in patients with stress-related exhaustion using the Cognitive Assessment Battery (CAB).

INTRODUCTION: The health care system is facing an increased number of patients seeking care for burnout/stress-related exhaustion. One of the core features of this condition is cognitive impairment-effective and easy tools are needed to assess cognition in this patient group. Our objective was to determine whether the Cognitive Assessment Battery (CAB) could be used for this purpose. METHOD: Ninety-three patients diagnosed with exhaustion disorder (ED) and 111 controls were included in the study and tested with CAB. CAB consists of six short tests covering the cognitive domains speed and attention, episodic memory, visuospatial, language, and executive functions. The patients also completed questionnaires on subjective memory problems, degree of burnout, anxiety, and depression. RESULTS: The patients performed worse than the controls on four tests of speed and attention, language, and executive function. Subjective memory problems, degree of burnout, and anxiety did not influence cognitive performance, only degree of depression influenced performance negatively on an executive test. CONCLUSION: CAB is a useful instrument for rapid, comprehensive screening of cognitive status in patients with stress-related exhaustion. Using it, we confirmed the most replicated findings regarding cognitive impairments in patients with stress-related exhaustion.