Safety and feasibility of a Dalcroze eurhythmics and a simple home exercise program among older adults with mild cognitive impairment (MCI) or mild dementia: the MOVE for your MIND pilot trial.

BACKGROUND: Falls represent a major health problem for older adults with cognitive impairment, and the effects of exercise for fall reduction are understudied in this population. This pilot randomized controlled trial evaluated the feasibility, safety, and exploratory effectiveness of a Dalcroze eurhythmics program and a home exercise program designed for fall prevention in older adults with mild cognitive impairment (MCI) or early dementia. METHODS: For this three-arm, single-blind, 12-month randomized controlled pilot trial, we recruited community-dwelling women and men age 65 years and older with MCI or early dementia through participating memory clinics in Zurich, Switzerland. Participants were randomly assigned to a Dalcroze eurhythmics group program, a simple home exercise program (SHEP), or a non-exercise control group. All participants received 800 IU of vitamin D3 per day. The main objective of the study was to test the feasibility of recruitment and safety of the interventions. Additional outcomes included fall rate, gait performance, and cognitive function. RESULTS: Over 12 months, 221 older adults were contacted and 159 (72%) were screened via telephone. Following screening, 12% (19/159) met the inclusion criteria and were willing to participate. One participant withdrew at the end of the baseline visit and 18 were randomized to Dalcroze eurhythmics (n = 7), SHEP (n = 5), or control (n = 6). Adherence was similarly low in the Dalcroze eurhythmics group (56%) and in the SHEP group (62%; p = 0.82). Regarding safety and pilot clinical endpoints, there were no differences between groups. CONCLUSION: The MOVE for your MIND pilot study showed that recruitment of older adults with MCI or early dementia for long-term exercise interventions is challenging. While there were no safety concerns, adherence to both exercise programs was low. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02279316. Registered on 31 October 2014.

Fully automated atlas-based hippocampal volumetry for detection of Alzheimer's disease in a memory clinic setting.

Hippocampal volume is a promising biomarker to enhance the accuracy of the diagnosis of dementia due to Alzheimer's disease (AD). However, whereas hippocampal volume is well studied in patient samples from clinical trials, its value in clinical routine patient care is still rather unclear. The aim of the present study, therefore, was to evaluate fully automated atlas-based hippocampal volumetry for detection of AD in the setting of a secondary care expert memory clinic for outpatients. One-hundred consecutive patients with memory complaints were clinically evaluated and categorized into three diagnostic groups: AD, intermediate AD, and non-AD. A software tool based on open source software (Statistical Parametric Mapping SPM8) was employed for fully automated tissue segmentation and stereotactical normalization of high-resolution three-dimensional T1-weighted magnetic resonance images. Predefined standard masks were used for computation of grey matter volume of the left and right hippocampus which then was scaled to the patient's total grey matter volume. The right hippocampal volume provided an area under the receiver operating characteristic curve of 84% for detection of AD patients in the whole sample. This indicates that fully automated MR-based hippocampal volumetry fulfills the requirements for a relevant core feasible biomarker for detection of AD in everyday patient care in a secondary care memory clinic for outpatients. The software used in the present study has been made freely available as an SPM8 toolbox. It is robust and fast so that it is easily integrated into routine workflow.

BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data.

INTRODUCTION: Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients' subjective impairments, (b) cognitive testing, and (c) information from informants. The present study developed a new, very quick and easily administered case-finding tool combining these assessments ('BrainCheck') and tested the feasibility and validity of this instrument in two independent studies. METHODS: We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6; 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer's disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7; 40% female) partook. All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE. RESULTS: Feasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable. Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4%; sensitivity = 97.4%, specificity = 81.6%). CONCLUSION: A new and very brief instrument for general practitioners, 'BrainCheck', combined three sources of information deemed critical for effective case-finding (that is, patients' subject impairments, cognitive testing, informant information) and resulted in a nearly 90% CCR. Thus, it provides a very efficient and valid tool to aid general practitioners in deciding whether patients with suspected cognitive impairments should be further evaluated or not ('watchful waiting').