Screening for Cognitive Impairment in Older Adults

Patnode, Carrie D.; Perdue, Leslie A; Rossom, Rebecca C.; Rushkin, Megan C.; Redmond, Nadia; Thomas, Rachel; Lin, Jennifer S

doi:10.1001/jama.2019.22258

Cited by 208 publications

(133 citation statements)

References 344 publications

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“…Subjective memory complaints have been found useful to detect early AD [33]. Likewise objective screening tests have been found useful [34]. In fact it seems reasonable to not rely on subjective memory impairment to decide on whom further procedures are initiated but rather to include the results of objective tests in this decision [35].…”

Section: Discussionmentioning

confidence: 99%

On the conundrum of cognitive impairment due to depressive disorder in older patients

et al. 2020

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Objectives Depressive symptoms and cognitive impairment often concur in older persons. Differentiating the cause of cognitive impairment in older persons with Depressive Disorder (DD) from other diseases such as Alzheimer's Disease (AD) is challenging. The goal of this study was to characterize cognitive impairment in older persons with DD. Design Cross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018. Setting Gerontopsychiatric services of Ulm University at Bezirkskrankenhaus Gü nzburg serving as primary psychiatric care institution and tertiary referral center for psychiatric care for older persons. Partcipants DD was diagnosed according to ICD-10 criteria. When indicated by the medical history or neuropsychological assessment further diagnostic procedures were initiated. Cerebrospinal fluid (CSF) tap was routinely the first additional procedure. If patients did not consent to CSF tap or contraindications were present, 18 F-fluordesoxyglucose-PET (FDG-PET) or Amyloid-PET (Am-PET) were performed. Materials and methods Extensive neuropsychological test battery to assess cognitive profile. Results 457 subjects were diagnosed with DD (DD-all; age 50-94; 159 males, 298 females). Biomarkers were assessed in 176 persons; in 90 of these subjects AD-biomarkers were negative (DD-BM-; age 54-89; 40 males, 50 females), and in 86 subjects at least one biomarker

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Section: Discussionmentioning

confidence: 99%

On the conundrum of cognitive impairment due to depressive disorder in older patients

et al. 2020

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“…In addition to the 16 tests selected by the USPSTF, 13,14 others have recommended the Modified Mini-Mental Examination (3MS), 15 a four-item version of the MoCA, 16,17 and the Rowland Universal Dementia Assessment Scale (RUDAS), 18,19 all of which will be addressed below.…”

Section: Discussionmentioning

confidence: 99%

One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

Molnar

Benjamin

Hawkins

et al. 2020

J American Geriatrics Society

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Every year, millions of patients worldwide undergo cognitive testing. Unfortunately, new barriers to the use of free open access cognitive screening tools have arisen over time, making accessibility of tools unstable. This article is in follow-up to an editorial discussing alternative cognitive screening tools for those who cannot afford the costs of the Mini-Mental State Examination and Montreal Cognitive Assessment (see www.dementiascreen.ca). The current article outlines an emerging disruptive "free-to-fee" cycle where free open access cognitive screening tools are integrated into clinical practice and guidelines, where fees are then levied for the use of the tools, resulting in clinicians moving on to other tools. This article provides recommendations on means to break this cycle, including the development of tool kits of valid cognitive screening tools that authors have contracted not to charge for (i.e., have agreed to keep free open access). The PRACTICAL.1 Criteria (PRACTIcing Clinician Accessibility and Logistical Criteria Version 1) are introduced to help clinicians select from validated cognitive screening tools, considering barriers and facilitators, such as whether the cognitive screening tools are easy to score and free of cost. It is suggested that future systematic reviews embed the PRACTICAL.1 criteria, or refined future versions, as part of the standard of review. Methodological issues, the need for open access training to insure proper use of cognitive screening tools, and the need to anticipate growing ethnolinguistic diversity by developing tools that are less sensitive to educational, cultural, and linguistic bias are discussed in this opinion piece.

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“…The accurate identification of AD is exacerbated by the global lack of routine diagnostic tools for identifying patients early enough in their disease course, i.e., the "prodromal" period, for designing a suitable intervention or prospective treatment regimen. Of equal concern is our lack of basic understanding of the underlying root causes of AD and the widely observed variability in the clinical presentation of AD once the onset of the disease process is clinically recognized (Ashford et al, 1992;Hudon et al, 2020;Patnode et al, 2020). For AD only symptomatic treatments that suppress the clinical manifestations are currently available Hampel and Lista, 2013;Lukiw, 2013a,b;Praticò, 2013;Hampel et al, 2014;Kim et al, 2014;Yanagida et al, 2017;Blennow and Zetterberg, 2018;Cole and Seabrook, 2020).…”

Section: Overviewmentioning

confidence: 99%

“…These include a significant dedication of medical personnel to individual AD patients in cooperation with family and caregivers, multiple combinatorial approaches including extensive clinical assessment, intermittent brain neuroimaging over the onset and course of AD and a host of multiple molecular, genetic, epigenetic, neurophysiological, and neurobiological strategies with focus on CSF, serum biomarkers, miRNA and perhaps other sncRNA abundance in these biofluid compartments. While significant progress is being made: it is important to point out that: (i) combinatorial diagnostic methodologies incorporating molecular genetic markers such as miRNA screening combined with DNA-based gene mutation analysis, advanced MRI-or PET-neuroimaging techniques and conscientious clinical evaluations, still have difficulty in the diagnosis of AD, often requiring the stratification of AD into complex subgroups and post-mortem verification (Guerreiro et al, 2012;Pogue and Lukiw, 2018;Penner et al, 2019;Peña-Bautista et al, 2019;Guest et al, 2020;Habes et al, 2020;Hampel et al, 2020a,b;Hudon et al, 2020;Khoury and Grossberg, 2020;Sherva et al, 2014;Rossini et al, 2020;Serpente et al, 2020;Sims et al, 2020;Singh and Yadav, 2020;Swarbrick et al, 2019;Turner et al, 2020;van den Berg et al, 2020;Weller, 2020); and (ii) currently available pharmacology and strategic treatments (including targeted drug delivery) based on these diagnostic tools, in the majority of cases, still do not directly address the primary underlying cause of either EOAD or LOAD but are sadly limited to the temporary alleviation of clinical symptoms (Di Resta and Ferrari, 2019;Veitch et al, 2019;Guest et al, 2020;Khoury and Grossberg, 2020;Lewczuk et al, 2020;Patnode et al, 2020;Rahman et al, 2020).…”

Section: Microrna "Human Biochemical Individuality" and Therapeutic mentioning

confidence: 99%

microRNA-Based Biomarkers in Alzheimer’s Disease (AD)

et al. 2020

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Alzheimer's disease (AD) is a multifactorial, age-related neurological disease characterized by complex pathophysiological dynamics taking place at multiple biological levels, including molecular, genetic, epigenetic, cellular and large-scale brain networks. These alterations account for multiple pathophysiological mechanisms such as brain protein accumulation, neuroinflammatory/neuro-immune processes, synaptic dysfunction, and neurodegeneration that eventually lead to cognitive and behavioral decline. Alterations in microRNA (miRNA) signaling have been implicated in the epigenetics and molecular genetics of all neurobiological processes associated with AD pathophysiology. These changes encompass altered miRNA abundance, speciation and complexity in anatomical regions of the CNS targeted by the disease, including modified miRNA expression patterns in brain tissues, the systemic circulation, the extracellular fluid (ECF) and the cerebrospinal fluid (CSF). miRNAs have been investigated as candidate biomarkers for AD diagnosis, disease prediction, prognosis and therapeutic purposes because of their involvement in multiple brain signaling pathways in both health and disease. In this review we will: (i) highlight the significantly heterogeneous nature of miRNA expression and complexity in AD tissues and biofluids; (ii) address how information may be extracted from these data to be used as a diagnostic, prognostic and/or screening tools across the entire continuum of AD, from the preclinical stage, through the prodromal, i.e., mild cognitive impairment (MCI) phase all the way to clinically overt dementia; and (iii) consider how specific miRNA expression patterns could be categorized using miRNA reporters that span AD pathophysiological initiation and disease progression.

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Screening for Cognitive Impairment in Older Adults

Cited by 208 publications

References 344 publications

On the conundrum of cognitive impairment due to depressive disorder in older patients

On the conundrum of cognitive impairment due to depressive disorder in older patients

One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

microRNA-Based Biomarkers in Alzheimer’s Disease (AD)

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