Dataset Information

Diagnostic Precision in the Detection of Mild Cognitive Impairment: A Comparison of Two Approaches.

ABSTRACT:

Objective

This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging-Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria.

Design

Cross-sectional examination of baseline data from the Prevention of Alzheimer's dementia (AD) using Cognitive remediation and transcranial direct current stimulation in Mild Cognitive Impairment (MCI) and Depression (PACt-MD; ClinicalTrials.gov Identifier: NCT02386670) trial.

Setting

Five geriatric psychiatry and memory clinics located at academic hospitals affiliated with the Department of Psychiatry, University of Toronto.

Participants

Older adults (N = 431) with a history of major depressive disorder (MDD) in remission, MCI, or both.

Measurements

Main outcome was a comparison of NIA-AA diagnostic rates of MCI or dementia versus DSM-5 rates of mild or major neurocognitive disorder. Secondary analyses examined demographic, race, gender, premorbid intellectual ability, psychosocial, health-related, and genetic predictors of discrepancy between DSM-5 and NIA-AA diagnoses.

Results

There were 103 (23.8%) discrepant cases, with most (91; 88.3%) of these discrepant cases reflecting more impairment with the detailed neuropsychological testing and NIA-AA criteria. Discrepancies were more likely in individuals with a history of MDD or who had at least one ApoE4 allele.

Conclusion

The NIA-AA criteria, in conjunction with comprehensive neuropsychological testing, identified a greater prevalence of cognitive impairment than DSM-5 criteria, in conjunction with the Montreal Cognitive Assessment. Detailed neuropsychological evaluations are recommended for older adults who have a history of MDD or a genetic vulnerability to dementia.

SUBMITTER: Weinstein AM

PROVIDER: S-EPMC8720569 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

Diagnostic Precision in the Detection of Mild Cognitive Impairment: A Comparison of Two Approaches.

Weinstein Andrea M AM Gujral Swathi S Butters Meryl A MA Bowie Christopher R CR Fischer Corinne E CE Flint Alastair J AJ Herrmann Nathan N Kennedy James L JL Mah Linda L Ovaysikia Shima S Pollock Bruce G BG Rajji Tarek K TK Mulsant Benoit H BH

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20210414 1

<h4>Objective</h4>This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging-Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria.<h4>Design</h4>Cross-sectional examination of baseline data from the Prevention of Alzheimer's dementia (AD) using Cognitive remediation and trans ...[more]

PMID: 34023224

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Project description:We compared two methods of diagnosing mild cognitive impairment (MCI): conventional Petersen/Winblad criteria as operationalized by the Alzheimer's Disease Neuroimaging Initiative (ADNI) and an actuarial neuropsychological method put forward by Jak and Bondi designed to balance sensitivity and reliability. 1,150 ADNI participants were diagnosed at baseline as cognitively normal (CN) or MCI via ADNI criteria (MCI: n = 846; CN: n = 304) or Jak/Bondi criteria (MCI: n = 401; CN: n = 749), and the two MCI samples were submitted to cluster and discriminant function analyses. Resulting cluster groups were then compared and further examined for APOE allelic frequencies, cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarker levels, and clinical outcomes. Results revealed that both criteria produced a mildly impaired Amnestic subtype and a more severely impaired Dysexecutive/Mixed subtype. The neuropsychological Jak/Bondi criteria uniquely yielded a third Impaired Language subtype, whereas conventional Petersen/Winblad ADNI criteria produced a third subtype comprising nearly one-third of the sample that performed within normal limits across the cognitive measures, suggesting this method's susceptibility to false positive diagnoses. MCI participants diagnosed via neuropsychological criteria yielded dissociable cognitive phenotypes, significant CSF AD biomarker associations, more stable diagnoses, and identified greater percentages of participants who progressed to dementia than conventional MCI diagnostic criteria. Importantly, the actuarial neuropsychological method did not produce a subtype that performed within normal limits on the cognitive testing, unlike the conventional diagnostic method. Findings support the need for refinement of MCI diagnoses to incorporate more comprehensive neuropsychological methods, with resulting gains in empirical characterization of specific cognitive phenotypes, biomarker associations, stability of diagnoses, and prediction of progression. Refinement of MCI diagnostic methods may also yield gains in biomarker and clinical trial study findings because of improvements in sample compositions of 'true positive' cases and removal of 'false positive' cases.

Project description:The Optimal electrode configuration of Electroencephalograms (EEG) systems for mild cognitive impairment (MCI) detection and monitoring in non-clinical settings, i.e. number of electrodes and the positions of the electrodes, remains to be explored. In the current study, we explored the optimization of electrode configuration for MCI detection. We used a 32-channel EEG device to record the data of 21 MCI patients and 20 cognitively normal elderly (NC) undergoing working memory (WM) tasks. Based on the differential value (MCI group vs. NC group) from the Power Spectral Density (PSD) value of each electrode in θ and α frequency band during WM coding stage, six different electrode configurations were obtained: (1) four electrodes in the occipital lobe (OCL4); (2) three electrodes in the prefrontal lobe (PRL3); (3) four electrodes in the parietal lobe (PLL4), (4) eight electrodes in occipital combined parietal lobe (OPL8), (5) seven electrodes in occipital combined prefrontal lobe (OPL7); and (6) seven electrodes in parietal combined prefrontal lobe (PPL7). A multi-parameter combination-assisted binary logistic regression model was established to distinguish two groups. Receiver operating characteristic (ROC) curves were used to evaluate the MCI diagnostic power of each electrode configuration. The area under curve (AUC) of the ROC of electrode configurations OCL4, PRL3, PLL4, OPL8, OPL7 and PPL7 were 0.765, 0.683, 0.729, 0.83, 0.788, and 0.769, respectively. And the sensitivity of six electrode configurations were 0.962, 0.794, 0.873, 0.943, 0.859, and 0.938, respectively. Among these six configurations, OCL4, i.e. PO3, PO4, PO8, and PO7, had the highest sensitivity 96.2%, which meant that relying solely on these four electrodes of the occipital lobe had the potential to serve as an objective tool for preliminary screening of MCI. The abnormal brain rhythm characteristics of the frontal, parietal, and occipital lobes in the memory encoding stage of MCI provide a new perspective for MCI-WM impairment, which has the potential to be a novel biomarker for the early detection of pathological age-related cognitive decline. Further, a potential four-electrode configuration may be used for a novel detecting and monitoring EEG system of MCI in non-clinical settings.

Dataset Information

Diagnostic Precision in the Detection of Mild Cognitive Impairment: A Comparison of Two Approaches.

Objective

Design

Setting

Participants

Measurements

Results

Conclusion

Publications

Diagnostic Precision in the Detection of Mild Cognitive Impairment: A Comparison of Two Approaches.

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