Mild Cognitive Impairment with a High Risk of Progression to Alzheimer's Disease Dementia (MCI-HR-AD): Effect of Souvenaid® Treatment on Cognition and 18F-FDG PET Scans.

BACKGROUND: Previous studies have shown that Souvenaid (medical food) can have benefits on memory, cognition, and function in early Alzheimer's disease (AD) and mild cognitive impairment (MCI). OBJECTIVE: Demonstrate that Souvenaid could improve or maintain cognition and has an effect on neurodegeneration biomarkers. METHODS: This cohort study was carried out from June 2015 through December 2016 in the Neurology Department, Infanta Cristina Hospital, Madrid, Spain. MCI-HR-AD were recruited using Petersen criteria, neuropsychology (NPS), and 18F-FDG PET scans to confirm the high risk of progression to dementia with one year of follow-up. Age, sex, vascular risk factors (VRF), and NPS values (Barcelona brief version) were analyzed. 18F-FDG PET scans were analyzed as a visual procedure. The study was approved by the Research Committee of ICH. Statistical analysis was made with SPSS 22.0 version. RESULTS: Subjects included 43 MCI patients (58.5% women; mean age 69.78±7.89): 17 receiving Souvenaid® treatment (ST), 24 receiving no treatment (WT) and 2 who withdrew. No differences were seen in VRF, only hypercholesterolemia, and were less prevalent in the ST group (p = 0.002). The rate of progression to dementia was 48.8% (no differences between groups, p = 0.654). A second round of 18F-FDG PET scans showed a significance worsening of glucose metabolism in WT (p = 0.001) versus ST, in which it was low (p = 0.050). For NPS testing, there was a significant worsening in memory performance in the WT group (p = 0.011) and a stabilization in ST (p = 0.083), as well as in executive functions and attention (worsening in WT, p = 0.014). For the Subjective Changing Scale (SCS), caregivers indicated a stabilization/improvement in ST (p = 0.017). CONCLUSION: Souvenaid had a significant effect on several cognitive domains, and on SCS in patients with MCI-HR-AD. Its intervention had an impact on preservation on 18F-FDG PET scans.

Análisis de las derivaciones por trastorno cognitivo a consultas externas de neurología: investigando la probabilidad pretest de deterioro cognitivo y demencia / Analysis of referrals by cognitive disorder in outpatient neurology clinic: investigating pretest probability of cognitive impairment and dementia

La probabilidad de presentar un trastorno depende más de la exactitud con que se haya determinado la probabilidad pretest que de las características de las pruebas diagnósticas empleadas. Se analizó a todos los pacientes derivados a consultas externas de neurología por sospecha de trastorno cognitivo durante 3 años. Se registraron 519 primeras consultas derivadas para evaluación cognitiva (8,5 % del total). En el 41,4 % se diagnosticó algún trastorno cognitivo (15,4% DCL y 26,0 % demencia). La probabilidad pretest se relacionó con la edad, la presencia de depresión y de trastorno conductual. En el subgrupo de 18-50 años la probabilidad pretest para presentar deterioro cognitivo fue del 3,4 % comparada con un 73,8 % en el subgrupo de >80 años. La presencia de trastornos de conducta aumentó la probabilidad pretest en todos los grupos (globalmente, del 41,4 % al 81,0 %) y, en cambio, la depresión redujo la probabilidad pretest (globalmente, del 41,4 % al 26,0 %). La edad, la presencia (o ausencia) de depresión y la existencia de un trastorno conductual influyen significati vamente en la probabilidad pretest. Es fundamental conocer la probabilidad pretest a la hora de tomar una decisión sobre las pruebas diagnósticas en la neurología de la conducta(AU)

The probability of a disorder depends more on the accuracy of pretest probability than characteristics of the diagnostic tests employed. We analyzed all patients referred to neurology outpatients with suspected cognitive disorder for 3 years. There were 519 first consultations referred for cognitive assessment (8.5 % of total). In 41.4 % subjects were diagnosed with a cognitive disorder (15.4 % MCI and 26.0 % dementia). The pretest probability was associated with age, presence (or absence) of depression and presence of neuropsychiatric symptoms. In the subgroup of 18-50 years pretest probability to present cognitive impairment was 3.4 % compared with 73.8 % in the subgroup of >80 years. The presence of neuropsychiatric symptoms increased the pretest probability in all groups (overall 41.4 % to 81.0 %) and depression reduced the pretest probability (overall 41.4 % to 26.0 %). Age, the presence (or absence) of depression and the existence of neuropsychiatric symptoms influence significantly over pretest probability. Neurologist needs to know the pretest probability when they are making a clinical decision about diagnostic testing in behavioral neurology(AU)