Objective To explore the change of gait of middle-aged and elderly people with mild cognitive impairment in the community,the correlation between gait and cognitive domain,and the role of gait in early recognition of cognitive decline. Methods 140 people over 40 years old in Tongxing Village,Yancheng City,Jiangsu Province were enrolled.The subjects were divided into normal cognitive group (n=64) and mild cognitive impairment group(n=76)through the Montreal Cognitive Assessment and the Minimum Mental State Examination,and gait tests were conducted at the same time.The data were collected and statistically analyzed to explore the difference of gait indicators between the two groups,the relationship between gait indicators and cognitive domains,and the ability of gait indicators to recognize mild cognitive impairment. Results The gait of the mild cognitive impairment group was worse than that of the normal cognitive group in terms of space (stride length,step height,step width) and time (step speed,stride speed,swing speed).Partial correlation analysis showed that step width was negatively correlated with delayed recall;Step size,step width and delayed recall,step height and naming were positively correlated.The logistic regression model constructed by step speed,stride length,stride speed,swing speed,step height and step width can reliably identify the existence of MCI (AUC=0.761,95%CI 0.683-0.840,P<0.05). Conclusion In the middle-aged and elderly community,the spatial and temporal performance of gait of patients with mild cognitive impairment is worse than that of the normal cognitive population.There is a close relationship between spatial indicators and delayed recall and naming.The temporal and spatial characteristics of gait have the potential to identify cognitive decline at an early stage.
Mild cognitive impairment

OBJECTIVE: The aims of this study were to investigate the effects of daily low-dose tadalafil on cognitive function and to examine whether there was a change in cerebral blood flow (CBF) in patients with erectile dysfunction (ED) and mild cognitive impairment. METHODS: Male patients aged 50 to 75 years with at least three months of ED (International Index of Erectile Function [IIEF]-5 score ≤ 21) and mild cognitive impairment (Montreal Cognitive Assessment [MoCA] score ≤ 22) were included in the study. The subjects were prescribed a low-dose PDE5 inhibitor (tadalafil 5 mg) to be taken once daily for eight weeks. Changes in MoCA score and single-photon emission computed tomography (SPECT) study between the two time-points were assessed by paired t tests. RESULTS: Overall, 30 male patients were assigned to the treatment group in this study and 25 patients completed the eight-week treatment course. Five patients were withdrawn due to adverse events such as myalgia and dizziness. Mean baseline IIEF and MoCA scores were 7.52 ± 4.84 and 18.92 ± 1.78. After the eight-week treatment, mean IIEF and MoCA scores were increased to 12.92 ± 7.27 (p < 0.05) and 21.8 ± 1.71 (p < 0.05), respectively. Patients showed increased relative regional CBF in the postcentral gyrus, precuneus, and brainstem after tadalafil administration versus at baseline (p < 0.001). CONCLUSION: The results of this prospective clinical study suggest that daily use of tadalafil 5 mg increases some regional CBF and improves cognitive function in patients with ED and mild cognitive impairment.
Brain Stem ; Cerebrovascular Circulation ; Clinical Study ; Cognition ; Dizziness ; Erectile Dysfunction ; Humans ; Male ; Methylenebis(chloroaniline) ; Mild Cognitive Impairment ; Myalgia ; Parietal Lobe ; Perfusion ; Phosphodiesterase Inhibitors ; Prospective Studies ; Somatosensory Cortex ; Tadalafil ; Tomography, Emission-Computed

BACKGROUND AND PURPOSE: Semantic verbal fluency test is a neuropsychological assessment that can sensitively detect neuropathological changes. Considering its multifactorial features tapping various cognitive domains such as semantic memory, executive function, and working memory, it is necessary to examine verbal fluency performance in association with underlying cognitive functions. The objective of the current study was to investigate semantic fluency patterns of people with mild cognitive impairment (MCI) based on clustering and switching and their relationship with working memory. METHODS: Twenty-six individuals with MCI and 23 normal elderly adults participated in this study. A semantic verbal fluency test (animal version) was administered and the performance was analyzed using the following measures: number of correct words, cluster size, and number of switches. Scores of digit forward (DF) and backward span tasks were employed as working memory measures. RESULTS: Analyses of variance revealed significant group differences in the numbers of correct words and switches. Multivariate logistic regression and receiver-operating characteristic analyses showed that the number of switches more sensitively distinguished MCI existence than the number of correct words. Stepwise linear regression analysis showed that DF task and age significantly predicted the number of correct words while only the DF task significantly predicted the number of switches. CONCLUSIONS: Decrement in semantic verbal fluency in MCI seems to be associated with impaired switching abilities. Working memory capacity might serve as the underlying cognitive factor related to decreased verbal fluency in MCI.
Adult ; Aged ; Cluster Analysis ; Cognition ; Executive Function ; Humans ; Linear Models ; Logistic Models ; Memory ; Memory, Short-Term ; Mild Cognitive Impairment ; Semantics

BACKGROUND AND PURPOSE: The Korean version of Story Memory (SM) in the Korean-Mini Mental State Examination, 2nd Edition: Expanded Version (K-MMSE-2: EV) was developed. Based on the SM, we additionally developed a full version of SM including delayed recall (DR) and recognition adding to immediate recall (IR). This study aimed to examine the reliabilities and validities of the newly developed SM in the K-MMSE-2: EV and its full version. METHODS: Ninety-five healthy elderly individuals (HE), 90 patients with amnestic mild cognitive impairment (aMCI), and 53 patients with dementia of the Alzheimer's type (DAT) participated in the study. They were administered the full version of SM with the Seoul Verbal Learning Test-Elderly's version (SVLT-E) and Rey Complex Figure Test (RCFT). In addition, the SM was re-administered to 51 participants after a 5-week interval. Two clinical neuropsychologists independently rated the performance of 50 participants. RESULTS: The test-retest reliabilities of the IR, DR, and recognition of the SM were statistically significant. The inter-rater reliabilities (Cohen's kappa) were high (0.87–1.00) for all the measures. The IR, DR, and recognition of SM had significant positive correlations with those of the SVLT-E and RCFT. Significant group differences in IR and DR of SM were found among the HE, aMCI, and DAT groups. The recognition scores were significantly different between the aMCI and DAT groups, but not between the HE and aMCI groups. CONCLUSIONS: The newly developed full version of SM in the K-MMSE-2: EV was proven to be a reliable and valid memory measure for clinical use.
Aged ; Dementia ; Humans ; Memory ; Memory, Short-Term ; Mild Cognitive Impairment ; Seoul ; Verbal Learning

BACKGROUND AND PURPOSE: In Alzheimer's continuum (a comprehensive of preclinical Alzheimer's disease [AD], mild cognitive impairment [MCI] due to AD, and AD dementia), cognitive dysfunctions are often related to cortical atrophy in specific brain regions. The purpose of this study was to investigate the association between anatomical pattern of cortical atrophy and specific neuropsychological deficits. METHODS: A total of 249 participants with Alzheimer's continuum (125 AD dementia, 103 MCI due to AD, and 21 preclinical AD) who were confirmed to be positive for amyloid deposits were collected from the memory disorder clinic in the department of neurology at Samsung Medical Center in Korea between September 2013 and March 2018. To analyze neuropsychological test-specific neural correlates representing the relationship between cortical atrophy measured by cortical thickness and performance in specific neuropsychological tests, a linear regression analysis was performed. Two neural correlates acquired by 2 different standardized scores in neuropsychological tests were also compared. RESULTS: Cortical atrophy in several specific brain regions was associated with most neuropsychological deficits, including digit span backward, naming, drawing-copying, verbal and visual recall, semantic fluency, phonemic fluency, and response inhibition. There were a few differences between 2 neural correlates obtained by different z-scores. CONCLUSIONS: The poor performance of most neuropsychological tests is closely related to cortical thinning in specific brain areas in Alzheimer's continuum. Therefore, the brain atrophy pattern in patients with Alzheimer's continuum can be predict by an accurate analysis of neuropsychological tests in clinical practice.
Alzheimer Disease ; Atrophy ; Brain ; Cognition ; Dementia ; Humans ; Korea ; Linear Models ; Memory Disorders ; Mild Cognitive Impairment ; Neuroanatomy ; Neurology ; Neuropsychological Tests ; Plaque, Amyloid ; Semantics

cognitive enhancement training combined treatment on cognitive function in mild cognitive impairment (MCI) patients, comparing to the application of the rTMS alone and the sham stimulation.METHODS: Six MCI patients received high-frequency rTMS applied to the bilateral dorsolateral prefrontal cortex, followed by the computerized cognitive enhancement training. In addition, six MCI patients took high-frequency rTMS alone. A sham stimulation was used as a control condition in 7 MCI patients. All stimuli were delivered at a frequency of two sessions per week for four weeks. Neuropsychological test was performed at each time points in each group.RESULTS: Although there was the main effect of interaction between time and group on the score of the Korean version of Montreal Cognitive Assessment, only participants of the rTMS single treatment group showed significant improvement of this score.CONCLUSION: In order to overcome the weaknesses of previous studies confirming the efficacy of the combination therapy, this study included patients with MCI, which was the pre-dementia stage, and included rTMS single treatment group, but did not confirm the clinical efficacy of the combination therapy. Small sample size, the baseline cognitive function score, and the ceiling effect of the group were considered to be the bias factor of this study and further studies supplementing these factors are needed.]]>
Bias (Epidemiology) ; Cognition ; Humans ; Mild Cognitive Impairment ; Neuropsychological Tests ; Pilot Projects ; Placebos ; Prefrontal Cortex ; Sample Size ; Transcranial Magnetic Stimulation ; Treatment Outcome

mild cognitive impairment (MCI) groups and to investigate the correlations between blood-based inflammatory factors and cognitive functions.METHODS: Seventy one subjects participated in this study [AD : 28, MCI : 23, normal control (NC) : 20]. The overall cognitive function of the subjects and the severity of the disease stage were assessed using Mini-Mental Status Examination in the Korean Version of the the CERAD Assessment Packet (MMSE-KC), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR), Korean neuropsychiatric inventory (K-NPI) and Geriatric Depression Scale (K-GDS). Plasma fibrinogen and CRP were also measured in AD, MCI, and NC groups.RESULTS: Fibrinogen and CRP levels were not significantly different among AD, MCI, and NC groups. Fibrinogen and CRP did not show a significant correlation with MMSE-KC, CDR, GDS, K-NPI and K-GDS scores.CONCLUSION: In this study, it was found that plasma fibrinogen and CRP did not increase as cognitive function decreased. But this study was the first meaningful study in Korea about the relationship between cognitive impairment and plasma fibrinogen and CRP levels. It is necessary to conduct prospective cohort studies on more patients in the future.]]>
Alzheimer Disease ; C-Reactive Protein ; Cognition ; Cognition Disorders ; Cohort Studies ; Dementia ; Depression ; Fibrinogen ; Humans ; Korea ; Mild Cognitive Impairment ; Plasma ; Prospective Studies

cognitive training program entitled Web-based Cognitive Training (Web-CoT) developed for the elderly in the community.METHODS: Of the elderly aged 65 or older who have visited in the Local Dementia Centers located in Chungcheongbuk-do, a total of 29 participants took part in a 10-week Web-CoT program. The Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Assessment Packet 2nd edition and short form of Geriatric Depression Scale (SGDS) were evaluated before and after the program.RESULTS: Total SGDS scores have decreased and a significant increase in CERAD-K total scores was confirmed. Details including word list memory, word list recall, constructional praxis, trail making, and stroop tests, improved. Especially in the case of free recall test, the greater increase of scores in elderly with high risk of dementia was shown.CONCLUSION: Participation in this program has confirmed improvements in verbal memory registration and retrieval ability, attention and executive function. Since the improvement was especially prominent in memory retrieval ability in elderly with high risk of dementia, it can be said that early application of the program before the diagnosis of dementia is important.]]>
Aged ; Alzheimer Disease ; Chungcheongbuk-do ; Dementia ; Depression ; Diagnosis ; Education ; Executive Function ; Humans ; Memory ; Mild Cognitive Impairment ; Program Development ; Stroop Test

BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) is a prodromal stage of dementia. Amyloid deposits in positron-emission tomography (PET) imaging of MCI patients imply a higher risk for advancing to dementia, with rates of 10%–15% yearly. The purpose of this study was to investigate the clinical characteristics of subgroups of amnestic MCI (aMCI) that may have a higher impact on amyloid positivity.METHODS: We recruited 136 aMCI patients. All patients underwent a 20-minute F-18 florbetaben or flutemetamol PET scan. We classified amyloid PET images as positive or negative according to a semi-quantitative method. We evaluated the amyloid positivity of subgroups of aMCI (early vs. late type, single vs. multiple amnestic type, verbal vs. verbal, and visual amnestic type), and compared baseline clinical characteristics including key risk factors, apolipoprotein E4 (apoE4) genotype, and neuropsychological assessments with amyloid positivity in aMCI.RESULTS: The amyloid positivity in total aMCI was 41%. The positivity rate according to subgroup of aMCI were as follow: Late aMCI (49%) vs. early aMCI (33%) (p=0.13), multiple aMCI (40%) vs. single aMCI (38%) (p=0.51), and verbal and visual aMCI (59%) vs. verbal aMCI (35%) (p=0.01), respectively. The mean age and the frequency of apoE4 allele of the amyloid-positive group was higher than that of the amyloid-negative group in aMCI (p< 0.01).CONCLUSIONS: We found that the amyloid positivity was related to patterns of clinical subtypes, characteristics, and risk factors in patients with aMCI.
Alleles ; Amyloid ; Apolipoprotein E4 ; Dementia ; Genotype ; Humans ; Methods ; Mild Cognitive Impairment ; Plaque, Amyloid ; Positron-Emission Tomography ; Prodromal Symptoms ; Risk Factors

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the impact of multi-tasking exercise on cognitive and motor function in patients with mild cognitive impairment (MCI) and cognitive normal elderly (CNE).METHODS: A total of 144 subjects were recruited from 14 regional dementia centers in Busan Metropolitan City. With the exception of 77 subjects unsuitable for the study, 67 subjects participated in the intervention. The Korean version of Mini-Mental State Examination for Dementia Screening (MMSE-DS), Subject Memory Complain Questionnaire (SMCQ), and the Korean version of the Short-Form Geriatric Depression Scale (SGDS-K) were used to determine changes in cognitive function and depressive symptoms pre-post intervention in patients with MCI and CNE, respectively. To observe changes in motor function, 5-chair sit to stand and 5-meter walking speed on the lower body strength and walking ability were also measured in both groups.RESULTS: For the MCI group, changes in cognitive and depressive symptoms on the tasks of MMSE-DS (p=0.006), SMCQ (p=0.000), SGDS-K (p=0.000) and the result of the motor function analysis on the items of 5-chair sit to stand (p=0.000), normal speed (p=0.004) and maximal speed (p=0.002) of 5-meter walking speed (p< 0.005). In the CNE group, all the items except MMSE-DS (p=0.068) and SGDS-K (p=0.095) showed statistically significant improvement.CONCLUSIONS: Multi-tasking exercise intervention, including exercise and cognitive tasks, may possibly improve the cognitive and motor function in patients with MCI and CNE.
Aged ; Busan ; Cognition Disorders ; Cognition ; Dementia ; Depression ; Humans ; Mass Screening ; Memory ; Mild Cognitive Impairment ; Walking