Struggling to make Indian Curry…. Early indication of dementia?

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The September International Psychogeriatrics Article of the Month is entitled “Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population” by P. De Vriendt, T. Mets, M. Petrovic and E. Gorus.


This blog post was written for us by one of the paper’s authors, Prof. Dr. Patricia De Vriendt

Struggling to make Indian Curry…. Early indication of dementia?

With a diagnosis of Alzheimer’s dementia (AD) comes an understanding that the affected individual will suffer an inevitable and progressive decline in their functional abilities. In order to identify and treat dementia as early as possible the concept of Mild Cognitive Impairment (MCI) was established. MCI is seen as the intermediate stage between normal aging and AD and is characterized by subjective and objective memory impairments in the absence of functional decline [the loss of ability to perform everyday tasks without assistance]. However, this criterion is controversial since our previous studies and also many other studies showed that mild changes in Activities of Daily Living (ADL) can be present and probably predict conversion to dementia.

The overall issue was whether an evaluation of ADL might underpin the diagnosis of MCI in a valid and reliable way, with an accuracy comparable with cognitive assessment.

For this reason, we hypothesized that an evaluation of ADL should be done on the level of “the advanced (a)-ADL”, encompassing all the most complex activities one can perform, such as using (household) technology, preparing complex dishes, driving, going on holidays, doing sports, practice hobbies, or arts, etc. The a-ADL are considered as the most difficult activities, requiring high level cognitive organization, and accordingly are most vulnerable to early cognitive decline.

We set out to study this issue by developing and validating a new advanced (a)-ADL tool, based on the International Classification of Functioning, Disability and Health framework (ICF), evaluating high-level activities. Taking each participant as their own reference, we calculated a global Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), based on the number of activities performed and the severity and causes of the functional problem.

The study published as ‘paper of the month’ evaluated the discriminative power of the a-ADL tool in order to establish diagnostic accuracy.

Based upon clinical evaluation and a set of global, cognitive, mood, and functional assessments, 150 community-dwelling participants (average age 80.3 years) were included and diagnosed as (1) cognitively healthy participants (n = 50); (2) patients with a-MCI (n = 48), or (3) mild to moderate AD (n = 52). The a-ADL tool was not a part of the clinical evaluation.

The a-ADL tool was able to detect the diagnostic distinction between cognitively healthy older persons, patients with a-MCI, and patients with AD. Both the a-ADL-DI and the a-ADL-CDI – of interest in this population – showed promising results and differed significantly between the groups; in contrast, the a-ADL-PDI did not.

What is the take home message of this research?

The a-ADL tool showed a good ability to distinguish normal and pathological cognitive aging. Its discriminative power for underlying causes of limitations is an advantage. Concluding, the evaluation of a-ADL, when administered in a systematic and scientific way, enables the diagnosis of MCI and – moreover – is experienced as less invasive by the patients. In the same time, this evaluation offers directions for clinical treatment, rehabilitation, advice and coaching.


The full paper “Discriminative power of the advanced activities of daily living (a-ADL) tool in the diagnosis of mild cognitive impairment in an older population” is available free of charge for a limited time here.

The commentary paper “A useful development in measuring activities of daily living” by David Ames is also available free of charge here.

Variability in estimating the self-awareness of memory deficits


The March International Psychogeriatrics Article of the Month is entitled ‘Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease’ by Johann Lehrner, Sandra Kogler, Claus Lamm, Doris Moser, Stefanie Klug, Gisela Pusswald, Peter Dal-Bianco, Walter Pirker and Eduard Auff

As the world population ages, we face sharp rises in prevalence rates for neurodegenerative diseases. In order to minimize entailing individual and societal burdens, early diagnosis is becoming increasingly important. Efforts to enable early recognition of impending cognitive decline led to the development of the concept of Mild Cognitive Impairment (MCI), which describes a transitional stage between normal age-related memory decline and dementia. Yet, not all individuals diagnosed with MCI can be considered as being in a prodromal phase of dementia. Accordingly, ongoing research is now focusing on the identification of (a) those individuals with MCI who are most likely to convert to dementia and (b) asymptomatic individuals in a pre-MCI stage. Yet, which early markers are available for their identification?

With some evidence pointing towards a connection between low memory awareness – an inability to (fully) recognize memory deficits – and subsequent memory decline, awareness measures bear potential as an important marker of underlying dementia pathologies. However, as research in this field is defined by inconsistencies, this hypothesis needs further investigation.

We therefore used data concerning our patients’ subjective memory appraisals and objective memory performance to create an awareness index, which allowed us to compare levels of awareness (and frequencies of memory overestimation) across healthy elderly people and patients with varying degrees of memory impairment. Our question was whether our approach would reveal characteristic awareness differences similar to prior research.

As expected, our findings suggest that self-awareness of memory deficits decreases as cognitive deficits – especially memory deficits – increase. Accordingly, the highest rate of overestimation of memory function was found among patients suffering from Alzheimer’s disease (63%), followed by amnestic MCI patients without and with Parkinson’s disease (46%, 38%), while patients with cognitive deficits other than memory (non-amnestic MCI) showed a tendency towards underestimation of memory function. Our analyses further revealed considerable between-group overlaps in awareness scores and strong influences of non-cognitive factors such as depression.

The main implication of our study is that memory awareness reflects objective deterioration to some extent, but that there is considerable inter-individual variability in awareness. It is this variability which gives rise to the question whether differences in awareness are predictive of future conversion to dementia.

We hold the view that research in this field is important insofar as awareness measures are of high practical relevance: As opposed to biomarkers and neuroimaging technologies, which are of restricted availability in primary care settings, both measures of subjective memory complaint and objective memory performance provide easily, time- and cost efficiently accessible sources of information. Moreover, they count among the standard repertoire of diagnosis in MCI and other dementia-related diseases. Researchers could use these data to further explore the diagnostic and predictive validity of awareness measures. We hope that our work inspires further research concerning memory awareness and strongly welcome any comments and remarks.

The full paper “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is available free of charge for a limited time here.

The commentary on the paper, “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is also available free of charge here.

Mind over matter

Family Fun

The June International Psychogeriatrics Article of the Month is entitled ‘Mind over matter – what do we know about neuroplasticity in adults?’ by Vyara Valkanova, Rocio Eguia Rodriguez and Klaus P. Ebmeier


Until recently the capacity of the human brain for structural and functional reorganization (brain plasticity) was considered to be limited to critical periods during development. Neuroimaging provides a non-invasive window into the living brain and has been used to study different aspects of brain plasticity during the learning of new skills or after novel experiences. We reviewed the strongest neuroimaging evidence for experience-dependent plasticity in adult humans, and therefore focused on longitudinal studies only (i.e. participants are scanned before and after different interventions, and then the images are compared).

We identified 36 studies that employed different types of training, such as juggling, exercising working memory, meditation, learning abstract information (studying for exams), and aerobic exercise. Although different patterns of results were found, there was consistent evidence that the brain (gray as well as white matter – brain cells as well as neuronal connections) retains much greater plasticity in adults (<75 years old) than is traditionally thought.

Before such research results can be translated into medical practice, there are many questions that still need to be answered. We currently do not know enough about the type and duration of the interventions that are effective, about the upper limits of improvement, how gains can be maintained, and most importantly the exact relationship between structural change and functional improvement. Further, all reviewed studies are in healthy individuals, while the impact of such interventions in patients with dementia is less well studied.

Future research will need to include larger samples and standardised training protocols to allow comparison of studies done at different research centres. Animal studies combining imaging with histological studies [detailed microscopic analysis] can be very useful in understanding the cellular mechanisms underlying learning, which is important when devising effective interventions. Finally, a multimodal imaging approach, where measures derived from complementary imaging modalities is likely to play a major role in increasing our understanding of brain plasticity. It is possible today, for example, to examine the volume of brain grey matter, the quality of anatomical connections between different areas of the brain and the degree of cooperation between different regions of the brain during the same examination, in other words to examine structural and functional brain connectivity. We know now that even the adult brain has a significant potential to change and compensate for any damage, for example after a stroke. Research in this area will have important implications for our ability to harness the natural self-healing and compensation properties of our brains to the greatest effect, in neurodegenerative diseases such as the dementias.


The full paper “Mind over matter – what do we know about neuroplasticity in adults?” is available free of charge for a limited time here.

The commentary on the paper, “Expanding the mind – growing the brain…” is also available free of charge for one month here.


The effect of exercise on cognitive outcomes in Alzheimer’s disease

Seniors jogging on a forest road

From January 2014, International Psychogeriatrics will be choosing a paper of the month. It is selected by the editorial team to point out a review or an original contribution which they think should be of great interest to most readers. Each paper of the month will be accompanied by a short commentary, provided by an editor, reviewer, or expert in the field.

The first of these is a systematic review on the effect of exercise on cognitive outcomes in Alzheimer’s disease (AD) by Farina et al.

With the global aging of our societies and predicted increase of cognitive impairment and dementia, it is no surprise that there is an increasing interest not only in the research community, but also among clinicians and the general population to learn more about how to focus on modifiable protective factors and how to avoid modifiable risk factors.

However, we should not forget about the various stages of prevention, and especially in the field of psychogeriatrics should also ask what preventative measures might be effective for older adults who have already experienced cognitive impairment.

The number of randomized controlled trials (RCT) investigating the effectiveness of physical activity on cognition is limited for healthy participants and those with MCI, but is even more sparse for those with dementia.

In the January issue of International Psychogeriatrics, Farina and colleagues publish a systematic review titled “The effect of exercise interventions on cognitive outcome in Alzheimer’s disease: a systematic review”. This paper will help readers of International Psychogeriatrics to critically review the evidence for physical activity and cognition provided by RCTs in patients with AD.”

The paper reviewed six studies that considered the effect of exercise in AD patients. Following analysis, the results suggest that exercise can have a positive effect on the rate of cognitive decline. This finding is encouraging and should be considered as another piece of evidence to encourage physical activity for older adults with AD.

While the overall positive result of this systematic review is promising, the limitations when interpreting this finding are plentiful, which Farina and colleagues thoroughly discuss in their paper. Most importantly, the number of studies included and the number of participants in these studies are small, which is a reminder that this area of research is still in its infancy.

The editorial team of International Psychogeriatrics selected this systematic review as paper of the month, since next to reviewing the evidence it discusses in detail what further research is needed in this important area. We also want to encourage other authors who consider writing systematic reviews in the field of psychogeriatrics to consider a submission to International Psychogeriatrics.

The full paper “The effect of exercise interventions on cognitive outcome in Alzheimer’s disease: a systematic review” is available free of charge for one month here.

The commentary on the paper “Physical activity in Alzheimer’s disease: research in its infancy or why we need more randomized controlled trials” is also available free of charge for one month here.

The Mind in Modern Medicine

Blog Post by Ennapadam S. Krishnamoorthy, (ESK) MBBS, MD, DCN (Lond), PhD (Lond), FRCP (Lond, Edin & Glas), MAMS (India), FIMSA, FIPS, an internationally recognized as a leader in the brain-mind interface, the field of Neuropsychiatry. Founder Director of The Neuropsychiatry Group
It is curious that the mind, so important at the turn of the 20th century, is experiencing today a reawakening in scientific and societal consciousness. The founders of modern medical science in the 18th and 19th centuries had clearly conceived the mind to be a representation of the brain; people like Alois Alzheimer demonstrated pathological abnormalities in the brain of people affected with dementia. Indeed, centuries earlier, the father of modern medicine, Hippocrates, had firmly placed “our joys, sorrows, desires and feelings” in the brain. Read more of this post

Dementia Awareness Week: Conversations with an Alzheimer’s Patient, and other books from Cambridge Medicine

Blog Post by Nisha Doshi, Editorial, Cambridge University Press

4th-10th July 2010 is Dementia Awareness Week in the UK, and this year the Alzheimer’s Society have been asking us to think about people we know living with dementia, and how their lives can be made more enjoyable.

From an in-depth study of communication with an elderly female Alzheimer’s patient over four-and-half-years, to a unique collection of dementia case studies from around the world, Cambridge Medicine’s mental health list offers a wide range of resources to help clinicians and family members caring for dementia patients across the globe.

Read more of this post

A Meeting of Minds – Cambridge Clinical Neuroscience and Mental Health Symposium

Blog Post by Jenny Ridge, Academic & Professional Marketing, Medicine

neuroscience logoThe Cambridge Clinical Neuroscience and Mental Health Symposium starts today, with Press authors ready to speak on the most up-to-date research.

Organised by Cambridge Neuroscience, whose mission is to increase our fundamental understanding of brain function and enhance quality of life, the Symposium is a highly significant event for all neuroscientists. The Symposium connects the varied and vast areas of neuroscience research and teaching that takes place across the University of Cambridge and affiliated institutions and is vital to furthering the aims of Cambridge Neuroscience.

Read more of this post


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