MF142 認知症予防を目的とする共想法における会話活性度の解析と評価(MF14 情報・コミュニケーション支援,あたり前のことを知る)

Studies in experimental animal models provide a convincing rationale for a role for ERT in the treatment and prevention of dementia. These studies establish the role of estrogen in the regeneration and preservation of neuronal elements within the CNS that are analogous to those regions of the brain most sensitive to the neurodegenerative changes associated with AD. Furthermore, behavioral studies in these animals establish a correlation between the hormone dependent changes in the neuronal architecture and learning and memory. However, extrapolation of these studies to post-menopausal women must be done with caution. Surgical and natural loss of ovarian function does not result in a clinically relevant decline in cognitive function over the short term (1 to 2 decades) or ever in some women. The modest changes that are observed may relate to the hormone's effect on neurotransmitter levels or their receptors. Although Singh et al. noted changes in neurotransmitter concentrations 5 weeks after ovariectomy, changes in cognitive performance in their rat model did not become significant until 28 weeks after ovariectomy--the equivalent of approximately 2 decades of human life. Except for the familial forms of the disease, AD is rarely seen in the first 2 decades after the menopause. However, by the third decade after the menopause, 50% of women can be expected to manifest the histopathological changes of AD. Approximately half of these women are without clinical evidence of disease. Thus, the neurodegenerative process of AD probably precedes by many years the age of onset of the disease. We do not know what factors contribute to the selective neuronal injury which, over time, eventually leads to the neuronal loss and reduced synaptic density that result in the cognitive impairment of AD. At this time we can only speculate as to estrogen's role in modifying this process. Data from experimental animal models suggest that estrogen deficiency would selectively increase the vulnerability of estrogen-responsive neural elements, for example, the cholinergic neurons of the basal forebrain and hippocampus--offulnerability mediated perhaps by the reduced expression of neurotrophic factors, decreased clearance of the amyloid protein, and/or reduced cerebral blood flow that are associated with estrogen deficiency. The brain's ability to adapt to the neuronal loss by stimulating axonal and synaptic regeneration would also be impaired by estrogen deficiency as suggested by estrogen's ability to restore the synaptic density of lesioned brains of ovariectomized animals. Thus, estrogen deficiency, like the apolipoprotein E4 allele, can be considered not a cause of AD but one of perhaps several factors modifying the neuronal injury and loss leading to AD. The limited epidemiologic data and intervention trials currently available are consistent with this interpretation. Because of the urgency and enormity of the problem of dementia in our aging society, there would now appear to be sufficient reason to allocate the resources needed to conduct the appropriate clinical trials to determine estrogen's efficacy in both the treatment and prevention of this devastating condition. These trials are needed so that women and their physicians can adequately weigh the risks and benefits of hormone replacement for the treatment and, more importantly, the prevention of dementia.

Objective:One of the main tasks for a clinical psychologist, when faced with referrals for neuropsychological assessment, is to differentiate between cognitive decline due to old age and an early stage of dementia. Mild cognitive impairment, the most common initial diagnosis, is assumed to be a transitional phase through which some individuals evolve in the process of developing dementia.Identifying dementia at an early stage is of considerable importance, given the fact that new pharmacological therapies have been made more accessible.Background:The literature in the field is clearly growing. It is possible to identify population- based studies as opposed to studies based on clinical samples, as well as longitudinal as opposed to cross-sectional studies. The ‘clinical’ type studies investigate the most common forms of dementia, and provide a number of indicators that may help in clinical decision making. However, the clinician’s task remains to decide which ones, out of the numerous indicators, are those most relevant for decisions following assessment.Method:This paper reviews 50 patients assessed between 1999 and 2002. They were all diagnosed as mild cognitive impairment at the time of referral. The full neuropsychological assessment was performed approximately six months later, with a prediction given for each individual as part of the neuropsychological report. Their condition was checked again in May/June 2003. At the time of follow-up the sample was split into ‘stable’ and ‘deteriorated’. Their age, education, IQ status and test results were analysed by one-way ANOVA using the SPSS. Additional analyses helped to find the association between their test results and outcome as well as between prediction and outcome.Results:Significant differences between groups were found for IQ status, MMSE and MEAMS scores. Also, episodic memory (Story Recall and Rey Complex Figure (RCF) –Recall), letter fluency, two tests of visual-spatial/visual-constructional ability (RCF – Copy and Block Design) and one test of attention and executive function (Digits Backward) clearly differentiated ‘stable’ from ‘deteriorated’. Pearson’s chi-square revealed a significant association (p< .001) between prediction and outcome.Conclusions:It was possible to differentiate between those who would remain stable and those who would deteriorate at the time when they were diagnosed as mild cognitive impairment. Screening procedures (MMSE and MEAMS) had moderate prediction power, whereas the full assessment, relying on more than one set of indicators, allowed a higher level of accuracy.

Although it is increasingly accepted that people with dementia retain a sense of self, there is a need for empirical evidence regarding the nature of the self-concept in early stage dementia, how this changes over time and how it relates to quality of life. Self-concept was assessed using the short form of the Tennessee Self-concept Scale in 95 individuals with early stage dementia; 63 were reassessed after 12 months, and 45 were seen again at 20 months. Participants also completed measures of mood, cognitive functioning and quality of life. Caregivers provided proxy ratings of self-concept, completed measures of symptoms and distress at symptoms and rated their own levels of stress and well-being. Self-ratings of self-concept were close to the average range for the standardization sample, and the distribution did not differ significantly from expected values. Although caregiver ratings were slightly lower, discrepancies were small. There were no significant changes over time in self-ratings or informant ratings or discrepancies. At Time 1, self-ratings were predicted by anxiety, depression and memory, caregiver ratings were predicted by caregiver distress and by depression in the person with dementia and discrepancies were predicted by caregiver distress. These models remained predictive at later time points. Self-rated self-concept predicted quality of life, with the relationship only partially mediated by depression and anxiety. Self-concept appears largely intact in early stage dementia, but in view of the association between self-concept and quality of life, a preventive approach focused on supporting self-concept may offer benefits as dementia progresses.

The Factorial Structure Of The Mini Mental State Examination (mmse) In Japanese Setting

Given the demographic change with an aging society in Germany, cognitive performance assessment of the elderly is of great importance. The Viacogscreen developed by us is a computer- and web-based brain performance screening for older adults that not only meets the criteria of a measurement instrument, but is also economical and repeatable. The test captures interlocking word list learning with delayed free recall and recognition, semantic word selection and fluidity, phonemic word fluidity and inverted number range, as well as incidental memory, resulting in a total of 17 performance parameters that provide a quick orientation (approximate test duration: 10-12 minutes) regarding the cognitive performance of a test subject. Three performance areas are depicted: executive functions, episodic and semantic memory. The test was standardized for 200 healthy test subjects in 6 different age groups (range: 50-85 years). For the first clinical validation, the test was used in the memory clinics in Bonn and Ulm, where 33 patients with MCI (mild cognitive impairment) and 42 patients with suspected Alzheimer's disease (VAD) were tested. A control group of 42 healthy people of approximately the same age served as the control group. With regard to the cognitive test procedure, all three groups showed significantly different results regarding the overall score (ANOVA F=73.9, p<0.001), executive functions (F=27.6 p<0.001) and semantic memory (F=54.4 p<0.001). Regarding episodic memory, both clinical groups differed significantly from the control group, but not from each other (F=48.7, p<0.001). The Viacogscreen thus produced very good results in its first validation in two memory clinics with regard to differentiation of VAD, and good results with regard to MCI. In addition to use in neurodegenerative diseases, the Viacogscreen is also suitable for other neurological and neuro-oncological diseases, as well as for use in large clinical studies since it enables electronic data collection.

Background and Objective: Existing evidence indicates the potential benefits of electroencephalography neurofeedback (NFB) training for cognitive function. This study aims to comprehensively review all available evidence investigating the effectiveness of NFB on working memory (WM) and episodic memory (EM) in the elderly population. Material and Methods: A systematic search was conducted across five databases to identify clinical trials examining the impact of NFB on memory function in healthy elderly individuals or those with mild cognitive impairment (MCI). The co-primary outcomes focused on changes in WM and EM. Data synthesis was performed using a random-effects meta-analysis. Results: Fourteen clinical trials (n = 284) were included in the analysis. The findings revealed that NFB was associated with improved WM (k = 11, reported as Hedges' g = 0.665, 95% confidence [CI] = 0.473 to 0.858, p < 0.001) and EM (k = 12, 0.595, 0.333 to 0.856, p < 0.001) in the elderly, with moderate effect sizes. Subgroup analyses demonstrated that NFB had a positive impact on both WM and EM, not only in the healthy population (WM: k = 7, 0.495, 0.213 to 0.778, p = 0.001; EM: k = 6, 0.729, 0.483 to 0.976, p < 0.001) but also in those with MCI (WM: k = 6, 0.812, 0.549 to 1.074, p < 0.001; EM: k = 6, 0.503, 0.088 to 0.919, p = 0.018). Additionally, sufficient training time (totaling more than 300 min) was associated with a significant improvement in WM (k = 6, 0.743, 0.510 to 0.976, p < 0.001) and EM (k = 7, 0.516, 0.156 to 0.876, p = 0.005); however, such benefits were not observed in groups with inadequate training time. Conclusions: The results suggest that NFB is associated with enhancement of both WM and EM in both healthy and MCI elderly individuals, particularly when adequate training time (exceeding 300 min) is provided. These findings underscore the potential of NFB in dementia prevention or rehabilitation.

The purpose of this study was to examine the effects of “PASCAL” education on the cognitive function and dementia risk factors of the elderly and to suggest the efficacy of the cognitive function and dementia risk factors for the prevention of dementia in the elderly. The subjects of this study were 20elderly women aged 65~75years, and 10control groups and 10exercise groups participated in the “PASCAL” education and the elderly physical stimulation exercise program regularly for 3days a week. The dementia prevention education was conducted for seven days in 60minutes a day. The physical stimulation exercise program for 12-weeks consisted of warm-up, main exercise, and cool-down. The measurement variables were composed of body composition, blood pressure, cognitive function, and dementia risk factors. Body composition and blood pressure were measured in measurement items. K-MMSE score was used for cognitive function test. β-amyloid, insulin, DHEAs, and BDNF were measured for dementia risk factors. The results of the study showed that K-MMSE score, a cognitive function test, showed the main effect(p<.001) and interaction effect(p<.001) after participating in the 12-week dementia prevention “PASCAL” education and physical stimulation exercise program. In the risk factors for dementia, β-amyloid, insulin, DHEAs, and BDNF showed the main effect(p<.001) and interaction effect(p<.001) after 12-weeks of prevention of dementia “PASCAL” education and participation in physical stimulation exercise program. In conclusion, the program of “PASCAL” education and physical stimulation exercise for prevention of dementia applied to this study showed significant effects on cognitive function and risk factors for dementia for dementia. Therefore, when applying the “PASCAL” education and physical stimulation exercise program to the development of cognitive function of the elderly, it can be an important management method to prevent dementia and early diagnosis of dementia and to restore cognitive function.

Charles Bonnet syndrome (CBS) is defined as complex persistent visual hallucinations in the absence of mental disorder. It is common in conditions causing significant visual impairment. Many authors advise reassurance, considering the condition benign. However, others have suggested that CBS may in some patients represent the early stages of dementia. This review seeks to systematically examine the evidence for any link between CBS and cognitive impairment. Literature search using OVID Medline, PsychINFO, and Embase. Three studies where cognitive functioning was the primary focus of the research were found. All were small, did not properly apply diagnostic criteria, and reported conflicting results. Eight other studies commented on cognitive functioning, but none used tests sufficiently sensitive to detect changes seen in early dementia. One hundred and thirty four case reports were scrutinized, and reports found of 16 patients with CBS where dementia emerged. High rates of partial insight at diagnosis of CBS were seen in these patients. There have been no adequately powered studies, using accepted diagnostic criteria, where changes in cognitive functioning were the primary outcome. Existing studies are of limited methodological quality and allow no conclusion regarding a relationship between cognitive impairment and CBS to be reached. Numerous case reports of dementia developing in patients with CBS and partial insight raise the possibility of a link between these conditions. There is a clear need for properly constructed studies to investigate this.

BackgroundDetails implementation of an innovative care program or practice: Fortasyn connect medical food, approved for early stages of Alzheimer dementia, can have a synergistic effect with cholinesterase inhibitors drugs.ObjectivesTo analyse the possible synergistic effect between Fortasyn Connect medical food and Cholinesterase Inhibitors drugs in Alzheimer disease patients in a common medical practice.Patients and Methods60 patients at early stages of dementia due to Alzheimer disease were followed. CDR (Clinical Dementia Rating) scale was administered at the beginning and at the end of the follow‐up period. The rate of change of CDR‐SB (sum of Blocks) was chosen as a efficacy criteria. Informed Consent was aquired. An approval of the Ethical Committee of the protocol was obtained. SSPS (v20) was used as a Statistical Software.ResultsThe combination therapy with Fortasyn Connect and Cholinesterase inhibitors was well tolerated. There were no significative advers effect. The patients were distribute at the final visit in 4 groups: Those who had taken both Fortasyn Connect and Cholinesterase inhibitors (Group 1), those who had taken Fortasyn Connect and no Cholinesterase inhibitors (Group 2), those who had taken Cholinesterase inhibitors and non Fortasyn Connect (Group 3), those who had not taken neither Fortasyn Connect nor Cholinesterase inhibitors (Group 4). There was a statistical difference between the Group 1 with the Group 3 and Group 4, indicating a potential synergistic effect between both therapies.ConclusionsThe combination therapy with Fortasyn Connect medical food and Cholinesterase inhibitors was well tolerated. It seem to be a potential synergistic efect between Fortasyn Connect medical food and Cholinesterase inhibitors Drugs. An statistical difference between the Group 1 (Fortasyn Connect medical food and Cholinesterase inhibitors therapy) with the Group 3 (Cholinesterase Inhibitor alone) and Group 4 (Fortasyn Connect medical food and Cholinesterase inhibitors therapy), indicating a potential synergistic effect between both therapies. Due to the limitations of this preliminary study (non‐blinded, non randomized, small sample of patients, non placebo control), more studies are needed.

Objective:Mind-wandering—the spontaneous shift in attention away from the external task to internal thoughts (including daydreaming, fantasizing, rumination, and worrying)—is negatively associated with performance across a variety of tasks including the sustained attention to response task, the Stroop task, tasks of working memory, choice reaction time, visual search, as well as more ecologically related tasks like reading comprehension and mathematics. There has also been promising evidence suggesting a potential link between mind-wandering, functional connectivity of the canonical networks of the brain, and Alzheimer’s disease (AD). However, no study has directly examined the relationship between neural correlates of mind-wandering and AD pathogenesis. In prior work, our lab has identified a whole-brain, functional connectivity-based marker of mind-wandering—the mwCPM—which predicted response time variability in older adults. In this study, we sought to evaluate the ability of this mind wandering CPM, derived from response time variability, to predict CSF p-tau/Aß42 ratio in 289 older adults from the Alzheimer’s Disease Neuroimaging Initiative. We hypothesized that the combined mind-wandering model including functional connections that predict high mind-wandering and functional edges that predict stability in attention, would predict AD pathology.Participants and Methods:Resting-state functional MRI data from 289 older adults (147 healthy older adults, 111 individuals with mild cognitive impairment, and 31 older adults with AD) from the Alzheimer’s Disease NeuroImaging Initiative was analyzed for the current study. Participants were only included in the analyses if they had resting-state fMRI data, CSF measures of amyloid beta and tau pathology, and performance on cognitive composites of global cognition, episodic memory, and executive functioning. Using the well-established methodology of connectome-based predictive modeling, the mind-wandering model was applied to the resting-state fMRI data to predict CSF-based biomarker levels of p-tau and Aß42. Moreover, we also examined if this mind-wandering model predicted individual differences in composite measures of global cognition, episodic memory, and executive functioningResults:The high mwCPM model successfully predicted measured CSF p-tau/Aß ratios (high model: p = .137, p = .0196), controlling for mean framewise displacement. However, the combined network and the low MW network were not significant (combined model: p = .0731, p = .216; low model: p = -.0027, p = .960). We next examined the association between connectivity strengths of the high mwCPM and cognitive functioning in the domains of general cognition, episodic memory, and executive functioning. Connectivity strength in the high mwCPM—functional edges that were associated with high behavioral variability—were negatively associated with all three cognitive composites (global cognition: r = -.239, p &lt; .0001; episodic memory: r = -.208, p = &lt; .0001; executive functioning: r = -.178, p &lt; .0001).Conclusions:This study provides the first empirical support for a link between a neuromarker of mind-wandering and AD pathophysiology. Moreover, mind-wandering also has downstream consequential effects for key domains of cognitive functioning in older adults. Interventions targeted at reducing mind-wandering, particularly before the onset of AD pathogenesis, may make a significant contribution to the prevention of AD-related cognitive decline.

A PERSPECTIVE IMAGING STUDY OF AGEING (PISA): GENETIC RISK PREDICTION FOR STUDYING AN AT-RISK POPULATION FOR ALZHEIMER’S DISEASE

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention...

BackgroundCurrent studies had shown that cognitive impairment related to metabolic syndrome, but the relationship between the two has not determined absolutely. Mild Cognitive impairment (MCI) has a high incidence in cognitive impairment and is the early stage of dementia. The analysis of the correlation between MCI and metabolic syndrome related factors can help prevent and cure mild cognitive impairment in the early stag, and reduce the occurrence of dementia and reduce the social burden.MethodWe enrolled 235 cases in community over the age of 50 years. We used the Montreal Cognitive Assessment (MoCA) to assess cognitive function, screening the patients with mild cognitive impairment, and Analyzed the cognitive function and factors associated with metabolic syndrome, such as creatinine (CREA), urea(UA), blood glucose (GLU), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL), body mass index (BMI), waist hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure(DBP).ResultThe prevalence of mild cognitive impairment was about 79.2%)n=187( among community residents over 50 years old. Comparing to normal cognitive function group and mild cognitive impairment group, the blood glucose and systolic blood pressure showed significant differences( (P&lt;0.05)),and no significant differences in CREA,UA,LDL,VLDL,BMI,WHR,DBP. Compared to normal blood glucose group, the score of executive, calculation and naming in high blood glucose were decreased, and the differences were significant (P&lt;0.05). Compared to normal systolic blood pressure group, the Score of letter fluency in high systolic blood pressure was decreased, and the differences was significant (P&lt;0.05).ConclusionThe incidence of MCI in community residents over the age of 50 was high, which was closed related to blood glucose and systolic blood pressure. High blood glucose can reduce the patient’s ability of executive, calculation and language, and high systolic blood pressure can reduce letter fluency. Control the metabolic syndrome related factors, can reduce the incidence of mild cognitive impairment, benefit to the life quality of community residents.

Introduction: The lack of longitudinal data of comorbidity burden makes the association between comorbidity and cognitive decline inconclusive. We aimed to measure comorbidity and assess its effects on cognitive decline in mild to moderate dementia. Methods: This was a prospective cohort study. The participants were enrolled from the Hualien Tzu Chi Hospital between January 2015 and December 2018. We enrolled 175 older adults with mild to moderate dementia and conducted in-person interviews to follow-up comorbidity and cognitive function annually. The comorbidity burden indices included Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Charlson Comorbidity Index (CCI), and Medication Regimen Complexity Index (MRCI), and cognitive function was measured by Mini-Mental State Examination (MMSE) and clock drawing test. We employed the generalized estimating equations to assess the longitudinal effect of time-varying comorbidity burden on cognitive decline after adjusting for age, sex, and education. Results: Most patients were diagnosed with Alzheimer’s disease (88.6%) and in the early stage of dementia (Clinical Dementia Rating [CDR] = 0.5, 57.1%; CDR = 1, 36.6%). Multimorbidity was common (median: 3), and the top 3 most common comorbidities were osteoarthritis (67.4%), hypertension (65.7%), and hyperlipidemia (36.6%). The severity index of CIRS-G was significantly associated with cognitive decline in MMSE after adjusting for age, sex, and education. CCI and MRCI scores were, however, not associated with cognitive function. Conclusion: The severity index of CIRS-G outperforms CCI and MRCI in reflecting the longitudinal effect of comorbidity burden on cognitive decline in mild to moderate dementia.

Delusion of theft and phantom intruder delusion are among the most frequent delusions in dementia. The purpose of this study was to clarify the clinical characteristics of patients with these symptoms. The authors conducted a questionnaire survey; items included age, gender, dementia diagnosis, cognitive function, and activities of daily living. Other clinical characteristics were evaluated using the quality of life questionnaire for dementia. A total of 217 patients with dementia were rated. Frequencies of delusion of theft were as follows: frequent, 7%; sometimes, 11%; rare, 16%; and none, 66%. Frequencies of phantom intruder delusion were as follows: frequent, 4%; sometimes, 10%; rare, 9%; and none, 77%. Comparison between positive and negative groups with these symptoms revealed that positive groups had higher scores in 2 of 6 domains of the quality of life questionnaire for dementia, namely, negative affect and actions, and restlessness. The positive group with delusion of theft had higher scores in cognitive function and activities of daily living than did the negative group. These results suggest that negative affect and action and restlessness might be related to delusion of theft or phantom intruder delusion and that delusion of theft frequently occurs in the early stage of dementia.