ObjectiveTo compare daily functional performance and potential predictive factors in patients with Alzheimer's disease (AD) and subcortical ischemic vascular disease (SIVD). MethodsSixty-eight community patients with AD and 39 with SIVD were evaluated using the informantbased Barthel Index of Activities of Daily Living (B-ADL) and Instrumental Activities of Daily Living (IADL). Motor function, cognition, and white matter hyperintensities (WMHs) were assessed using the modified Rankin Scale (mRS), Cognitive Abilities Screening Instrument (CASI)/Clinical Dementia Rating (CDR), and Scheltens scale, respectively. ResultsAfter controlling for systemic diseases and medications, toilet use was the only B-ADL subset in which the patients with SIVD performed worse than those with AD in overall comparisons and CDR0.5-1. Additionally, the SIVD group with CDR0.5-1 performed worse in bathing, mobility, and climbing stairs. Regarding IADL performance, the SIVD group had worse performances than the AD group in mode of transportation during CDR2. In WMHs analysis, periventricular WMHs (PWMHs) was the only factor showing significant inverse correlations with both CASI and B-ADL/IADL. Hierarchical regression of all patients suggested that the best models including age, education, PWMHs, CASI, and mRS accounted for 71% and 78% of the variances in B-ADL and IADL, respectively. While mRS accounted for a significant effect in both B-ADL and IADL, CASI accounted for a significant effect only in IADL. Subgroup analysis suggested that the effects of CASI and PWMHs were confined within B-ADL/IADL and IADL in the AD group, respectively. ConclusionsMotor function was the major factor in both B-ADL and IADL, and cognition had a significant effect on IADL. Although PWMH load had inverse associations with both motor and cognitive functions, this radiological marker better predicted IADL in AD than in SIVD. The variation in daily functional profiles with dementia stage and subtypes highlights the need to assess motor function for preventive interventions. Keywords Subcortical ischemic vascular disease; Alzheimer's disease; Cognition; Motor function; Activities of daily life; Instrumental activities of daily life; White matter hyperintensities Neuropsychiatry (London) (2018) 8(2) 558Research Yen-Hsuan Hsu care strategy [14].Several studies have reported ADL profiles and their relevant impact among patients with AD [15][16][17]. However, the functional profiles and determining factors in individuals with SIVD have yet to be fully elucidated [18][19][20], and comparisons of these two prevalent subtypes of dementia are even more limited [19][20]. Therefore, the aims of the current study were to compare the profiles of ADL performance between patients with SIVD and AD subtypes, and to analyze predictors of daily functional performance in different subtypes of dementia by examining the associations between clinical factors, cognitive/motor function, and WMHs. Materials and MethodsSixty-eight community patients with AD and 39 with SIVD who visited the...
Vitamin B12 deficiency has been associated with various neuropsychiatric symptoms, and to be a reversible cause of dementia. As the negative impact of low vitamin B12 status on cognition can range from subclinical neuronal metabolic derangement to an overt debilitating state in line with permanent brain structural changes, prompt recognition of vitamin B12 deficiency is of paramount clinical importance as it is a treatable condition. Several studies have investigated the pathogenesis of vitamin B12 deficiency.
BackgroundThe clinical phenotypes of cobalamin (Cbl) deficiency is often overlooked in clinical practice as their presentations vary according to the level of involvement between the hematologic and nervous systems. Although the negative impact of Cbl deficiency on cognition has been underpinned, the reported therapeutic responses after Cbl supplement therapy differ. Therefore, we aimed to describe the neurological presentations of patients with Cbl deficiency and investigate the potential biomarkers in predicting therapeutic responses with emphasis on cognitive aspects. MethodsFifty consecutive neurologically symptomatic patients with Cbl deficiency (serum level ≤ 250 pg/ml) were recruited. Serological data, baseline Mini-Mental Status Examination (MMSE) and Cognitive Abilities Screening Instrument, initial white matter hyperintensities (WMHs), and follow-up cognitive evaluations after Cbl supplementation were analyzed. Comparisons between poor (ΔMMSE < 0) and good (ΔMMSE ≥ 0) responders were performed. ResultsThe most common neurological presentations included cognitive complaints (78%), dementia (38%), anxiety (38%), and cerebrovascular disease (28%). Among the patients with cerebrovascular disease, a high prevalence of recurrence (57.1%) and related major intracranial artery occlusion (35.7%) were noted. Of the 30 patients with follow-up cognitive evaluations, benefits on short-term memory and verbal fluency (both p < 0.05) were noted. Among the good responders, benefits in total MMSE and short-term memory scores were significant (both p < 0.05). The good responders had higher serum folate levels than the poor responders (p < 0.05; Cohen's d = 1.044). The poor responders had a greater total WMH load and deep white matter hyperintensities (DWMHs) [both p < 0.05; Hedges' g of total WMHs = 0.8429; Hedges' g of DWMHs = 0.8890]. ConclusionsAlthough Cbl supplement therapy had positive and domain-specific benefits on cognition, the therapeutic responses were modulated by serum folate levels and initial WMH load. A serum folate level between 16.8 and 24.6 ng/mL had a synergistic benefit on cognition during Neuropsychiatry (London) (2017) 7(3) 186Research Min-Chien Tu and 2.00 µmol/l had neurological improvements after Cbl therapy [11]. In addition, limited studies have stressed the importance of evaluating both cognition and structural brain imaging in patients with a low Cbl status [8,14]. Taken together, changes in cognition related to replacement therapy may be affected by preexisting and relevant brain parenchymal damage. Therefore, in this study we aimed to (i) describe the various neuropsychiatric presentations before and after Cbl supplement treatment, and (ii) elucidate factors predicting therapeutic responses among patients with Cbl deficiency. Materials and Methods Subjects and clinical registryThis study recruited 50 consecutive symptomatic patients with Cbl deficiency (≤ 250 pg/mL) [15], who visited the Department of Neurology of our hospital from March 2012 to March 2015. The initial neurological disease...
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