| Background:Mild cognitive impairment(MCI) refers to a transitional state between the cognition of normal aging and dementia.Screening for MCI has crucial meaning for early diagnosis or intervention for dementia.MCI can be further divided into four subtypes as follows:Ⅰ:pure memory impairment(Amnestic MCI-single domain, aMCI-s);Ⅱ:multi-domain impairment including memory deficit(Amnestic MCI-multiple domain,aMCI-m);Ⅲ:single-domain impairment without memory disorder(Nonamnestic MCI-single domain,naMCI-s);Ⅳ:multi-domain impairment without memory disorder(Nonamnestic MCI-multiple domain,naMCI-m).SubtypeⅠandⅡare amnestic MCI,while subtypeⅢandⅣare non-amnestic MCI.Reports of validation of the Chinese version of Montreal Cognitive Assessment(MoCA) of three cities(Beijing,Guangzhou and Chongqing) had been published.However,its validation of Shanghai is still unknown.Moreover,there still questions that whether MoCA can identify non-amnestic MCI in early stage.Objective:To examine the validity of the Shanghai version of MoCA(MoCA-S) and the newly designed Quick Cognitive Screening Test(QCST).Methods:(1) 178 healthy controls(46 cases experenced 5 to 8 education years,52 cases experenced 9 to 12 education years and 80 cases experenced 13 and over education years),104 MCI patients including 30 aMCI-s,43 aMCI-m and 31naMCI, (31 cases experenced 5 to 8 education years,34 cases experenced 9 to 12 education years and 39 cases experenced 13 and over education years) and 32 AD patients were recruited.All participants were administered MoCA-S,MMSE and other neuropsychological tests covering global cognitive function,executive function, memory function,language function and visual spatial skills.Comparisons were made between NC,MCI and AD or between aMCI-s,aMCI-m and naMCI of their MoCA-S performance.We made the cut-off of MoCA-S according to education years.(2) 171 healthy controls(41 cases experenced 5 to 8 education years,54 cases experenced 9 to 12 education years and 76 cases experenced 13 and over education years) and 83 MCI patients including 26 aMCI-s,36 aMCI-m and 21 naMCI(11 cases experienced 5 to 8 education years,42 cases experenced 9 to 12 education years and 30 cases experenced 13 and over education years) were recruited.All participants were administered QCST. Comparisons were made between the items of QCST and tests which are representative of each cognitive domain.Comparisons were made between NC and MCI or between aMCI-s,aMCI-m and naMCI as well.We made the cut-off of QCST according to education years.Results:(1) Comparison between NC,MCI and AD of MoCA-S performance shows significant differences.MCI group performs the worst in delayed memory and the best in similarities test and clause repeat relative to NC group.The cut-offs of MoCA-S in elderly people according to their education years were equal to or less than score of 21 points for 5-8 years,22 for 9-12 years and 23 for 13 and over years, respectively(Sensitivity:76.0%as a whole;70%for aMCI-s,93%for aMCI-m,and 55%for naMCI,respectively;Specialty:80%).(2) Comparison between NC and MCI of QCST total score and subscores shows significant differences.The cut-offs of QCST in elderly people according to their education years were equal to or less than score of 70 points for 5-8 years,73 for 9-12 years and 76 for 13 and over years, respectively(Sensitivity:88.3%as a whole;80.8%for aMCI-s,91.7%for aMCI-m, and 90.5%for naMCI,respectively;Specialty:81.9%).Conclusion:MoCA-S and QCST show good sensitivity and specialty in screening MCI.MoCA-S is suitable for screening aMCI patients,while QCST for both aMCI and naMCI patients. Background:There has been disagreement over the prevalence of apraxia and the stage of the disease at which it occurs most commonly,although apraxia is one of the core symptoms of the NINCDS-ADRDA(National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer's Disease and Related Disorders Association) criteria.The previous studies separated the components between "semantic memory and actions" or "pantomime,imitation and act use" into different subsets to assess the praxic function that some parts of the praxic function were evaluated whereas other parts were ignored.So it is hard to know the distribution of different apraxic types or whether double dissociate of praxic components exists. Negri et al tested a group of unilateral stroke patients for their ability to demonstrate the use of the objects,recognize the objects,recognize the corresponding object-associated pantomimes,and imitate those same pantomimes,analyzing the impaired domains to learn whether apraxia is occurs at the stage of reception or motor processing.Such paradigm has never used in researches of patients with Alzheimer's disease(AD).Objective:To investigate the apraxic features of AD patients by evaluating the different components in a battery of praxic tests.To find a good test for screening the praxic function of AD patients.Methods:25 mild AD patients,14 moderate to severe AD patients,23 patients with mild cognitive impairment(MCI) and 60 normal controls(NC) were assessed on a battery of praxic tests,involving transitive and intransitive actions,meaningful and meaningless gestures both on command and imitation.The items of conceptual system includes object naming,object function and action naming,whereas the production system includes pantomime,actual use,imitation of pantomime and actual use.The subjects should also accomplished Mini-Mental Status Examination,Clinical Dementia Rating scale and other neuropsychological tests,scales for activities of daily living life as well.Comparison was made between the four groups.Results.MCI performed worse in gesture imitation involving both hands and object naming relative to NC.The features of praxic impairment in AD patients were as follows:1) The correct percentage of transitive single actions:imitation of pantomime＜pantomime＜imitation of actual use＜actual use.2) The performance of transitive both hands sequence actions(TBSA) was worse than that of transitive one hand single actions(TOA) in actual use.3) The performance of transitive both hands single actions(TBA) was significantly worse than that of TOA.4) The performance of actual use was best in different types of tasks of production system.5) The impairment of meaningless gestures was more severe than that of meaningful gestures.6) The sensitivity of intransitive complex gestures imitation(ICGI) to identify AD patients from NC was 81.3%,while the specialty was 88.9%.7) The praxic impairment was most severe in imitation,less severe in sequence and production of actions,and mildest in concept of objects or tools in mild AD patients, while most severe in imitation,less severe in concept of objects or tools and sequence of actions,and mildest in production of actions in moderate to severe AD patients.Conclusion:Praxic impairment could occur in early stage of AD,even in MCI.All performances of AD patients were impairment in different domains of praxia.The impairment of moderate to severe AD was more severe than that of mild AD.ICGI could be used as a screening instrument for praxic function in AD patients. |
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