Two Year Outcomes, Cognitive and Behavioral Markers of Decline in Healthy, Cognitively Normal Older Persons with Global Deterioration Scale Stage 2 (Subjective Cognitive Decline with Impairment)

Reisberg, Barry; Torossian, Carol; Shulman, Melanie; Monteiro, Isabel; Boksay, István; Golomb, James; BenArous, Francoise Guillo; Ulysse, Anaztasia; Oo, Thet; Vedvyas, Alok; Rao, Julia; Marsh, Karyn; Kluger, Alan; Sangha, Jaspreet; Hassan, Mudasar; Alshalabi, Munther; Arain, Fauzia; Shaikh, Noor Ahmed; Buj, Maja; Kenowsky, Sunnie; Masurkar, Arjun V.; Noroozıan, Maryam; Sánchez-Saudinós, Mar A Belén; Blesa, Rafael; Auer, Stefanie; Zhang, Yian; Leon, Mony J. de; Sadowski, Marcin; Wısnıewskı, Thomas; Gauthier, Serge; Shao, Yongzhao

doi:10.3233/jad-180341

Cited by 12 publications

(8 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a clinical situation, where a patient seeks medical help due to cognitive symptoms, the physician needs to be able to differentiate MCI from the more benign condition SCD. Although SCD can be a very early sign of a neurodegenerative disorder, the annual progression rate from SCD to MCI is only 6-7% [44][45][46][47], and in community-based populations, the incidence of AD is not significantly higher in SCD compared to healthy controls [48]. On the other hand, for MCI, the annual conversion rate to AD dementia range from 7.5% to 16.5% in clinic-based studies, and from 5.4% to 11.5% in community-based samples [49].…”

Section: Discussionmentioning

confidence: 99%

Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline

Petrazzuoli

Vestberg

Midlöv

et al. 2020

JAD

View full text Add to dashboard Cite

Background: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage. Objective: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD. Methods: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population. Results: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE < 27 points or AQT > 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p < 0.001-0.05); otherwise no differences were seen between any combination of two or three tests. Conclusion: Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.

show abstract

Section: Discussionmentioning

confidence: 99%

Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline

Petrazzuoli

Vestberg

Midlöv

et al. 2020

JAD

View full text Add to dashboard Cite

show abstract

“….Patients with a GDS score of 2 were categorized as having very mild cognitive/subjective cognitive impairment [ 36 ]. GDS of 2 or higher is the first stage on the scale that represents cognitive symptoms, and it was rated as pathological [ 37 ].…”

Section: Methodsmentioning

confidence: 99%

Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

et al. 2021

View full text Add to dashboard Cite

Background Chronic brain pathology and pre-stroke cognitive impairment (PCI) is predictive of post-stroke dementia. The aim of the current study was to measure pre-stroke neurodegenerative and vascular disease burden found on brain MRI and to assess the association between pre-stroke imaging pathology and PCI, whilst also looking for potential sex differences. Methods This prospective brain MRI cohort is part of the multicentre Norwegian cognitive impairment after stroke (Nor-COAST) study. Patients hospitalized with acute ischemic or hemorrhagic stroke were included from five participating stroke units. Visual rating scales were used to categorize baseline MRIs (N = 410) as vascular, neurodegenerative, mixed, or normal, based on the presence of pathological imaging findings. Pre-stroke cognition was assessed by interviews of patients or caregivers using the Global Deterioration Scale (GDS). Stroke severity was assessed with the National Institute of Health Stroke Scale (NIHSS). Univariate and multiple logistic regression analyses were performed to investigate the association between imaging markers, PCI, and sex. Results Patients’ (N = 410) mean (SD) age was 73.6 (±11) years; 182 (44%) participants were female, the mean (SD) NIHSS at admittance was 4.1 (±5). In 68% of the participants, at least one pathological imaging marker was found. Medial temporal lobe atrophy (MTA) was present in 30% of patients, white matter hyperintensities (WMH) in 38% of patients and lacunes in 35% of patients. PCI was found in 30% of the patients. PCI was associated with cerebrovascular pathology (OR 2.5; CI = 1.4 to 4.5, p = 0.001) and mixed pathology (OR 3.4; CI = 1.9 to 6.1, p = 0.001) but was not associated with neurodegeneration (OR 1.0; CI = 0.5 to 2.2; p = 0.973). Pathological MRI markers, including MTA and lacunes, were more prevalent among men, as was a history of clinical stroke prior to the index stroke. The OR of PCI for women was not significantly increased (OR 1.2; CI = 0.8 to 1.9; p = 0.3). Conclusions Pre-stroke chronic brain pathology is common in stroke patients, with a higher prevalence in men. Vascular pathology and mixed pathology are associated with PCI. There were no significant sex differences for the risk of PCI. Trial registration NCT02650531, date of registration: 08.01.2016.

show abstract

“…Since GDS 2 is considered the first stage of pathological decline we rated it as pathological. [32]. Patients with GDS 1 were scored as not having cognitive impairment.…”

Section: Methodsmentioning

confidence: 99%

“…Since GDS 2 is considered the first stage of pathological decline we rated it as pathological. [32].Patients with GDS 1 were scored as not having cognitive impairment. We used the GDS score to analyze the association between imaging marker groups and cognitive function before stroke.…”

Section: Cognitive Assessment and Cerebrovascular Risk Factorsmentioning

confidence: 99%

Vascular brain pathology is more important than neurodegeneration in pathogenesis of pre-stroke cognitive impairment

Schellhorn

Zucknick

Askim

et al. 2020

Preprint

View full text Add to dashboard Cite

Introduction: To better understand the development of post-stroke cognitive impairment, we explored the association between pre-stroke neuroimaging features and pre-stroke cognitive impairment and investigated possible gender differences. Few previous studies on this topic have been performed. Methods: In this large prospective longitudinal multicenter brain-MRI cohort study, patients admitted to five stroke units at five different Norwegian hospitals were recruited as part of the Norwegian cognitive impairment after stroke study. Visual radiological assessment of small vessel disease and neurodegenerative changes were performed on brain MRI from 410 patients. Pre-stroke cognition was assessed using the Global Deterioration Scale. Results: At least one pathological marker was found in 68% of the patients. The mean age (SD) of the patients with no pathological changes other than the acute stroke, was 70 (12.9) and 75 (10.2) years for those with pathological scans (p <= 0.001). Men were more likely to have at least one pathological brain MRI finding, lacunes, or pathological medial temporal lobe atrophy. The highest percentage of patients with a pathological pre-stroke GDS was found in the 'cerebrovascular pathology' group (37.5%) and in the 'mixed pathology'-group (44%). In these groups, both men and women had an increased risk of impaired pre-stroke cognition. Conclusion: The majority of patients showed preexisting structural brain pathology. Cerebrovascular pathology was the dominating imaging finding associated with cognitive impairment, thus indicating that the pathogenesis of pre-stroke cognitive impairment might be driven more by small vessel disease (SVD) than neurodegenerative changes. Gender differences exist, with less pathology in women.

show abstract

Two Year Outcomes, Cognitive and Behavioral Markers of Decline in Healthy, Cognitively Normal Older Persons with Global Deterioration Scale Stage 2 (Subjective Cognitive Decline with Impairment)

Cited by 12 publications

References 61 publications

Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline

Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline

Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

Vascular brain pathology is more important than neurodegeneration in pathogenesis of pre-stroke cognitive impairment

Contact Info

Product

Resources

About