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We report the case of a 67-year-old woman who experienced a sudden onset of psychotic illness (i.e., prominent delusions and hallucinations) that has endured for approximately 3 years. As part of her neurobehavioral work-up, a SPECT scan revealed right frontal and left anterior temporal-lobe hypoperfusion. Serial neuropsychological evaluations obtained 2 years apart demonstrated a steady decline on tests of executive control (monitoring, allocation of attention, perseveration) and visuospatial abilities, whereas performance in other areas of cognitive functioning have remained steady and in the normal range for the patient's age. Over this same period of time, serial EEG, MRI, and neurology examinations have been within normal limits. Thus, there was little evidence with which to diagnose dementia. It is suggested that concomitant impairment in executive control, coupled with a degraded capacity to process perceptual information, can give rise to enduring psychotic behavior. (J Geriatr Psychiatry Neurol 1996; 9:146-153) [ABSTRACT FROM PUBLISHER]

The literature regarding Binswanger's disease is reviewed. Emphasis is placed on reviewing the neuropsychological literature related to Binswanger's disease. In addition, a retrospective analysis was carried out among four groups of subjects (N = 61) who were divided according to the presence or absence of dementia and deep white-matter alterations. A main effect for deep white-matter alterations was found for almost all measures of diastolic and systolic blood pressure. Among the two nondemented groups there was an effect of deep white matter alteration on neuropsychological functioning. Subjects with deep white matter changes performed worse on tests of immediate and delayed recall of a prose passage. Among the two demented groups there were no differences on any of the neuropsychological measures, although subjects with deep white matter alterations exhibited a higher incidence of focal neurologic signs and stroke. We conclude that Binswanger's disease is probably more prevalent than currently appreciated. Also, among clinically nondemented individuals periventricular white-matter alterations may be associated with subtle but definable neuropsychological deficits, and these individuals may be at risk for developing a dementing illness. (J Geriatr Psychiatry Neurol 1990;3:31-40). [ABSTRACT FROM PUBLISHER]

Introduction: Alzheimer's disease and related dementias (ADRD) represent a substantial global public health challenge with multifaceted impacts on individuals, families, and healthcare systems. Brief cognitive screening tools such as the Mini-Cog© can help improve recognition of ADRD in clinical practice, but widespread adoption continues to lag. We compared the Digital Clock and Recall (DCR), a next-generation process-driven adaptation of the Mini-Cog, with the original paper-and-pencil version in a well-characterized clinical trial sample., Methods: DCR was administered to 828 participants in the Bio-Hermes-001 clinical trial (age median ± SD = 72 ± 6.7, IQR = 11; 58% female) independently classified as cognitively unimpaired ( n  = 364) or as having mild cognitive impairment (MCI, n  = 274) or dementia likely due to AD (DLAD, n  = 190). MCI and DLAD cohorts were combined into a single impaired group for analysis. Two experienced neuropsychologists rated verbal recall accuracy and digitally drawn clocks using the original Mini-Cog scoring rules. Inter-rater reliability of Mini-Cog scores was computed for a subset of the data ( n  = 508) and concordance between Mini-Cog rule-based and DCR scoring was calculated., Results: Inter-rater reliability of Mini-Cog scoring was good to excellent, but Rater 2's scores were significantly higher than Rater 1's due to variation in clock scores ( p  < 0.0001). Mini-Cog and DCR scores were significantly correlated ( τ B  = 0.71, p  < 0.0001). However, using a Mini-Cog cut score of 4, the DCR identified more cases of cognitive impairment ( n  = 47; χ 2  = 13.26, p  < 0.0005) and Mini-Cog missed significantly more cases of cognitive impairment ( n  = 87). In addition, the DCR correctly classified significantly more cognitively impaired cases missed by the Mini-Cog ( n  = 44) than vice versa ( n  = 4; χ 2  = 21.69, p  < 0.0001)., Discussion: Our findings demonstrate higher sensitivity of the DCR, an automated, process-driven, and process-based digital adaptation of the Mini-Cog. Digital metrics capture clock drawing dynamics and increase detection of diagnosed cognitive impairment in a clinical trial cohort of older individuals., Competing Interests: DB is a co-founder of Linus Health and declares ownership of shares or share options in the company. JG-O, CT-S, RB, MC, AJ, WM, RS, DL, ST, and JS are employees of Linus Health and declare ownership of shares or share options in the company. AP-L is a co-founder of Linus Health and TI Solutions and declares ownership of shares or share options in the company. AP-L serves as a paid member of the scientific advisory boards for Neuroelectrics, Magstim Inc., TetraNeuron, Skin2Neuron, MedRhythms, and Hearts Radiant, and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging, applications of noninvasive brain stimulation in various neurological disorders, as well as digital biomarkers of cognition and digital assessments for early diagnosis of dementia. SB is a member of the Linus Health Scientific Council for the 2023–2024 term., (Copyright © 2024 Gomes-Osman, Borson, Toro-Serey, Banks, Ciesla, Jannati, Morrow, Swenson, Libon, Bates, Showalter, Tobyne and Pascual-Leone.)

The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research Center Minority Aging Research Study (MARS) and African American Clinical Core (AACORE). We assessed baseline DCTclock scores in 646 participants (baseline median age = 78.0 ± 6.4, median years of education = 14.0 ± 3.2, 78% female) and found significantly lower baseline DCTclock scores in those who received a dementia diagnosis within 3 years. We also found that 16.4% of participants with a baseline DCTclock score less than 60 were significantly more likely to develop dementia in 5 years vs. those with the highest DCTclock scores (75-100). This research demonstrates the DCTclock's ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs., Competing Interests: DB was a co-founder of Linus Health and declares ownership of shares or share options in the company. MC, JP, JG-O, RB, AJ, ST, and JS are employees of Linus Health and declare ownership of shares or share options in the company. AP-L was a co-founder of Linus Health and TI Solutions and declares ownership of shares or share options in the company. AP-L serves as a paid member of the scientific advisory boards for Neuroelectrics, Magstim Inc., TetraNeuron, Skin2Neuron, MedRhythms, and Hearts Radiant, and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging, applications of non-invasive brain stimulation in various neurological disorders, as well as digital biomarkers of cognition and digital assessments for early diagnosis of dementia. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ciesla, Pobst, Gomes-Osman, Lamar, Barnes, Banks, Jannati, Libon, Swenson, Tobyne, Bates, Showalter and Pascual-Leone.)

Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI., (© The Author(s) 2013.)

Alzheimer's disease (AD) is known to be associated with disruption in semantic networks. Previous studies examining changes in spreading activation in AD have used a lexical decision task paradigm. We have used a paradigm based on average word frequencies obtained from the words generated on the Controlled Oral Word Association Test (COWAT) and the Animal Naming (AN) test. The COWAT and AN tests were administered to a group of 25 patients with AD and 20 control participants. We predicted that the patients with AD would have higher average word frequencies on the COWAT and AN tests than the control participants. The results indicated that the AD group generated words with a higher average word frequency on the AN test but a lower average word frequency on the COWAT. The reasons for the discrepancy in average word frequencies on the AN test and COWAT are discussed.

Alzheimer's disease is associated with degeneration of the cholinergic system, which affects memory and attention functioning. Acetylcholinesterase inhibitors (AChEI) have been found to increase attention and given this effect might reduce spreading activation of memory nodes in lexical/semantic networks. We sought to determine whether this effect of AChEIs existed in a group of patients with dementia. A mixed sample of 34 patients with dementia (17 taking AChEIs and 17 not taking these medications) were administered the Controlled Oral Word Association Test and the Animal Naming Test. The average word frequency for their responses was obtained and used as a measure of spreading activation. Patients taking AChEIs had a significantly higher average word frequency for the COWAT as compared to those not taking AChEIs. No difference was found for the average word frequencies for the AN test. Administration of AChEIs appears to reduce spreading activation, possibly due to cholinergic innervations of the frontal cortex., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The neuropsychological substrate of scripts, routines which guide much of human behavior, is unclear. We propose a model of script comprehension characterized by the interaction of semantic knowledge for script content, and executive resources that organize this knowledge into goal directed behavior. We examined these neuropsychological components by asking participants with Alzheimer's disease (AD) and frontotemporal dementia (behavioral disorder/dysexecutive syndrome (BDD) and semantic dementia (SD) subtypes), to judge the coherence of four-phrase scripts. The BDD group detected significantly fewer sequencing errors than semantic errors; the AD and SD groups detected these errors with equal frequency. Independent semantic measures predicted both semantic and sequencing script errors, while executive measures predicted sequencing errors only. Findings support a multi-component model of script comprehension., (Copyright (c) 2006 APA, all rights reserved.)

On an influential model of limb praxis, ideomotor apraxia results from damage to stored gesture representations or disconnection of representations from sensory input or motor output (Heilman & Gonzalez Rothi, 1993; Gonzalez Rothi et al., 1991). We report data from a patient with progressive ideomotor limb apraxia which cannot be readily accommodated by this model. The patient, BG, is profoundly impaired in gesturing to command, to sight of object, and to imitation, but gestures nearly normally with tool in hand and recognizes gestures relatively well. In addition, performance is profoundly impaired on imitation of meaningless gestures and on tasks requiring spatiomotor transformations of body-position information. We provide evidence that BG's apraxia is largely attributable to impairments external to the stored gesture system in procedures coding the dynamic positions of the body parts of self and others; that is, the body schema. We propose a model of a dynamic, interactive praxis system subserved by posterior parietal cortex in which stored representational elements, when present, provide "top-down" support to spatiomotor procedures computed on-line. In addition to accounting for BG's performance, this model accommodates a common pattern of ideomotor apraxia more readily than competing accounts., (Copyright 2000 Academic Press.)

Visuoconstructional ability was assessed by asking patients diagnosed with Alzheimer's disease (AD), ischaemic vascular dementia (IVD), and Parkinson's disease (PD) and a normal control group (NC) to copy a modification of the Rey-Osterrieth Complex Figure (M-ROCF). The drawings of the NC group were superior to all dementia participants. AD patients generally outperformed IVD and PD patients; however, there were few differences between IVD and PD groups. Nonetheless, the drawings of IVD and PD patients were very fragmented and contained numerous perseverations and omissions. Despite these errors, patients with IVD and PD obtained higher delayed recognition memory scores than AD patients. Correlational analyses among dementia patients between neuropsychological tests and the copy of the M-ROCF found that accurate figure copy was most consistently correlated with tests of working memory, that is, tests requiring patients to monitor their behavior and sustain a complex mental set while performing mental manipulations. By contrast, no relationship between executive function tests related to measures of response selection/inhibition or other domains of neuropsychological functioning was found.

Music is a universal language, and its effects on pain relief and stress reduction are well known. We evaluated patients' opinions of the effects of background music in their family doctors' surgery. Low volume, background, classical music was played in the doctors' surgery on 5 consecutive clinic days. All patients were asked to fill a short anonymous questionnaire on leaving. Among the 135 consecutive patients offered the questionnaire, there was 87.4% compliance. Among the 118 who completed the questionnaire, 95% said that the background music did not disturb them, 89% thought it made them feel better and 80% thought that it aided the doctor's performance. We conclude that low volume, background music in the doctors's surgery may contribute to better doctor-patient interaction, although larger studies are needed to confirm our findings.

This research investigated whether subjects with Alzheimer's disease (AD) and ischaemic vascular dementia (IVD) associated with periventricular and deep white matter alterations can be dissociated on tests of declarative and procedural memory, as well as on MRI indices of white matter alterations and the size of the hippocampal formation. The California Verbal Learning Test (CVLT) and the Pursuit Rotor Learning Tests (PRLT) were used to measure declarative and procedural memory, respectively. Subjects with IVD obtained a higher score on the CVLT recognition discriminability index; however, on the PRLT total time on target, carry-over between trial blocks, and slope calculated for all test trials was low. Subjects with AD exhibited the opposite profile. MRI studies indicated that subjects with IVD had considerably greater white matter alterations, but larger hippocampal formations than subjects with AD. Higher scores on the CVLT recognition discriminability index were correlated with increased size of the body of the hippocampus and parahippocampal gyrus. By contrast, as the severity of white matter alterations increased the slope on the PRLT declined. In sum, subjects with AD and IVD can be dissociated on the basis of differing patterns of impairment on tests of declarative and procedural memory, and MRI indices of white matter alteration and the integrity of the hippocampal formation.