Elderly Cognitive Impairment, Risk Factors And Psychosocial Research

Background:Whether the severity and cause of cognitive impairment in elderly could be diagnosed accurately is of great significance to early prevention and treatment of dementia. Diagnostic accuracy is important foundation of further research.Objective:To explore the diagnosis of cognitive impairment in elderly in community, and to lay an important foundation of following study.Methods:Subjects of baseline cognitive impairment group were recruited from cases diagnosed by Memory Clinic of Huashan Hospital, whereas subjects of baseline control group, volunteers without cognitive complaints, were recruited from the community served by the Clinic. Subjects of cognitive impairment group and control group were live in the same community. In addition to history taking and physical examination, all subjects completed a bakery of neuropsychological tests (nearly 20 tests) covering activities of daily living, memory, language, attention, executive function and other cognitive domains. The criteria used for diagnosis including DSM-IV, NINCDS-ADRDA, NINDS-AIREN for dementia and the broad diagnostic criteria for MCI by the international working group on MCI.Results:23 of 103 cases with complete information were changed their diagnosis.9 cases of dementia were re-diagnosed as MCI in baseline cognitive impairment group of 55 cases, whereas 2 cases of normal were re-diagnosed as dementia,12 cases of normal were re-diagnosed as MCI in normal control group of 48 cases. In the 12 cases re-diagnosed as MCI from normal,9 cases were in high school and above educational level.In the 9 cases re-diagnosed as MCI from dementia,6 cases were illiteracy. In the 12 cases re-diagnosed as MCI from normal,4 of them did not go to doctor because their evaluations from subjects and caregivers of whether the subjects had cognitive impairment were inconsistent,4 of them denied their cognitive impairment although they acknowledged their memory loss. Finally,6 cases without cognitive complaints were diagnosed as MCI according to their objective deficits in tests evaluating delayed memory, language or executive function, although neither the subjects nor caregivers mentioned symptoms of cognitive impairment. Conclusion:Comprehensive and detailed diagnostic methods and diagnostic processes were of important significance to improve the diagnostic accuracy, especially of the diagnosis of MCI. Background:Diabetes has been identified as a risk factor for MCI, Alzheimer's disease, vascular dementia and cognitive decline. However, the association between variations in fasting blood glucose (FBG) in the normal range and and dementia has not been studied.Objective:To assess the association between fasting blood glucose and cognitive status (normal cognition, amnestic Mild Cognitive Impairment aMCI, dementia).Methods:An age-and sex-matched sample of 32 dementia patients,27 aMCI patients and 31 controls with normal cognition (mean age=74.0,49% female) was given a neurologic exam, comprehensive neuropsychological battery, MRI scan, and extensive risk factor evaluation. Logistic regression was used to compare individuals with normal cognition, MCI and dementia. Analyses were repeated restricted to those with FBG in the normal range (FBG <6.1 mmol/l). The association between FBG and scores on individual neuropsychological tests was examined using partial correlation.Results:Controlling for the Modified Hachinski Ischemic score and MRI-derived brain and white mater hyperintensity volumes, higher FBG was associated with dementia vs. aMCI status (OR=3.91; 95%CI:1.31-11.62). This association remained (OR= 5.54 (1.22-25.08) when the analyses were restricted to the subjects with normal levels of FBG. Unadjusted analyses comparing dementia patients with controls also showed significant associations between FBG and dementia status. When patients with normal FBG were divided into those with low and high normal FBG, the percentage of dementia patients with high normal FBG (84%) was significantly higher than the percentage of aMCI patients with high normal FBG (32.9%) (c2=13.9, p<0.001). FBG did not predict aMCI status compared with normal cognition.Conclusions:Higher fasting blood glucose is associated with dementia independently of vascular risk factors and MRI indicators of vascular disease, and remains a significant risk factor when analyses are restricted to subjects with normal levels of FBG. The results suggest that a high normal level of FBG may be a risk factor for dementia. Background:It has been suggested that lower overall rates of dementia and Mild Cognitive Impairment in China may be due to a lower frequency of the Apolipoprotein E (APOE)-ε4 allele in the Chinese population. The question of how the isoforms (ε2 andε4) relate to dementia risk in non-Caucasians is important, because it may point to a common pathogenesis across racial/ethnic groups.Objective:We examined allele frequencies for APOE in a sample of cognitively normal, community-dwelling elderly and in cases with mild cognitive impairment and dementia in Shanghai, China.Methods:Thirty-four MCI and 34 dementia cases were recruited from the Memory Disorders Clinic at Hua Shan Hospital in urban Shanghai and 32 controls with normal cognition were recruited using a door-to-door approach in a residential community served by this hospital. All participants were genotyped for APOE using standard methods.Results:We analyzed data from 30 amnestic MCI patients (aMCI),34 dementia patients and 32 controls. Mean ages were 74.8±4.0,74.4±5.4 and 73.4±5.5 among aMCI, dements and controls, respectively, with about 50% female in each group. There were noε2ε2 genotypes.APOE frequencies among controls were, forε2,0.11;ε3,0.84 andε4,0.04; among MCI, frequencies forε2,ε3 andε4 were 0.05,0.77 and 0.18, respectively, and for dementia,0.02,0.83 and 0.15. In logistic regression models, the Odds Ratio was 5.6 for dementia (95% Cl=1.09-29.3) and 4.7 for MCI (95%Cl=0.90-25.2) associated with any s4 allele. Presence of anε2 allele was inversely associated with dementia (OR=0.12,95% CI=0.013-0.997) and MCI (OR=0.38,95% CI=0.08-1.61).Conclusions:The APOE-ε4 allele increases and theε2 allele decreases the risk of dementia in comparison with normal cognition. Similar trends, though non-significant, were observed for aMCI. Despite the overall lower frequency of theε4 allele in Chinese populations, it remains an important risk factor for cognitive disorders in China. This points to a common pathogenesis of these disorders in different ethnic groups. Background:Studies on cognitive disorder in the elderly have focused on the clinical, psychological, genetic, imaging and other areas. However, studies on social psychology of patients and their caregivers have not yet been carried out well; especially the conditions of patients with mild cognitive impairment (MCI) and their caregivers were lack of attention.Objective:To investigate the social psychological conditions of MCI patients and their caregivers in communities.Methods:Screened by the standardized diagnosis routine of cognitive impairment,103 patients and their caregivers were recruited and then divided into 3 groups of normal control(NC) (n=34), MCI (n=35) and dementia (n=34). Quality of life (QOL) and psychological status of subjects were evaluated by Chinese version of the EQ-5D self-report questionnaire (EQ-5D), Alzheimer's Carer's Quality of Life Instrument (ACQLI) and others scales.Results:EQ-VAS scores between 3 groups were significantly different. Multiple comparison showed significant differences (p<0.001) that NC group scored the highest, followed by the MCI group, and dementia group scored the lowest. ED-5Q score significantly correlated with total score of CASI. Comparison of ACQLI score between 3 groups showed significant differences (p<0.001); multiple comparison showed that total score of ACQLI in caregiver of dementia patients significantly different from NC and MCI group (p<0.001), whereas no statistical difference were found between NC and MCI group. Total score of ACQLI negatively correlated with EQ-5D index and EQ-VAS score.Conclusion:QOL decreased with the deterioration of cognitive disorder; QOL of caregivers decreased with the decline of QOL of patients with cognitive disorder. QOL of caregivers of MCI group, as well the NC group, were much better than that of dementia group. It will be important for elderly patients with cognitive disorder and their caregivers to improve their QOL if effective prevention and control could defer the transformation of MCI to dementia.