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To investigate the predictive ability of the previously established global cerebrovascular disease (CeVD) burden scale on long-term clinical outcomes in a longitudinal study of Asian elderly participants across the spectrum of cognitive impairment.
A case-control study was conducted over a 2-year period involving participants with no cognitive impairment, cognitive impairment-no dementia (CIND), and Alzheimer's disease (AD). Annually, cognitive function was assessed with a comprehensive neuropsychological battery and the clinical dementia rating (CDR) scale was used to stage disease severity.
Of 314 participants, 102 had none/very mild CeVD, 31 mild CeVD, 94 moderate CeVD, and 87 severe CeVD at baseline. There was a 1.14 and 1.42 units decline per year on global cognitive z-scores in moderate and severe CeVD groups, respectively, compared to none/very mild CeVD. Moderate-severe CeVD predicted significant functional deterioration at year 2 (HR = 2.0, 95% CI = 1.2–3.4), and conversion to AD (HR = 6.3, 95% CI = 1.7–22.5), independent of medial temporal atrophy.
The global CeVD burden scale predicts poor long-term clinical outcome independent of neurodegenerative markers. Furthermore, CeVD severity affects the rate of cognitive and functional deterioration. Hence, cerebrovascular burden, which is potentially preventable, is a strong prognostic indicator, both at preclinical and clinical stages of AD, independent of neurodegenerative processes.
The validity and reliability of the informant AD8 in primary healthcare has not been established. Therefore, the present study examined the validity and reliability of the informant AD8 in government subsidized primary healthcare centers in Singapore.
Eligible patients (≥60 years old) were recruited from primary healthcare centers and their informants received the AD8. Patient-informant dyads who agreed for further cognitive assessments received the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a locally validated formal neuropsychological battery at a research center in a tertiary hospital.
1,082 informants completed AD8 assessment at two primary healthcare centers. Of these, 309 patients-informant dyads were further assessed, of whom 243 (78.6%) were CDR = 0; 22 (7.1%) were CDR = 0.5; and 44 (14.2%) were CDR≥1. The mean administration time of the informant AD8 was 2.3 ± 1.0 minutes. The informant AD8 demonstrated good internal consistency (Cronbach's α = 0.85); inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.85); and test–retest reliability (weighted κ = 0.80). Concurrent validity, as measured by the correlation between total AD8 scores and CDR global (R = 0.65, p < 0.001), CDR sum of boxes (R = 0.60, p < 0.001), MMSE (R = −0.39, p < 0.001), MoCA (R = −0.41, p < 0.001), as well as the formal neuropsychological battery (R = −0.46, p < 0.001), was good and consistent with previous studies. Construct validity, as measured by convergent validity (R ≥ 0.4) between individual items of AD8 with CDR and neuropsychological domains was acceptable.
The informant AD8 demonstrated good concurrent and construct validity and is a reliable measure to detect cognitive dysfunction in primary healthcare.
To investigate the presence of neuropsychiatric symptoms (NPS) and sub-syndromes in elderly community-dwelling Asians with varying severity of cognitive impairment.
Chinese and Malay participants (n = 613) from the Epidemiology of Dementia in Singapore (EDIS) Study aged ≥ 60 years underwent clinical examination, neuropsychological testing, and NPS assessment using the Neuropsychiatric Inventory (NPI). Diagnosis of no cognitive impairment (NCI), cognitive impairment-no dementia (CIND), including CIND-mild and CIND-moderate, and dementia were made using established criteria.
A significant increase in the numbers of NPS was observed accompanying with increasing severity of cognitive impairment (p < 0.001). Compared to those with NCI/CIND-mild, participants with CIND-moderate [Odds ratio (OR): 4.2, 95% confidence interval (CI): 1.8–10.0] or dementia [OR: 9.2, 95% CI: 2.3–36.0] were more likely to have two or more neuropsychiatric sub-syndromes. Participants with CIND-moderate were more likely to have hyperactivity [OR: 2.0, 95% CI: 1.0–3.8] and apathy [OR: 2.9, 95% CI: 1.0–8.4] sub-syndromes, whereas patients with dementia were more likely to have psychosis [OR: 6.9, 95% CI: 2.4–20.1], affective (OR: 8.7, 95% CI: 1.8–42.9), and hyperactivity (OR: 5.4, 95% CI: 1.8–16.1). Furthermore, executive dysfunction and visual memory impairment were associated with the presence of three neuropsychiatric sub-syndromes; whist language and visuomotor speed impairment were related to the presence of two sub-syndromes. By contrast, impairment in attention, verbal memory, and visuoconstruction were not associated with any of the sub-syndromes.
The presence of NPS and sub-syndromes increase with increasing severities of cognitive impairment, and different neuropsychiatric syndromes are associated with specific impairment on cognitive domains in community-dwelling Asian elderly.
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