Dataset Information

Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa.

ABSTRACT:

Introduction

We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa.

Methods

Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web-based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia.

Results

Six hundred thirty-five participants were assigned a final diagnostic category, with 298 requiring adjudication conference calls. Overall agreement between each rater's independent diagnosis and final diagnosis (via the portal or consensus conference) was 78.3%. A moderate level of agreement between raters' individual ratings and the final diagnostic outcomes was observed (average κ coefficient = 0.50).

Discussion

Findings show initial feasibility in using an online consensus approach for the diagnosis of cognitive impairment and dementia in remote, rural, and low-resource settings.

SUBMITTER: Bassil DT

PROVIDER: S-EPMC10072202 | biostudies-literature | 2023 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa.

Bassil Darina T DT Farrell Meagan T MT Weerman Albert A Guo Muqi M Wagner Ryan G RG Brickman Adam M AM Glymour M Maria MM Langa Kenneth M KM Manly Jennifer J JJ Tipping Brent B Butler India I Tollman Stephen S Berkman Lisa F LF

Alzheimer's & dementia (Amsterdam, Netherlands) 20230404 2

<h4>Introduction</h4>We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa.<h4>Methods</h4>Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web-based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or ...[more]

PMID: 37025188

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Project description:BackgroundMild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia in elderly people. Controversy surrounds their characterization, definition and application in clinical practice. In this article, we provide physicians with practical guidance on the definition, diagnosis and treatment of mild cognitive impairment and cognitive impairment, no dementia, based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006.MethodsWe developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Subsequent to the conference, we searched for additional articles published between January 2006 and January 2008. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.ResultsWe identified 2483 articles, of which 314 were considered to be relevant and of good or fair quality. From a synthesis of the evidence in these studies, we made 16 recommendations. In brief, family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted as part of a healthy lifestyle in elderly people and those with mild cognitive impairment. Vascular risk factors should be treated optimally. No other specific therapies can yet be recommended.InterpretationPhysicians will increasingly see elderly patients with mild memory loss, and learning an approach to diagnosing states such as mild cognitive impairment is now warranted. Close monitoring for progression to dementia, promotion of a healthy lifestyle and treatment of vascular risk factors are recommended for the management of patients with mild cognitive impairment.

Project description:Accurate and early diagnosis of Alzheimer's disease and vascular dementia is crucial for enabling timely interventions and improving patient outcomes. This study evaluates the diagnostic performance of plasma biomarkers (neurofilament light chain and phosphorylated tau181) and retinal biomarkers (retinal nerve fibre layer and ganglion cell-inner plexiform layer), individually and in combination, in differentiating moderate cognitive impairment and dementia from mild cognitive impairment and no cognitive impairment. A cross-sectional study was conducted involving 509 participants, aged 50 and older, recruited from a memory clinic. The participants were categorized as normal (n = 100), mild cognitive impairment (n = 144), moderate cognitive impairment (n = 90) or dementia (n = 175) based on detailed clinical assessments, neuropsychological testing and MRI scans. The thickness of the ganglion cell-inner plexiform layer (P < 0.001) and retinal nerve fibre layer (P = 0.030) decreased progressively from normal cognition to cognitive impairment and dementia. The thickest layers were observed in individuals with no cognitive impairment (mean ± standard deviation: ganglion cell-inner plexiform layer: 76 ± 11 µm, retinal nerve fibre layer: 92 ± 10 µm), while the thinnest layers were found in individuals with dementia (ganglion cell-inner plexiform layer: 72 ± 14 µm, retinal nerve fibre layer: 89 ± 12 µm). Plasma biomarker levels increased progressively from normal cognition to cognitive impairment and dementia (P < 0.001). Levels were lowest in individuals with no cognitive impairment [median (interquartile range): neurofilament light chain: 15 (9) pg/mL, phosphorylated tau181: 1.85 (1.00) pg/mL] and highest in those with dementia [neurofilament light chain: 34 (27) pg/mL, phosphorylated tau181: 3.24 (2.81) pg/mL]. After adjusting for retinal scan signal strength, neurofilament light chain showed a stronger negative association with retinal nerve fibre layer thickness [standardized beta estimate (β) = -0.184] and ganglion cell-inner plexiform layer thickness (β = -0.139) compared to phosphorylated tau181, which exhibited weaker associations with ganglion cell-inner plexiform layer (β = -0.091) and retinal nerve fibre layer (β = -0.059). While retinal parameters provided modest discriminatory ability (AUC = 0.60), plasma biomarkers demonstrated superior diagnostic performance (AUC = 0.76). Notably, neurofilament light chain had a stronger association with retinal thinning than phosphorylated tau181 and offered superior diagnostic value for identifying moderate cognitive decline. These findings underscore the potential of plasma biomarkers, particularly neurofilament light chain, for the early detection of dementia.

Dataset Information

Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa.

Introduction

Methods

Results

Discussion

Publications

Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa.

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