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

BACKGROUND AND PURPOSE: Semantic memory remains more stable than episodic memory across the lifespan, which makes it potentially useful as a marker for distinguishing pathological aging from normal senescence. To obtain a better understanding of the transitional stage evolving into Alzheimer's dementia (AD), we focused on the amnestic mild cognitive impairment (aMCI) stage stratified based on β-amyloid (Aβ) pathology. METHODS: We analyzed the raw data from Korean version of the Boston Naming Test (K-BNT) and the Controlled Oral Word Association Test (COWAT). For K-BNT, the frequencies of six error types and accuracy rates were evaluated. For a qualitative assessment of the COWAT, we computed the number of switching, number of clusters, and mean cluster size. RESULTS: The data from 217 participants were analyzed (53 normal controls, 66 with Aβ− aMCI, 56 with Aβ+ aMCI, and 42 disease controls). There were fewer semantically related errors and more semantically unrelated errors on the K-BNT in Aβ+ aMCI than in Aβ− aMCI, without a gross difference in the z score. We also found that Aβ+ aMCI showed a more prominent deficit in the number of clusters in the semantic fluency task [especially for animal names (living items)] than Aβ− aMCI. CONCLUSIONS: In spite of similar clinical manifestations, Aβ+ aMCI was more similar to AD than Aβ− aMCI in terms of semantic memory disruption. Semantic memory may serve as an early indicator of brain Aβ pathology. Therefore, semantic memory dysfunction deserves more consideration in clinical practice. Longitudinal research with the follow-up data is needed.
Aging ; Alzheimer Disease ; Animals ; Brain ; Dementia ; Follow-Up Studies ; Humans ; Memory* ; Memory, Episodic ; Mild Cognitive Impairment* ; Pathology ; Semantics* ; Word Association Tests

PURPOSE: This study aimed to examine the effects of subjective memory complaints, depression and cognitive function on performance of activities of daily living (ADL) in individuals with mild cognitive impairment (MCI). METHODS: A total sample consisted of 250 MCI patients diagnosed within one year. All participants were assessed with a battery of standardized neuropsychological tests, self-report measures of subjective memory complaints and depression, and performance of basic and instrumental ADL. Correlational and multiple linear regression analyses were conducted to identify the factors associated with performance of basic and instrumental ADL, respectively. RESULTS: Executive function and depression explained 9.4% of the variance in basic ADL. Reduced executive function and greater depressed mood were associated with worse performance on basic ADL. Executive function, subjective memory complaints, and time since onset of cognitive symptoms accounted for 22.2% of the variance in instrumental ADL in individuals with MCI. Lower executive function (t=−2.02, p=.044), greater memory complaints (t=5.36, p<.001), and longer periods of experiencing cognitive symptoms (t=2.24, p=.026) were associated with worse instrumental ADL performance. CONCLUSION: These results may help healthcare professionals develop interventions to improve cognitive outcomes with better understanding of the relationship among cognition, mood, and behavioral performance in individuals with MCI.
Activities of Daily Living ; Cognition ; Delivery of Health Care ; Depression ; Executive Function ; Humans ; Linear Models ; Memory Disorders ; Memory ; Mild Cognitive Impairment ; Neurobehavioral Manifestations ; Neuropsychological Tests

This study aimed to investigate the cognition-enhancing effect of Panax ginseng. A randomized, double-blind, placebo-controlled clinical trial was conducted to address the cognition-enhancing effects of Panax ginseng. A total of 90 Korean volunteers with mild cognitive impairment participated in this study. All subjects were allocated randomly into ‘Ginseng’ group or ‘Placebo’ group. All subjects were administered 3g of Panax ginseng powder or starch (placebo) for 6 months. The Korean version of the Mini-Mental Status Examination (K-MMSE), Korean version of Instrumental Activities of Daily Living (K-IADL), and Seoul Neuropsychological Screening Battery (SNSB) were used to assess the changes in cognitive function at the end of the 6 month study period. The subjects of the ‘Ginseng’ group improved significantly on the Rey Complex Figure Test (RCFT) immediate recall (P = 0.0405 and P = 0.0342 in per-protocol (PP) and intention-to-treat (ITT) analysis, respectively) and on the RCFT 20-min delayed recall (P = 0.0396 and P = 0.0355 in PP and ITT analysis, respectively) compared with ‘placebo’ group throughout the 6 months of Panax ginseng administration. There were no serious adverse events. These results suggest that Panax ginseng has a cognition-enhancing effect.
Activities of Daily Living ; Cognition ; Mass Screening ; Memory, Short-Term ; Mild Cognitive Impairment ; Panax ; Seoul ; Starch ; Volunteers

PURPOSE: This study aimed to identify the neural basis of executive function (EF) in amnestic mild cognitive impairment (aMCI) according to beta-amyloid (Aβ) positivity. Furthermore, we explored if the identified brain areas could serve as predictors for clinical progression. MATERIALS AND METHODS: We included individuals with aMCI using data from [¹⁸F]-florbetapir-positron emission tomography (PET), fluorodeoxyglucose-PET, and EF scores, as well as follow-up clinical severity scores at 1 and 5 years from baseline from the Alzheimer's Disease Neuroimaging Initiative database. The correlations between EF score and regional cerebral glucose metabolism (rCMglc) were analyzed separately for aMCI with low Aβ burden (aMCI Aβ−, n=230) and aMCI with high Aβ burden (aMCI Aβ+, n=268). Multiple linear regression analysis was conducted to investigate the associations between rCMglc and clinical progression. RESULTS: Longitudinal courses differed between aMCI Aβ− and aMCI Aβ+ groups. On average, aMCI Aβ− subjects maintained their level of clinical severity, whereas aMCI Aβ+ subjects showed progression. EF impairment in aMCI Aβ− was related to the anterior cingulate cortex (ACC), whereas that in aMCI Aβ+ was related to Alzheimer's Disease-vulnerable brain regions. ACC and the posterior cingulate cortex were associated with clinical progression in aMCI Aβ− and aMCI Aβ+, respectively. CONCLUSION: Our findings suggest that although MCI subjects showed similar behavioral phenotypes at the time of diagnosis, EF and further progression were associated with different brain regions according to Aβ burden. Clarification of the etiologies and nature of EF impairment in aMCI are critical for disease prognosis and management.
Alzheimer Disease ; Amyloid ; Brain ; Cognition ; Diagnosis ; Executive Function ; Follow-Up Studies ; Glucose ; Gyrus Cinguli ; Linear Models ; Metabolism ; Mild Cognitive Impairment ; Neuroimaging ; Phenotype ; Positron-Emission Tomography ; Prognosis

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

BACKGROUND AND OBJECTIVES: Mild cognitive impairment (MCI) is a disorder that usually occurs in the elderly, leading to dementia in some progressive cases. The purpose of this study is to examine the utility of central auditory processing tests as early diagnostic tools for identifying the elderly with MCI. SUBJECTS AND METHODS: This study was conducted on 20 elderly patients with MCI and 20 healthy matched peers. The speech perception ability in a quiet environment and in the presence of background noise and also temporal resolution were assessed by using Speech Perception in Noise (SPIN) and Gap in Noise (GIN) tests, respectively. RESULTS: The results indicated that the ability to understand speech in a quiet environment did not differ significantly between the two groups. However, SPIN at the three signal-tonoise ratios and the temporal resolution scores were significantly different between the two groups (p<0.001). CONCLUSIONS: Individuals with MCI appear to have poorer speech comprehension in noise and a lower temporal resolution than those of the same age, but without cognitive defects. Considering the utility of these tests in identifying cognitive problems, we propose that since the GIN test seems to be less influenced by intervening factors, this test can therefore, be a useful tool for the early screening of elderly people with cognitive problems.
Aged ; Auditory Perceptual Disorders ; Cognition ; Cognition Disorders ; Comprehension ; Dementia ; Humans ; Mass Screening ; Mild Cognitive Impairment ; Noise ; Speech Perception