Clock Drawing Test: Types of Errors and Accuracy in Early Cognitive Screening.

BACKGROUND: Clock Drawing Test (CDT) is a commonly used screening tool for cognitive disorders, known for its ease of administration and scoring. Despite frequent use by clinicians, CDT is criticized for its poor predictive value in mild cases of impairment. OBJECTIVE: To evaluate CDT as a screening tool for early stage of cognitive impairment in biomarker-verified Alzheimer's disease (AD) and depressive disorder (DD). METHODS: We analyzed CDT of 172 patients with verified AD, 70 patients with DD, in whom neurodegenerative disorder was excluded using cerebrospinal fluid biomarkers, and 58 healthy older adults. CDT was scored using the semi-quantitative (Shulman) and itemized criteria (adapted from Mendez). RESULTS: Logistic regression showed that for both DD and AD patients with high Mini-Mental State Examination (MMSE) scores (27 and above) the significant predicting variable is uneven number spacing. As MMSE deteriorates (24-26 points), an additional error of setting clock hands is predictive of the disease. In the low MMSE condition, CDT showed an acceptable discrimination for AD (AUC itemized 0.740, Shulman 0.741) and DD (AUC itemized 0.827, Shulman 0.739) using both scoring methods. In the high MMSE condition, discrimination rates were acceptable using itemized scoring but poor using Shulman scoring for both AD (AUC itemized 0.707, Shulman 0.677) and DD (AUC itemized 0.755, Shulman 0.667) groups. CONCLUSION: Ideally, modern diagnostic process should take place before the cognitive performance drops beneath the healthy range. This makes CDT of little use when screening patients with very mild cognitive deficits.

Emotion induction in young and old persons on watching movie segments: Facial expressions reflect subjective ratings.

Film clips are established to induce or intensify mood states in young persons. Fewer studies address induction of mood states in old persons. Analysis of facial expression provides an opportunity to substantiate subjective mood states with a psychophysiological variable. We investigated healthy young (YA; n = 29; age 24.4 ± 2.3) and old (OA; n = 28; age 69.2 ± 7.4) participants. Subjects were exposed to film segments validated in young adults to induce four basic emotions (anger, disgust, happiness, sadness). We analyzed subjective mood states with a 7-step Likert scale and facial expressions with an automated system for analysis of facial expressions (FaceReader™ 7.0, Noldus Information Technology b.v.) for both the four target emotions as well as concomitant emotions. Mood expressivity was analysed with the Berkeley Expressivity Questionnaire (BEQ) and the Short Suggestibility Scale (SSS). Subjective mood intensified in all target emotions in the whole group and both YA and OA subgroups. Facial expressions of mood intensified in the whole group for all target emotions except sadness. Induction of happiness was associated with a decrease of sadness in both subjective and objective assessment. Induction of sadness was observed with subjective assessment and accompanied by a decrease of happiness in both subjective and objective assessment. Regression analysis demonstrated pre-exposure facial expressions and personality factors (BEQ, SSS) to be associated with the intensity of facial expression on mood induction. We conclude that mood induction is successful regardless of age. Analysis of facial expressions complement self-assessment of mood and may serve as a means of objectification of mood change. The concordance between self-assessment of mood change and facial expression is modulated by personality factors.

On the conundrum of cognitive impairment due to depressive disorder in older patients.

OBJECTIVES: Depressive symptoms and cognitive impairment often concur in older persons. Differentiating the cause of cognitive impairment in older persons with Depressive Disorder (DD) from other diseases such as Alzheimer's Disease (AD) is challenging. The goal of this study was to characterize cognitive impairment in older persons with DD. DESIGN: Cross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018. SETTING: Gerontopsychiatric services of Ulm University at Bezirkskrankenhaus Günzburg serving as primary psychiatric care institution and tertiary referral center for psychiatric care for older persons. PARTCIPANTS: DD was diagnosed according to ICD-10 criteria. When indicated by the medical history or neuropsychological assessment further diagnostic procedures were initiated. Cerebrospinal fluid (CSF) tap was routinely the first additional procedure. If patients did not consent to CSF tap or contraindications were present, 18F-fluordesoxyglucose-PET (FDG-PET) or Amyloid-PET (Am-PET) were performed. MATERIALS AND METHODS: Extensive neuropsychological test battery to assess cognitive profile. RESULTS: 457 subjects were diagnosed with DD (DD-all; age 50-94; 159 males, 298 females). Biomarkers were assessed in 176 persons; in 90 of these subjects AD-biomarkers were negative (DD-BM-; age 54-89; 40 males, 50 females), and in 86 subjects at least one biomarker was compatible with AD (DD-BM+; age 60-90; 31 males, 55 females). Cognitive performance was below healthy controls (HC; n = 56; age 50-80; 30 males, 26 females) for all groups of patients with DD. With case-control matching of HC and DD-BM- we find that executive functions are impaired in about one out of three and delayed recall in about two out of three patients with DD. CONCLUSION: Cognitive impairment is frequent in older persons with DD. Cognitive profile in older patients with DD without and with biomarkers of AD is not distinguishable. Therefore, cognitive impairment due to DD should be diagnosed after exclusion of comorbid AD.

Cognitive profiles in persons with depressive disorder and Alzheimer's disease.

Alzheimer's disease and depressive disorder are frequent in old age. Both may be associated with depressed mood and cognitive impairment. Therefore, finding a strategy to clarify the diagnosis underlying subjective complaints of impaired cognition and depressed mood in older persons is of utmost interest. We conducted a cross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018. From 3758 patients, we included patients aged 60 years and older with a Mini-Mental-Status Examination score of 24 and above. Final analysis included all patients in whom Alzheimer's disease biomarker analysis was performed (cerebrospinal fluid markers of Alzheimer's disease or positron emission tomography imaging; n = 179) and patients with depressive disorder in whom Alzheimer's disease was ruled out by analysis of biomarkers suggestive of Alzheimer's disease (n = 70). With case-control matching for age, education and gender, performance of patients with Alzheimer's disease was worse in acquisition, consolidation and recall of verbal information and false-positive answers. None of the results, however, sufficed to differentially diagnose individual patients with Alzheimer's disease or depressive disorder. With more severe symptoms of depression, patients with biomarker-verified Alzheimer's disease performed worse in executive testing but were not additionally impaired in verbal episodic memory performance. We conclude that distinguishing between Alzheimer's disease and depressive disorder is unreliable on clinical grounds and behavioural testing alone. Diagnosing the cause of subjective complaints about deteriorating cognitive function or depressed mood requires additional biomarker assessment, whereas cognitive assessment is needed to define appropriate targets of symptomatic treatment in patients with Alzheimer's disease and depressive disorder.

News and Commercials: Binding Deficits for Complex Information in Schizophrenia.

Memory for complex content is severely impaired in patients with schizophrenia spectrum disorders, which might make processing of daily information such as news and commercials particularly challenging. The goal of the present study was to assess the impairment of everyday memory in patients with schizophrenia. Healthy controls (HC) and patients with schizophrenia (SZ) were asked to watch a selection of six news segments and six commercials and complete a recognition task on the content of these video clips. All participants completed a neuropsychological test battery comprising measures of attention, working and episodic memory, and executive function. The total number of correctly recognized items was significantly lower in the SZ group. In contrast, the number of false recognitions was alike in both news and commercials paradigm. We conclude that memory in patients with schizophrenia is more prone to omissions than distortions for complex everyday stimuli. The results offer further support for impaired binding in SZ patients. Memory in SZ suffices to reject false multi-feature items on grounds of identifying at least one feature as incorrect but does not suffice to recall all features of a complex item and affirm it as correct.

Everyday Memory in Healthy Aging: Porous but Not Distorted.

Most studies targeting age-association of memory functions report a decline in recognition hits and an increase in false alarms. The goal of the present study was to assess these findings in tasks with day-to-day relevance. We investigated healthy young (YA; age 26.90 ± 3.55 years) and old (OA; age 69.80 ± 5.85 years) adults. Participants were asked to watch six news and six commercials and complete a recognition task relating to the information presented in the videos. OA had a lower hit rate in both news and commercials compared to YA. However, the number of false alarms (FA) was the same in both age groups. Applying signal detection theory, we found age differences in discriminability for both news and commercials paradigm. The groups showed no differences in bias and both chose a liberal answering tendency. We interpret our finding as a result of complex recognition items in an ecologically valid task. Multi-feature items offer an advantage in correct rejection-it is enough to know that at least one feature of an item is false. This benefit does not extend to hits, where all features of an item need to be recognized. This indicates that recognition memory of naturalistic stimuli in OA is porous, but not distorted.

Everyday false memories in older persons with depressive disorder.

Generally we tend to think that memory in daily living is complete and accurate in healthy persons. However, current memory research has revealed inconspicuous memory faults. Rarely omissions and distortions of memory are researched with tasks resembling everyday life. We investigated healthy older control subjects (HC) and patients with depressive disorder (DD). Cognitive function was assessed with a comprehensive neuropsychological test battery and mood with the Montgomery-Asberg Depression Scale (MADRS). We assessed everyday veridical and distorted memories on showing participants original news and commercials. In most aspects of attention, executive functions, and memory, patients with DD performed worse than HC. Regarding memory content on viewing news or commercials the difference between patients with DD and HC was more pronounced for false memory content than for veridical memory content. Linear regression analysis showed the extent of false memory content being associated with mental flexibility as assessed with the Trail Making Test and mood as assessed with the MADRS for both information obtained on viewing news and commercials. Increase of false memories impedes overall accuracy of memory more than decrease of veridical memories in older persons with depressive disorder. Diminished executive functions and depressive mood partly explain these memory distortions.

Everyday Memory in Patients with Alzheimer's Disease: Fragmentary and Distorted.

BACKGROUND: Errors of omission are an established hallmark of memory impairment in Alzheimer's disease (AD). Much less is known about other memory errors in AD such as false memories. OBJECTIVE: We investigated false memories in healthy elderly controls (HC; n = 23) and patients with AD (n = 20) using real-life tasks of watching news and commercials. METHODS: Participants received a comprehensive neuropsychological assessment and were shown original news and commercials with a subsequent recognition task to assess veridical and false memories. RESULTS: Subjective estimate of the number of errors were alike in HC and patients with AD. However, memory performance in both the news and the commercials task was significantly worse in patients with AD. Trail-Making Test and Symbol-Span Test were significant predictors of false memories on viewing news and commercials. In patients with AD, levels of Aß1 - 42, but not levels of tau-protein were correlated with false memories in both tasks. CONCLUSIONS: Everyday life in patients with AD is impeded not due to the incompleteness of memory but also due to its distortions. Furthermore, it is hindered by the lack of awareness towards these deficits. False memory content in patients with AD is associated with Aß42 levels in the CSF as a surrogate of the overall extent to which the brain has been affected by AD pathology. Future studies will need to address the impact of this duality of memory failure on everyday life of patients with AD and their proxies in greater detail.

Relationship Between Self-Reported Health and Stress in Mothers of Children with Autism Spectrum Disorders.

The current study explore the relationship between various forms of experienced stress (general stress and parenting stress) and both health-related quality of life (QoL) and reported physical health symptoms. One hundred and twenty-two mothers of children with autism spectrum disorder responded to an online survey included questionnaires on general stress, parenting stress, health-related QoL, and physical symptoms. The results suggested that perceived general stress as associated with both a reduced health-related QoL and more physical symptoms. However, parenting stress was only associated with a reduced health-related QoL, and not with physical health. These results are discussed in relation to the complex impact of prolonged and predictable parenting stress on the cortisol response and immune system.