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1.
Ther Umsch ; 78(2): 73-81, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33615869

RESUMO

Early recognition or screening of dementia in general practice Abstract. General practitioners play a key role in timely dementia diagnosis. In view that there are currently no drugs to prevent the progression of dementia or are effective in patients with mild cognitive impairment, a general screening of older people to recognize pre-symptomatic stages of dementia is not recommended. Crucial for a timely diagnosis is the GP's perception of warning signs, so-called "red flags". If the patients, family members, authorities or even the GP notice even discreet signs of a possible early dementia, a neuropsychological and medical evaluation should be initiated. Personal history, history by informant, a physical examination, supplemented by a GP's psychiatric evaluation and ideally the careful assessment with the MoCA form the basis of a preliminary clarification in general practice. If dementia is suspected, this clarification should be supplemented by an in-depth laboratory examination and, if applicable, neuroimaging before the patient is referred, depending on the findings, to a memory clinic or a consultant specialist to confirm the diagnosis and if appropriate initiate pharmacological and non-pharmacological therapies.


Assuntos
Demência , Medicina Geral , Clínicos Gerais , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Humanos , Programas de Rastreamento , Encaminhamento e Consulta
2.
Emerg Med Clin North Am ; 39(1): 47-65, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218662

RESUMO

The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.


Assuntos
Emergências , Doenças do Sistema Nervoso/diagnóstico , Doença Aguda , Fatores Etários , Idoso , Criança , Demência/diagnóstico , Demência/terapia , Serviço Hospitalar de Emergência , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Meningite/diagnóstico , Meningite/terapia , Doenças do Sistema Nervoso/terapia , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Convulsões/diagnóstico , Convulsões/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
3.
Med Clin North Am ; 105(1): 75-91, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246524

RESUMO

The primary care physician is well positioned to identify and treat patients with cognitive impairment (CI). Simple, validated tools can screen for CI in the office. Identifying the type of dementia and stage of the disease helps to guide care. A thorough history, medication review, physical examination, laboratory workup, and imaging studies can help identify specific causes contributing to memory loss. A patient-centered, multidisciplinary team approach includes nonpharmacological and pharmacologic treatments. Patient safety and preservation of functional status should be at the forefront of caring for the forgetful patient.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Demência/classificação , Demência/diagnóstico , Humanos , Anamnese , Medicare , Neuroimagem , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , Exame Físico , Atenção Primária à Saúde , Encaminhamento e Consulta , Estados Unidos
4.
J Formos Med Assoc ; 120(1 Pt 2): 533-541, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32653387

RESUMO

BACKGROUND/PURPOSES: Unimpaired activities of daily living (ADL) is essential for the diagnosis of normal cognition and mild cognitive impairment. However, diagnosis according to this concept is difficult to apply to patients comorbid with motor dysfunction. We aim to use a novel ADL questionnaire for operationally diagnosing unimpaired ADL in vascular cognitive impairment with no dementia (VCIND). METHODS AND PARTICIPANTS: This was a retrospective cohort study with both cross-sectional and long-term follow-up analysis. Patients with cerebrovascular disease with normal cognition (CVDNC), VCIND, and vascular dementia (VaD) were analyzed. Cutoff scores for differentiating different stages of cognitive impairment were compared between the new History-based Artificial Intelligent ADL questionnaire (HAI-ADL) and other tools. RESULTS: A total of 596 individuals were analyzed, including 40 CVDNC, 167 VCIND, 218 mild, 119 moderate, and 52 severe-dementia patients. The cutoff scores for determining unimpaired ADL in VCIND were 8.5, 3.5, 5, 100, and 60 in HAI-ADL, CDR-SB, IADL, BI, and CASI, respectively. HAI-ADL had the highest correlations with CDR-SB and the CDR staging system compared to other tools. Four models of progression rates from CVDNC/VCIND to VaD revealed it was much higher in the group with HAI-ADL > 8.5 compared to those with HAI-ADL≦8.5 with odds ratios of 3.75, 3.66, 3.31, and 2.77, respectively. CONCLUSION: Our study showed that HAI-ADL provides an operational determinates unimpaired ADL which is necessary for the diagnosis of VCIND. The predictive value for progression to dementia was proved by a long-term follow-up analysis of the research cohort.


Assuntos
Disfunção Cognitiva , Demência , Atividades Cotidianas , Disfunção Cognitiva/diagnóstico , Estudos Transversais , Demência/diagnóstico , Humanos , Testes Neuropsicológicos , Estudos Retrospectivos
5.
Arch Gerontol Geriatr ; 93: 104325, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33383356

RESUMO

BACKGROUND: Depression is common among residents in long term-care facilities. Therefore, access to a valid and reliable measure of depressive symptoms among nursing home (NH) residents is highly warranted. AIM: The aim of this study was to test the psychometrical properties of the Norwegian version of the Cornell Scale for Depression in Dementia (CSDD). METHODS: A sample of 309 NH residents were assessed for depressive symptoms using the CSDD in 2015-2016. Data on CSDD were missing for 64 residents, giving an effective sample of 245 (79.3%). Principal component and confirmatory factor analysis were used. RESULTS: A five-dimensional solution yielded the best fit with the data (χ2=174.927, df=94, χ2/df=1.86, p=0.0001, RMSEA=0.058, p-value for test of close fit=0.152, CFI=0.94, TLI=0.92 and SRMR=0.056). As expected, higher depressive symptoms correlated positively with higher scores on the Minimum Data Set Depression Rating Scale (MDSDRS) and correlated negatively with Quality of life assessed with the Quality of Life in Late Stage-Dementia Scale. LIMITATIONS: The excluded residents (n=64, 20.7%) had lower cognitive function, which may limit the generalizability of the study results. CONCLUSION: This study suggests a five-dimensional solution of the CSDD scale. Sixteen of the 19 original items showed highly significant loadings, explaining a notable amount of the variation in the CSDD-construct. Further development and testing of a well-adapted scale assessing depression in the nursing home population with and without dementia is required.


Assuntos
Demência , Demência/diagnóstico , Demência/epidemiologia , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Noruega/epidemiologia , Casas de Saúde , Escalas de Graduação Psiquiátrica , Psicometria , Qualidade de Vida
6.
Arch Gerontol Geriatr ; 92: 104246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32980573

RESUMO

PURPOSE: The combination of a growing population of older adults and increasing prevalence and awareness of dementia diagnoses suggests that dementia worry may also intensify. As a relatively new area of investigation, the dementia worry literature is growing, but variability in definitions and measurement continue. A scoping review was conducted to gather and examine existing research, as well as assist in guiding future studies in this area. The review focused on characterizing the conceptualization, measurement, and correlates of dementia worry. METHODS: Using PubMed, CINAHL, AgeLine, and PsycINFO, a search of literature concerning dementia worry was completed. RESULTS: A total of 45 articles examining dementia worry fulfilled the inclusion criteria. Most studies were cross-sectional (n = 39), quantitative (n = 38), and conducted in the United States (n = 22). Inconsistencies in the conceptualization, measurement, and correlates examined make it difficult to determine the meaning and true levels of dementia worry. CONCLUSIONS: Recent attention to dementia worry has increased awareness of the basic concept and its correlates. However, the lack of unity in the definition and measurement of dementia worry impedes advancement in this research area, as well as in establishing its clinical significance.


Assuntos
Formação de Conceito , Demência , Idoso , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Humanos
7.
Rev Saude Publica ; 54: 137, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331529

RESUMO

OBJECTIVE: To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes. METHODS: A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia. RESULTS: The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation. CONCLUSION: Investment in training is essential to improve physicians' performance in the field of dementia in primary care.


Assuntos
Atitude do Pessoal de Saúde , Demência , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Demência/diagnóstico , Demência/terapia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários
9.
PLoS Med ; 17(12): e1003474, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33320852

RESUMO

BACKGROUND: Very few studies have explored the patterns of cardiovascular health (CVH) metrics in midlife and late life in relation to risk of dementia. We examined the associations of composite CVH metrics from midlife to late life with risk of incident dementia. METHODS AND FINDINGS: This cohort study included 1,449 participants from the Finnish Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, who were followed from midlife (baseline from1972 to 1987; mean age 50.4 years; 62.1% female) to late life (1998), and then 744 dementia-free survivors were followed further into late life (2005 to 2008). We defined and scored global CVH metrics based on 6 of the 7 components (i.e., smoking, physical activity, and body mass index [BMI] as behavioral CVH metrics; fasting plasma glucose, total cholesterol, and blood pressure as biological CVH metrics) following the modified American Heart Association (AHA)'s recommendations. Then, the composite global, behavioral, and biological CVH metrics were categorized into poor, intermediate, and ideal levels. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed with Cox proportional hazards and the Fine and Gray competing risk regression models. During the follow-up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons in 2005 to 2008. The fully adjusted hazard ratio (HR) of dementia was 0.71 (95% confidence interval [CI]: 0.43, 1.16; p = 0.174) and 0.52 (0.29, 0.93; p = 0.027) for midlife intermediate and ideal levels (versus poor level) of global CVH metrics, respectively; the corresponding figures for late-life global CVH metrics were 0.60 (0.22, 1.69; p = 0.338) and 0.91 (0.34, 2.41; p = 0.850). Compared with poor global CVH metrics in both midlife and late life, the fully adjusted HR of dementia was 0.25 (95% CI: 0.08, 0.86; p = 0.028) for people with intermediate global CVH metrics in both midlife and late life and 0.14 (0.02, 0.76; p = 0.024) for those with midlife ideal and late-life intermediate global CVH metrics. Having an intermediate or ideal level of behavioral CVH in both midlife and late life (versus poor level in both midlife and late life) was significantly associated with a lower dementia risk (HR range: 0.03 to 0.26; p < 0.05), whereas people with midlife intermediate and late-life ideal biological CVH metrics had a significantly increased risk of dementia (p = 0.031). Major limitations of this study include the lack of data on diet and midlife plasma glucose, high rate of attrition, as well as the limited power for certain subgroup analyses. CONCLUSIONS: In this study, we observed that having the ideal CVH metrics, and ideal behavioral CVH metrics in particular, from midlife onwards is associated with a reduced risk of dementia as compared with people having poor CVH metrics. Maintaining life-long health behaviors may be crucial to reduce late-life risk of dementia.


Assuntos
Doenças Cardiovasculares/epidemiologia , Demência/epidemiologia , Indicadores Básicos de Saúde , Fatores Etários , Idoso , Doenças Cardiovasculares/diagnóstico , Comorbidade , Demência/diagnóstico , Feminino , Finlândia/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
10.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370976

RESUMO

As our population ages, the demand for surgical services in older people is increasing exponentially. Shown to be indispensable in the care of medical patients, use of the comprehensive geriatric assessment (CGA) is also growing in the perioperative setting. We present the case of a previously independent 82-year-old man who underwent a standard preoperative assessment and surgical aortic valve replacement. In the 7 months that followed, prior to his death, he suffered a rapid functional decline contributed to by slow postoperative recovery, delirium and recurrent falls. Post-mortem revealed cardiac amyloid deposition and extensive small vessel disease in the brain. This case highlights the importance of the CGA in the perioperative management of older patients, especially in identification and optimisation of geriatric syndromes and consideration of less-invasive alternative treatments. We review the existing literature on CGA use in cardiothoracic and vascular surgical settings, drawing on experiences learnt from the above case.


Assuntos
Estenose da Valva Aórtica/cirurgia , Demência/diagnóstico , Avaliação Geriátrica , Assistência Perioperatória/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Dispositivos de Terapia de Ressincronização Cardíaca , Tomada de Decisão Clínica , Demência/psicologia , Eletrocardiografia , Evolução Fatal , Humanos , Masculino , Complicações Pós-Operatórias , Síncope/etiologia , Substituição da Valva Aórtica Transcateter/psicologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-33348548

RESUMO

As the number of older adults with dementia increases, early diagnosis and intervention are crucially important. The purpose of this study was to conduct dementia screening on older adults to determine whether there are differences in depression, loneliness, social support, daily activities of living, and life satisfaction between older adults at high-risk for dementia compared with low-risk older adults. We hypothesized a negative relationship between high-risk older adults and these factors. This study also hypothesized a moderating effect for social support on the relationship between daily living activities and life satisfaction. This study used a cross-sectional design with survey data. Participants were recruited at 15 public community health centers in South Korea. A total of 609 older adults (male 208, female 401) living in the community were screened for early dementia, and 113 participants (18.9%) were assigned to the high-risk group. As hypothesized, participants in the high-risk group showed significantly more negative results in terms of activities of daily living, depression, loneliness, social support, and life satisfaction compared with participants in the low-risk group. The findings of this study provide a theoretical basis for the importance of early screening for dementia and policies for effective dementia prevention.


Assuntos
Atividades Cotidianas , Demência/diagnóstico , Depressão/epidemiologia , Solidão , Satisfação Pessoal , Apoio Social , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Qualidade de Vida , República da Coreia
12.
Medicine (Baltimore) ; 99(45): e23060, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157962

RESUMO

Parkinsonian syndromes include typical cases of idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) associated with cognitive and vegetative disorders, which are more challenging to diagnose. The aim of this study was to assess -the value of dual-tracer imaging 6-fluoro-(18F)-L-DOPA (FDOPA) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), performed in routine patients demonstrating extrapyramidal signs and cognitive complains, for the diagnosis and management of parkinsonian syndromes.We retrospectively included 143 consecutive patients who underwent both FDOPA PET/CT (for the evaluation of parkinsonism) and FDG PET/CT (for the evaluation of cognitive complaints) in the same institution. The suspected clinical diagnosis before imaging and the final post-imaging diagnosis were collected by a dedicated questionnaire.FDOPA was pathological in 90.2% of cases, including 74.1% of PD, 3.5% of parkinsonian dementia and 7% of APS. FDG was normal or near normal in 58.7% of patients. A pattern of diffuse cortical hypometabolism was observed in the remaining patients, more frequently in APS than in PD patients (P = .001). Importantly, in 7.7% of cases dual-tracer PET/CT allowed to decide between several diagnostic hypotheses and led to a new diagnosis in 14.0%. Therefore, the management of these patients was modified, with clinical re-evaluation in a specialized unit and a control of neuropsychological tests and imaging.Dual-tracer PET/CT imaging may be a precious help in the diagnosis and management of parkinsonian syndromes.


Assuntos
Fluordesoxiglucose F18/metabolismo , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Demência/diagnóstico , Demência/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/normas , Transtornos Parkinsonianos/metabolismo , Transtornos Parkinsonianos/patologia , Administração dos Cuidados ao Paciente/métodos , Estudos Retrospectivos
14.
PLoS One ; 15(10): e0239994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027275

RESUMO

BACKGROUND: Studies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups. METHODS AND FINDINGS: We conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women). CONCLUSIONS: We identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.


Assuntos
Demência/diagnóstico , Idoso , Demência/epidemiologia , Demência/etiologia , Escolaridade , Grupos Étnicos , Feminino , Nível de Saúde , Humanos , Solidão , Masculino , Pessoa de Meia-Idade , Pobreza , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2540-2543, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018524

RESUMO

Clinical and biological changes during the prodromal stages of dementia are both complicated and expensive. A biomarker for cognitive reserve exposure would be highly useful as a dementia risk predictor, but has eluded researchers. Speech, which exhibits disfluencies due to dementia, is a good candidate as it is easy to collect and non-invasive. However, previous studies have only looked at the impact of dementia on speech after diagnosis. Here we extend our previous work that showed paralinguistic features extracted from audio recordings of older participants completing the LOGOS episodic memory test can be used to discriminate between high vs low cognitive reserve, hence low vs high risk of dementia. Specifically, we use the clinically validated Lifetime of Experiences Questionnaire (LEQ) to refine our ground truth estimate of cognitive reserve instead of an abridged version. Also, we improve the generalizability of our system by using feature warping to normalize across speakers. Our k-nearest neighbours (KNN) based classifier achieved an accuracy of 84% when trained with paralinguistic features alone and 91% with paralinguistic and episodic memory features.Clinical Relevance- This establishes efficacy of using speech from older participants completing the LOGOS episodic memory test to estimate risk of dementia.


Assuntos
Reserva Cognitiva , Demência , Memória Episódica , Demência/diagnóstico , Humanos , Sintomas Prodrômicos , Fala
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5498-5501, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019224

RESUMO

Early detection of dementia is crucial to devise effective interventions. Comprehensive cognitive tests, while being the most accurate means of diagnosis, are long and tedious, thus limiting their applicability to a large population, especially when periodic assessments are needed. The problem is compounded by the fact that people have differing patterns of cognitive impairment as they progress to different forms of dementia. This paper presents a novel scheme by which individual-specific patterns of impairment can be identified and used to devise personalized tests for periodic follow-up. Patterns of cognitive impairment are initially learned from a population cluster of combined normals and cognitively impaired subjects, using a set of standardized cognitive tests. Impairment patterns in the population are identified using a 2-step procedure involving an ensemble wrapper feature selection followed by cluster identification and analysis. These patterns have been shown to correspond to clinically accepted variants of Mild Cognitive Impairment (MCI), a prodrome of dementia. The learned clusters of patterns can subsequently be used to identify the most likely route of cognitive impairment, even for pre-symptomatic and apparently normal people. Baseline data of 24,000 subjects from the NACC database was used for the study.


Assuntos
Disfunção Cognitiva , Demência , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Humanos , Aprendizagem
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5537-5543, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019233

RESUMO

The presented paper discusses a practical application of machine learning (ML) in the so-called 'AI for social good' domain and in particular concerning the problem of a potential elderly adult dementia onset prediction. An increase in dementia cases is producing a significant medical and economic weight in many countries. Approximately 47 million older adults live with a dementia spectrum of neurocognitive disorders, according to an up-to-date statement of the World Health Organization (WHO), and this amount will triple within the next thirty years. This growing problem calls for possible application of AI-based technologies to support early diagnostics for cognitive interventions and a subsequent mental wellbeing monitoring as well as maintenance with so-called 'digital-pharma' or 'beyond a pill' therapeutical strategies. The paper explains our attempt and encouraging preliminary study results of behavioral responses analysis in a facial emotion implicit-short-term-memory learning and evaluation experiment. We present results of various shallow and deep learning machine learning models for digital biomarkers of dementia progress detection and monitoring. The discussed machine-learning models result in median accuracies right below a 90% benchmark using classical shallow and deep learning approaches for automatic discrimination of normal cognition versus a mild cognitive impairment (MCI). The classifier input features consist of an older adult emotional valence and arousal recognition responses, together with reaction times, as well as with self-reported university-level degree education and age, as obtained from a group of 35 older adults participating voluntarily in the reported dementia biomarker development project. The presented results showcase the inherent social benefits of artificial intelligence (AI) utilization for the elderly and establish a step forward to advance machine learning (ML) approaches for the subsequent employment of simple behavioral examination for MCI and dementia onset diagnostics.Clinical relevance- This manuscript establishes a behavioral and cognitive biomarker candidate potentially substituting a Montreal Cognitive Assessment (MoCA) evaluation without a paper and pencil test.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Nível de Alerta , Inteligência Artificial , Biomarcadores , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Emoções , Humanos
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5563-5566, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019238

RESUMO

Wandering pattern classification is important for early recognition of cognitive deterioration and other health conditions in people with dementia (PWD). In this paper, we leverage the orientation data available on mobile devices to recognize dementia-related wandering patterns. In particular, we propose to use deep learning (DL) with long short-term memory networks (LSTM) as classifiers for detecting travel patterns including direct, pacing, lapping and random. Experimental results on a real dataset collected from 14 subjects show that deep LSTM classifiers perform better than traditional machine learning (ML) classifiers. Our proposed method can thus be potentially used in healthcare applications for dementia related wandering monitoring and management.Clinical Relevance- This demonstrates the potential of using readily available yet non-privacy information to detect dementia-related wandering patterns with high accuracy.


Assuntos
Aprendizado Profundo , Demência , Demência/diagnóstico , Humanos , Aprendizado de Máquina , Memória de Longo Prazo , Memória de Curto Prazo
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5619-5622, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019251

RESUMO

The combined provision of an arising number of dementia cases, and the substantial absence of effective treatments, led the scientific community toward the identification of early phases of this condition. Such an effort aims at the recognition of therapeutic windows and the characterization of the disease's different grades. In the last years, Motor and Cognitive Dual-Tasks (MCDT) have been widely used to address the early diagnosis of several neurocognitive disorders, among which dementia. Here we present different protocols: the walking MCDT, the toe-tapping MCDT, and the forefinger-tapping MCDT. Moreover, each task has been performed under different cognitive conditions: no cognitive effort, counting backwards by 1, 3, and 7. In this work, we report the results obtained through the combination of different motor and cognitive tasks, and we present 2 brand-new MCDT protocols, attempting to identify a sweet-spot for early diagnosis of dementia.


Assuntos
Demência , Caminhada , Cognição , Demência/diagnóstico , Humanos
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5798-5801, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019292

RESUMO

Early detection of dementia is becoming increasingly important as it plays a crucial role in handling the patients and offering better treatment. Many of the recent studies concluded a tight relationship between dementia and gait disorders. For this purpose, identification of gait abnormalities is key factor. Novel technologies provide many options such as wearable and non-wearable approaches for analysis of gait. As the occurrence of dementia is more prominent in elderly people, wearable technology is considered out of scope for this work. The gait data of several elderly people over 80 years is acquired over certain intervals during the scope of the project. The elderly people are classified into three study groups namely cognitively healthy individuals (CHI), subjectively cognitively impaired persons (SCI) and possible mildly cognitively impaired persons due to inconclusive test results (pMCI) based on their cognitive status. The gait data is acquired using Kinect sensor. The acquired data consists of both RGB image sequences and depth data of the test persons. 3D human pose estimation is performed on this gait data and gait analysis is done. The transformations in the gait cycles are observed and the health condition of the individual is analyzed. From the analysis, the patterns in the gait abnormalities are correlated with the above-mentioned classification and are used in the detection of dementia in advance. The obtained results look promising and further analysis of gait parameters is under progress.


Assuntos
Demência , Dispositivos Eletrônicos Vestíveis , Idoso , Demência/diagnóstico , Diagnóstico Precoce , Marcha , Análise da Marcha , Humanos
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